The Effect of Preoperative Pelvic Floor Physical Therapy (Prehabilitation) on Postoperative Pain Following Endometriosis Surgery: A Randomized Controlled Trial

Endometriosis is a chronic inflammatory condition where there is abnormal tissue growing in the pelvis or other places in the body that resembles the lining of the uterus (endometrium), and is a common cause of long lasting pelvic pain. Surgery is sometimes done for endometriosis to help people with pain, however it is common for people to have some pain after surgery that doesn't go away. This may be related to other painful things like muscle pain in the pelvis, bowel or bladder issues, or mental health conditions. Researchers would like to know if doing pelvic floor physiotherapy before surgery for endometriosis will help people with long lasting pain after surgery. Participants in the study will be randomly put into one of two groups: the intervention group, who will receive two to three structured in-person pelvic floor physiotherapy sessions prior to surgery ("prehabilitation"), in addition to usual surgical care, or the control group, who will receive usual surgical care, and may still access physiotherapy outside of the study if they want to. All participants will complete questionnaires before surgery, after completing prehabilitation or immediately before surgery if they are part of the control group, approximately 6 weeks after surgery, 6 months after surgery, and 12 months after surgery. The questionnaires ask about endometriosis-related pain, quality of life, bladder and bowel symptoms, and mental well-being.

Inclusion Criteria: * Presence of chronic pelvic pain (\>6 months) * Diagnosis of endometriosis (clinical, laparoscopic, or imaging-based diagnosis) * Scheduled for fertility-sparing endometriosis surgery or hysterectomy with excision of endometriosis Exclusion Criteria: * Undergoing gynecologic surgery in the absence of pelvic pain * Patients undergoing laparotomy or conversion to laparotomy * Have undergone endometriosis related surgery in the past 12 months * Have engaged in pelvic physiotherapy in the past 12 months * Non-English speakers (if validated tools unavailable) * Active malignancy * Post-menopausal * Prior oophorectomy * Prior hysterectomy