Endometriosis excision surgery can feel like a turning point for many people who have long suffered from chronic pelvic pain, painful periods, and other debilitating symptoms. However, it can be disheartening and confusing to find yourself experiencing pain again—even after what seemed like a successful surgery and initial recovery. If you’re wondering why the pain is back and what you can do about it, you’re not alone. Let’s dive into the possible reasons for pain after endometriosis surgery and explore how to support your healing process—both with professional help and home-based strategies.
Scar Tissue: The Hidden Culprit
After surgery, whether open or laparoscopic, your body begins the healing process. This involves clotting, inflammation, and eventually scar tissue formation. Just like a cut on your skin, internal incisions also create scabs that become scar tissue. In the early stages, scar tissue is soft and flexible. But over time, it becomes denser and less elastic.
This tight, matured scar tissue can lead to restrictions within your abdomen. While your external scars might look great and feel normal to the touch, the deeper adhesions forming under the surface are often the real problem. These internal adhesions can tether organs such as the bladder, bowels, uterus, fallopian tubes, and ovaries. This, in turn, disrupts how these organs move and function, contributing to pain and dysfunction.
The Iceberg Effect of Scar Tissue
A helpful metaphor to understand internal scar tissue is the “iceberg effect.” What you see on the outside may appear completely healed, but beneath the surface lies a deeper and often more extensive network of adhesions. These adhesions can wrap around organs and nerves, leading to:
- Bladder pain or urgency
- Constipation or irritable bowel symptoms
- Painful intercourse (especially with deep penetration)
- Abdominal or rectal pain
- Persistent pelvic discomfort
So, even if your surgeon confirms that the visible scar looks great, it doesn’t mean the internal environment is equally healthy.
Fascia and the Domino Effect
Scar tissue doesn’t just stick to organs—it can also bind up the fascia. Fascia is the thin, fibrous tissue that surrounds and interconnects your muscles, organs, and other structures. Think of it like the white, fibrous webbing inside a grapefruit—it touches everything.
When the fascia becomes restricted due to scar tissue or inflammation, it can create a domino effect. Tightness in one area, like the abdomen, may influence other distant areas of the body. This is why some people experience referred pain in places that seem unrelated to their surgery—such as the hips, low back, or even neck and shoulders.
Fascial restrictions can also lead to muscular imbalances and altered posture, which further perpetuate discomfort and tension.
Muscles Involved in Post-Surgical Pain
Let’s break down the muscular impact:
- Abdominal Muscles: After surgery, these can become stiff due to trauma, scar tissue, or guarding (unconscious tightening to protect the area).
- Pelvic Muscles: Muscles that support the pelvis may become tight or misaligned due to internal adhesions.
- Spinal Muscles: Many abdominal and pelvic muscles attach to the spine, so restrictions in one area can pull on joints and muscles in another.
- Hip and Gluteal Muscles: These muscles connect directly to the pelvis and can also be affected.
When one muscle group is tight or restricted, others often compensate. This leads to widespread pain, often mistaken for unrelated conditions.
The Pelvic Floor: Often Overlooked but Critical
Inside the pelvis lies a group of small but powerful muscles known as the pelvic floor. These muscles form a hammock-like structure that supports the bladder, uterus, rectum, and other pelvic organs. They’re responsible for functions such as urination, bowel movements, and sexual response.
Pelvic floor dysfunction is extremely common in people with endometriosis—both before and after surgery. These muscles can become spasmed, tight, and painful, especially if you’ve been in chronic pain for years. Pelvic floor muscle spasms can lead to:
- Pain with intercourse
- Vaginal or rectal pain
- Pressure or heaviness in the pelvis
- Urinary or bowel dysfunction
- Referred pain into the lower abdomen or inner thighs
Even if your surgery removed the endometrial lesions successfully, tight pelvic floor muscles may continue to generate pain until they are addressed specifically.
Why Pelvic Floor Therapy Matters
Some surgeons refer their patients to pelvic floor physical therapy after surgery—but unfortunately, not all do. And even when patients are referred, not all pelvic floor therapists offer the kind of hands-on, full-body approach that’s often needed.
A comprehensive pelvic floor therapy program typically includes:
- Internal and external manual therapy
- Fascia and scar tissue mobilization
- Stretching and strengthening exercises
- Education on body mechanics and pelvic awareness
- Techniques to release spasmed pelvic floor muscles
This kind of therapy can be a game-changer. However, access to skilled practitioners can be limited by geography, insurance, or availability.
What You Can Do at Home
If pelvic floor therapy isn’t accessible to you, don’t worry—there are things you can do at home to support your recovery and reduce pain. In fact, many people benefit from a combination of professional treatment and self-care practices.
Here are some strategies to consider:
1. Gentle Abdominal Massage
Learning how to gently massage your abdomen can help loosen scar tissue and improve blood flow. This should always be done gently and with care, ideally under the guidance of a therapist or instructional video.
2. Fascial Release Techniques
You can use tools like a soft foam roller or even a yoga ball to release tension in the hips, back, and thighs. Fascia release can help free up movement in areas affected by adhesions.
3. Stretching
Targeted stretching of the hip flexors, hamstrings, inner thighs, and low back can make a big difference. Go slow and listen to your body—this isn’t about pushing into pain.
4. Pelvic Floor Relaxation
Contrary to popular belief, not all pelvic floor issues require strengthening. In many cases, especially post-endometriosis, the focus should be on relaxing and lengthening the pelvic floor muscles. Breathwork, visualization, and specific relaxation techniques can help.
5. Online Programs
There are also online programs available that offer guided video lessons. These programs walk you through targeted techniques to release and stretch the muscles most commonly impacted after endometriosis surgery, including the pelvic floor.
Healing Takes Time—and the Right Tools
It’s important to understand that post-surgical pain doesn’t mean your surgery “failed.” Your body is complex, and healing isn’t always linear. Scar tissue, fascial restrictions, and muscular imbalances are all normal parts of the healing journey—but they need to be addressed with care and knowledge.
With the right support—whether from a pelvic floor therapist or through a well-structured home program—you can feel better again.
Pain After Endometriosis Surgery – Final Thoughts
If you’re still experiencing pain after endometriosis surgery, it’s not in your head. It’s in your tissue, your fascia, your muscles, and often your pelvic floor. Understanding the underlying causes can empower you to take the next step—whether that means finding a pelvic health professional or learning how to help yourself at home.
Remember: healing is not just about removing disease—it’s about restoring function and balance. Give yourself the grace, time, and tools to get there.
Also Read: What No One Tells You About Kegels and Leg Pain!
I’m Hina Sheth. I have been treating complex orthopedics, sports and pelvic floor physical problems for over 25 years with amazing results. Now I want to bring my knowledge to the global community so I can spread my knowledge to you.
Our bodies are complex systems of 600 muscles and organs intertwined in a fascial system that all work together. Imbalances in this system such as trigger points, visceral and myofascial restrictions can lead to joint, pelvic, and organ issues.
Factors like nutrition, exercise, sleep, and stress play a crucial role. Unfortunately, our current healthcare model does not look at our bodies as a whole and oftentimes compartmentalize musculoskeletal injuries and dysfunctions.
At Rebalance, our goal is to holistically treat this complex system to restore harmony in the body. By addressing these imbalances, we help clients improve their overall health and well-being. Our vision is to empower individuals to create a healthier lifestyle for themselves.
