WHAT SHOULD I DO BEFORE ENDOMETRIOSIS EXCISION SURGERY?

Sep 17

How to Prepare for

Endometriosis Excision Surgery:

A Whole-Person Approach

Expert Endometriosis excision surgery can feel like the light at the end of a very long, very painful tunnel, however, surgery day isn't the finish line. It's the starting point of your recovery. And like any race worth running well, the preparation you do beforehand makes all the difference in how that recovery unfolds.

As a pelvic health occupational therapist who has spent years working with women navigating complex recovery, I want to walk you through three areas of preparation that often get overlooked: your body, your mind, and your logistics.

1. Physical Prep: Start With Your Ribcage and Diaphragm

When people think about preparing for endometriosis surgery, they usually jump straight to "pelvic floor exercises." But one of the most important places to start is actually much higher up — your ribcage and diaphragm.

Your diaphragm and pelvic floor work as a team, moving together with every breath you take. After surgery, pain, incisions, bloating, and simply guarding your midsection can cause your breathing pattern to become shallow and restricted. When your diaphragm stops moving well, your pelvic floor often follows suit, and that can slow healing, increase pain, and make it harder to get your gut and bladder back on track.

Before surgery, spend time practicing:

Ribcage expansion breathing — placing your hands on the sides of your ribs and practicing breathing 360 degrees so your ribs expand outward and back, not just your belly rising and falling
360 Breathing in different positions — lying down, side-lying, and seated, so your body has practiced the pattern in a variety of positions before it needs to rely on it post-op
Gentle rib mobility work — simple stretches that keep the ribcage supple, since a stiff, guarded ribcage post-surgery makes deep breathing (and therefore comfortable movement & gas pain) much harder

Think of this as laying the tracks before the train needs to run. A body that already knows how to breathe well and move through the ribcage will recover more comfortably than one that's starting from scratch on day two post-op.

2. Mindset Prep: Catching the Thought Spiral Before It Starts

Surgery prep is rarely just physical. If you've lived with endometriosis for any length of time, you've likely also lived with fear, frustration, and grief — grief over lost time, dismissed symptoms, and a body that hasn't felt like home.

It's completely normal for anxious or catastrophic thoughts to creep in as surgery approaches: What if excision doesn't work? What if I'm back here again in a year? What if I can't handle the pain?

The goal isn't to eliminate these thoughts — it's to notice them earlier and have a plan for what to do when they show up. A few strategies to practice now, before surgery:

Name the spiral when it starts. Simply noticing when you have looping, racing thought can interrupt the momentum of a spiral before it takes over your whole afternoon.
Separate fact from fear. Ask yourself: is this something I know, or something I'm afraid of? Both are valid to feel, but they call for different responses.
Build your self care tool kit. Whether it's a breathing exercise, my favorite is the Cyclic Sigh—-click for a blog post I wrote on the technique!), a short walk, or a specific playlist (My full support clients with medical trauma and I use a listening therapy called the Safe and Sound Protocol ). Create options to choose from to help you through a pain flare. We don’t want you trying to figure it out for the first time while recovering.
Give yourself permission to feel more than one thing. Hope and fear can coexist. Excitement for relief and anxiety about the unknown can coexist too.

Preparing your nervous system for the emotional ups and downs of recovery is just as important as preparing your body for the physical ones.

3. Logistics Prep: Know Your Job Description and Plan Your Time Off

This is the piece that's easy to put off until the last minute — and the one that can cause the most stress if left unaddressed. Before your surgery date, take time to actually sit down with your job description (not just your general sense of what your job involves) and ask yourself some honest questions:

Does my role require lifting, prolonged standing, sitting or repetitive bending?
How much of my day is spent sitting versus moving?
Are there tasks I could modify or hand off temporarily during early recovery?
What does my employer's short-term disability or medical leave policy actually require, and by when?

Once you have clarity on the physical demands of your job, you can have a more informed conversation with your surgeon or care team about a realistic return-to-work timeline — one based on what your specific job requires, not a generic "6 weeks" estimate that may not apply to you.

From there, plan your time off deliberately:

Request leave paperwork early, since HR processes often take longer than expected
Build in buffer days if possible, especially if your role is physically demanding
Communicate with your supervisor about a phased return (reduced hours, modified duties) rather than an all-or-nothing return date
Line up support for household responsibilities during the first two weeks, when rest matters most

The more of this you sort out before surgery, the less mental load you'll be carrying while your body is trying to heal.

Preparation Sets the Foundation — But You Don't Have to Do It Alone

Getting your ribcage moving, catching your thought spirals, and squaring away your work plan are all pieces of the same puzzle: setting yourself up for a recovery that feels supported instead of chaotic. But preparation doesn't stop at surgery — the real work of rehab happens in the weeks and months afterward, and having guidance during that window can make an enormous difference.

That's exactly why I created the Post Op Group: Endometriosis Excision Rehab at OCCUPELVIC Health & Wellness.

This online group is designed to help you:

Feel confident in your post-op recovery
Decrease fear with movement
Learn evidence-based self-care strategies
Understand your pain
Create safety through nourishing daily routines
Connect with other Endo warriors who get it

Details:

Facilitated by: Karla Ehlers, OTR/L, MOT, PCES, TIPHP, RWP-1
When: Wednesdays at 1p EST / 12p CST / 11a MST / 10a PST
Where: Online, from the comfort of your home

You don't have to figure out recovery on your own, and you don't have to settle for generic post-op advice that doesn't account for the complexity of endometriosis excision. Join us, and let's close the gap in post-surgical care together.

👉 Reserve your spot in the Post Op Endo Recovery Group today