What to Expect at Your Initial Visit
When you schedule a consult with our clinic, we will ask you to fill out a detailed questionnaire giving us background on your medical history and your current symptoms. If you have had prior GYN surgeries, we will also want to review those.
During your initial consult visit, we will dive into the details of your symptoms, discuss what’s been done in the past, and do a detailed physical exam and a pelvic ultrasound in order to have the best idea possible of what’s causing your pain. We then have a thorough discussion about treatment options, taking time to address your individual questions. Many patients tell us that the pelvic ultrasound is much more informative than their prior scans, and that this is the first time they have had a provider really listen to and understand their symptoms.
What to Expect at Your Initial Visit
When you schedule a consult with our clinic, we will ask you to fill out a detailed questionnaire giving us background on your medical history and your current symptoms. If you have had prior GYN surgeries, we will also want to review those.
During your initial consult visit, we will dive into the details of your symptoms, discuss what’s been done in the past, and do a detailed physical exam and a pelvic ultrasound in order to have the best idea possible of what’s causing your pain. We then have a thorough discussion about treatment options, taking time to address your individual questions. Many patients tell us that the pelvic ultrasound is much more informative than their prior scans, and that this is the first time they have had a provider really listen to and understand their symptoms.
What to Expect Before & After Surgery
If surgery is the next step that you and your doctor decide on, the sections below provide an overview of what to expect along the way, from the preop visit through the recovery period.
Video from our Nurse Practitioner
What to Expect Before & After Surgery
If surgery is the next step that you and your doctor decide on, the sections below provide an overview of what to expect along the way, from the preop visit through the recovery period.
Video from our Nurse Practitioner
What to Expect Before & After Surgery
If surgery is the next step that you and your doctor decide on, the sections below provide an overview of what to expect along the way, from the preop visit through the recovery period.
Video from our Nurse Practitioner
You will be scheduled to have a preop visit with our NP or your surgeon within 30 days of surgery. At this visit, we’ll review any patient updates, the preoperative process, and readdress the plan for surgery in detail. We ask all patients to view the video above (see “What to Expect Before and After Surgery”) prior to the preop visit, so we have more time to address your individual questions. We will review your current medications, the plan for bowel prep prior to surgery, and the postop pain management plan. We can also place a referral for postoperative PT at this time, if pelvic floor dysfunction is a contributor to your pain. We have dedicated team members to assist with FMLA paperwork and coordinating medical preoperative clearance, if these are needed.
On the day of surgery, you will need to arrive at the hospital 2 hours before the anticipated time of your surgery. It is important to remember that the time of surgery is NOT an exact time unless you are the first case of the day, but our best estimate of when the case should start. We try very hard to stay on schedule, however sometimes things happen that are out of our control and either the surgery itself or the anesthesia can take a little more or less time than anticipated. Please keep your phone close by on the day of surgery and the day before as sometimes we need to rearrange the schedule or alter arrival times at the last minute and therefore may need to reach you. Know that we are committed to doing what’s right for each patient, regardless of the time it takes. You will sign the consent form for surgery in the preoperative area, and have another chance to ask your surgeon any lingering questions.
Almost all of our surgeries are done with either a robotic or laparoscopic approach. This allows for better visualization of the deep pelvis than open surgery, which means more endometriosis can be both seen and removed. It also reduces the risk of major complications during surgery as well as adhesion formation after surgery, and allows patients to heal faster with less post-op pain than open surgery. If you want to see videos of actual robotic surgeries, please check out the Videos section.
Most patients who undergo excision of endometriosis without a bowel resection should be able to leave the hospital the day of surgery, however everyone recovers from anesthesia differently. We try very hard to minimize pain and nausea in the immediate postop period so that you can go home (or to your hotel room) on the day of surgery. If you have a hysterectomy along with excision of endometriosis, you can generally still go home on the day of surgery. If you have a full thickness discoid bowel resection, then you will usually need to stay overnight. If you need a segmental bowel resection, then you will require an extended hospital stay, typically 4-7 days.
We have a multi-modal pain management plan that generally includes acetaminophen, NSAIDs, gabapentin, tramadol, and an On-Q bupivacaine pump which allows us to minimize the need for narcotic pain medications. Patients are also prescribed an anti-nausea medication to use if needed. We generally recommend taking an NSAID (Ibuprofen, Naproxen, or Sprix) on schedule for the first 7-10 days postop unless there is a contraindication. Most patients stop their narcotic medication sometime during the first week postop. The on-Q pain pump is generally removed on day 5 postop, please see our videos below, or you can watch then on YouTube by clicking on the following: “ON-Q Pain Pump Removal” and “Remove Pain Pump” . In the first few days after surgery you may not have a big appetite, and the most important thing is to drink adequate fluids. It is also important to be proactive about managing constipation, and our preop packet outlines a plan for this if needed. Our staff are available for support and questions throughout your recovery period. Patients generally have 2 week and 6 week postop appointments scheduled, and additional visits as needed.
If you live far away, we will make individualized plans for follow-up visits and generally will try to see you before you leave the area to go home. Some patients choose to come back to see us at 6 weeks postop, others will make arrangements to see their regular GYN doc in their hometown and send us the note.
It has been our experience that patients with chronic pain often take longer to feel good after surgery than patients who undergo similar surgeries for non-pain indications. Therefore, please don’t expect that at 6 weeks after your surgery you will magically wake up and feel fine. Some patients with endometriosis feel great at 4-6 weeks after excision, but most can take twice that long. Our rule of thumb is that as long as you are progressing and feeling better week by week, things are on the right track. You may have days where you feel not as good as the previous ones, but as long as there is not a trend in the wrong direction (ie several days in a row of increasing pain or nausea) this is normal and okay.
If you are feeling well 10-14 days after surgery and then you feel worse, the first question to ask is “what have I done lately?”. For most patients, once they start feeling better they decide to go out and about, and after a week or two of doing next to nothing, even the amount of effort it takes to go grocery shopping and get in and out of the car several times can make their pain increase significantly. However, if you haven’t changed your activity and all of a sudden are feeling worse, please let us know, especially if you have a fever, nausea, or other abnormal symptoms.
We advise our patients to pace their activity after surgery, and listen to their bodies. The first week or two it’s okay to take short walks, less than 15 minutes at a time. Between 2-4 weeks, you can start pushing yourself to walk farther and faster, but don’t lift anything heavier than 5-10 lbs. After 4 weeks postop, if you are an athlete and are accustomed to working out, you can slowly ease back into your athletic activities, but be very careful with abdominal work as it can aggravate your incisions and abdominal wall muscles. If it hurts, stop and wait a day or two before restarting.
Chronic pain sometimes takes a long time to go away. Most of our endo patients have had their pain for many years, so it may not go away in a month or two. Patients who have robotic excision of endometriosis with or without a presacral neurectomy will usually have pretty significant menstrual cramps the first few months after surgery. In fact, your first period after surgery may be worse than before surgery. Some lucky folks will have immediate pain relief including menstrual cramps, but it is difficult to predict who will react either way.
Once 3-6 months goes by, most of the endometriosis pain should be gone. If it is not, then most likely something else is causing the pain. The most common reasons are pelvic floor pain, bladder pain, and nerve pain. Pelvic floor muscle spasm commonly coexists with endo and some patients don’t realize how much the spasm is contributing to their overall pain. Physical therapy is much more effective after removing the stimulus of endo that usually causes the spasm in the first place, so if you’ve had ineffective PT before surgery, don’t dismiss it afterwards. Bladder pain, also known as Interstitial Cystitis (IC) is also frequently concurrent with endometriosis, and sometimes resolves spontaneously after removing the endo, but sometimes persists. Please read Dr. Mosbrucker’s article on Interstitial Cystitis on our website for more information.
Persistent “phantom endo pain” in the absence of any identifiable cause is rare, but can occurs in less than 5% of patients after excision. It is a similar phenomenon to phantom limb pain, and Complex Regional Pain Syndrome (CRPS), which are conditions where even though there’s nothing stimulating the nerve endings, they fire anyway and cause an exaggerated response in the brain. Please see Dr. Mosbrucker’s article called “My Philosophy on Treating Pelvic Pain Patients” for more details.
If you do have persistent pain months after excision surgery, please come back to see us and we will help to direct and coordinate your follow-up care. We are not “just” surgeons, we also want to make sure that every patient feels as good as they possibly can. We are happy to see you for any issue related to endometriosis or pelvic pain, whether it is a surgical issue or not. Additionally, our NP Crystal Walker is seeing patients for annual GYN visits, if you are looking for a primary provider with expertise in endometriosis or hormone management.
You will be scheduled to have a preop visit with our NP or your surgeon within 30 days of surgery. At this visit, we’ll review any patient updates, the preoperative process, and readdress the plan for surgery in detail. We ask all patients to view the video above (see “What to Expect Before and After Surgery”) prior to the preop visit, so we have more time to address your individual questions. We will review your current medications, the plan for bowel prep prior to surgery, and the postop pain management plan. We can also place a referral for postoperative PT at this time, if pelvic floor dysfunction is a contributor to your pain. We have dedicated team members to assist with FMLA paperwork and coordinating medical preoperative clearance, if these are needed.
On the day of surgery, you will need to arrive at the hospital 2 hours before the anticipated time of your surgery. It is important to remember that the time of surgery is NOT an exact time unless you are the first case of the day, but our best estimate of when the case should start. We try very hard to stay on schedule, however sometimes things happen that are out of our control and either the surgery itself or the anesthesia can take a little more or less time than anticipated. Please keep your phone close by on the day of surgery and the day before as sometimes we need to rearrange the schedule or alter arrival times at the last minute and therefore may need to reach you. Know that we are committed to doing what’s right for each patient, regardless of the time it takes. You will sign the consent form for surgery in the preoperative area, and have another chance to ask your surgeon any lingering questions.
Almost all of our surgeries are done with either a robotic or laparoscopic approach. This allows for better visualization of the deep pelvis than open surgery, which means more endometriosis can be both seen and removed. It also reduces the risk of major complications during surgery as well as adhesion formation after surgery, and allows patients to heal faster with less post-op pain than open surgery. If you want to see videos of actual robotic surgeries, please check out the Videos section.
Most patients who undergo excision of endometriosis without a bowel resection should be able to leave the hospital the day of surgery, however everyone recovers from anesthesia differently. We try very hard to minimize pain and nausea in the immediate postop period so that you can go home (or to your hotel room) on the day of surgery. If you have a hysterectomy along with excision of endometriosis, you can generally still go home on the day of surgery. If you have a full thickness discoid bowel resection, then you will usually need to stay overnight. If you need a segmental bowel resection, then you will require an extended hospital stay, typically 4-7 days.
We have a multi-modal pain management plan that generally includes acetaminophen, NSAIDs, gabapentin, tramadol, and an On-Q bupivacaine pump which allows us to minimize the need for narcotic pain medications. Patients are also prescribed an anti-nausea medication to use if needed. We generally recommend taking an NSAID (Ibuprofen, Naproxen, or Sprix) on schedule for the first 7-10 days postop unless there is a contraindication. Most patients stop their narcotic medication sometime during the first week postop. The on-Q pain pump is generally removed on day 5 postop, please see our videos below, or you can watch then on YouTube by clicking on the following: “ON-Q Pain Pump Removal” and “Remove Pain Pump” . In the first few days after surgery you may not have a big appetite, and the most important thing is to drink adequate fluids. It is also important to be proactive about managing constipation, and our preop packet outlines a plan for this if needed. Our staff are available for support and questions throughout your recovery period. Patients generally have 2 week and 6 week postop appointments scheduled, and additional visits as needed.
If you live far away, we will make individualized plans for follow-up visits and generally will try to see you before you leave the area to go home. Some patients choose to come back to see us at 6 weeks postop, others will make arrangements to see their regular GYN doc in their hometown and send us the note.
It has been our experience that patients with chronic pain often take longer to feel good after surgery than patients who undergo similar surgeries for non-pain indications. Therefore, please don’t expect that at 6 weeks after your surgery you will magically wake up and feel fine. Some patients with endometriosis feel great at 4-6 weeks after excision, but most can take twice that long. Our rule of thumb is that as long as you are progressing and feeling better week by week, things are on the right track. You may have days where you feel not as good as the previous ones, but as long as there is not a trend in the wrong direction (ie several days in a row of increasing pain or nausea) this is normal and okay.
If you are feeling well 10-14 days after surgery and then you feel worse, the first question to ask is “what have I done lately?”. For most patients, once they start feeling better they decide to go out and about, and after a week or two of doing next to nothing, even the amount of effort it takes to go grocery shopping and get in and out of the car several times can make their pain increase significantly. However, if you haven’t changed your activity and all of a sudden are feeling worse, please let us know, especially if you have a fever, nausea, or other abnormal symptoms.
We advise our patients to pace their activity after surgery, and listen to their bodies. The first week or two it’s okay to take short walks, less than 15 minutes at a time. Between 2-4 weeks, you can start pushing yourself to walk farther and faster, but don’t lift anything heavier than 5-10 lbs. After 4 weeks postop, if you are an athlete and are accustomed to working out, you can slowly ease back into your athletic activities, but be very careful with abdominal work as it can aggravate your incisions and abdominal wall muscles. If it hurts, stop and wait a day or two before restarting.
Chronic pain sometimes takes a long time to go away. Most of our endo patients have had their pain for many years, so it may not go away in a month or two. Patients who have robotic excision of endometriosis with or without a presacral neurectomy will usually have pretty significant menstrual cramps the first few months after surgery. In fact, your first period after surgery may be worse than before surgery. Some lucky folks will have immediate pain relief including menstrual cramps, but it is difficult to predict who will react either way.
Once 3-6 months goes by, most of the endometriosis pain should be gone. If it is not, then most likely something else is causing the pain. The most common reasons are pelvic floor pain, bladder pain, and nerve pain. Pelvic floor muscle spasm commonly coexists with endo and some patients don’t realize how much the spasm is contributing to their overall pain. Physical therapy is much more effective after removing the stimulus of endo that usually causes the spasm in the first place, so if you’ve had ineffective PT before surgery, don’t dismiss it afterwards. Bladder pain, also known as Interstitial Cystitis (IC) is also frequently concurrent with endometriosis, and sometimes resolves spontaneously after removing the endo, but sometimes persists. Please read Dr. Mosbrucker’s article on Interstitial Cystitis on our website for more information.
Persistent “phantom endo pain” in the absence of any identifiable cause is rare, but can occurs in less than 5% of patients after excision. It is a similar phenomenon to phantom limb pain, and Complex Regional Pain Syndrome (CRPS), which are conditions where even though there’s nothing stimulating the nerve endings, they fire anyway and cause an exaggerated response in the brain. Please see Dr. Mosbrucker’s article called “My Philosophy on Treating Pelvic Pain Patients” for more details.
If you do have persistent pain months after excision surgery, please come back to see us and we will help to direct and coordinate your follow-up care. We are not “just” surgeons, we also want to make sure that every patient feels as good as they possibly can. We are happy to see you for any issue related to endometriosis or pelvic pain, whether it is a surgical issue or not. Additionally, our NP Crystal Walker is seeing patients for annual GYN visits, if you are looking for a primary provider with expertise in endometriosis or hormone management.
