Preparing for Endometriosis Surgery: Why Prehab and Rehab Matter

Surgery is often seen as the start of recovery, but in reality, recovery begins long before you enter the operating theatre. Through a framework known as Enhanced Recovery After Surgery (ERAS), and with the right preparation, what we call prehab, you can reduce complications, feel more in control, and return to life sooner. Here’s how prehab and rehab work, and why they’re central to Matilda Health’s approach.

What Is Enhanced Recovery After Surgery (ERAS)?

Enhanced Recovery After Surgery (ERAS) is an evidence-based framework that helps people heal faster and experience fewer complications after surgery. Originally developed in general surgery, it’s now widely used (sometimes without realising it) in gynaecology and endometriosis care.

The ERAS approach focuses on supporting both your body and mind before and after surgery to improve outcomes such as:

  • Faster recovery and shorter hospital stays

  • Reduced post-operative pain and fatigue

  • Better physical and emotional wellbeing

Key ERAS principles include:

  • Preparing and educating patients before surgery

  • Optimising nutrition, sleep, and activity levels

  • Managing pain through multimodal strategies

  • Encouraging early, supported movement after surgery

What Is Prehab Before Endometriosis Surgery?

Prehabilitation, or prehab, refers to what you do before surgery to get your body and mind ready. It’s not about doing more, it’s about preparing smarter.

Studies show that people who complete prehab programs often:

  • Experience fewer surgical complications

  • Have less anxiety before surgery

  • Return to daily life sooner

At Matilda, the pre-surgery phase includes:

  • Gentle movement and breathing to build circulation, strength, and mobility

  • Mindfulness and nervous-system regulation to ease stress and promote calm

  • Educational modules to help you understand what to expect before, during, and after surgery

Prehab gives you a sense of control, helping you start surgery from a place of strength and understanding rather than fear or uncertainty.

What Is Rehab After Endometriosis Surgery?

Rehabilitation, or rehab, is the structured process that follows your operation. It’s about supporting your body’s natural healing, pacing your return to activity, and preventing setbacks.

A good rehab plan should address not only physical healing but also the emotional side of recovery. Many people find the weeks after surgery to be an emotionally vulnerable time, so compassionate guidance is essential.

Matilda’s post-surgery phase focuses on:

  • Safe, progressive return to movement and exercise

  • Pelvic, bowel, and bladder care

  • Rest, pacing, and sleep strategies

  • Nutrition and hydration for healing

  • Mind-body reconnection through gentle mindfulness and body awareness

The Evidence Behind Matilda’s Approach

The Matilda program was built on years of research in physiotherapy, pain science, and behavioural health, combined with insights from people with lived experience of endometriosis.

By combining ERAS principles with digital delivery, Matilda aims to make recovery support accessible to anyone, no matter where they live or how busy life feels. Every element of the program is designed to help you feel:

  • Informed about your body and recovery

  • Supported by a community of peers and clinicians

  • Empowered to take an active role in your healing

Why Preparation Is Power

As a physiotherapist and researcher, I’ve seen how small changes before surgery can transform recovery afterwards. When people understand their body, manage stress, and follow structured movement and education before surgery, they don’t just recover faster, they recover better.

Prehab and rehab give you the tools to navigate surgery with confidence, build trust in your body, and return to life feeling strong and capable.

Key Takeaway: Recovery Starts Before the Operation

Preparing for endometriosis surgery is about more than the day of the operation. It’s about building a foundation for healing- physically, mentally, and emotionally.

By engaging with Matilda’s prehab and rehab program, you’re not just supporting your recovery; you’re investing in your long-term wellbeing.

References:

  • RANZCOG. (2021). Australian clinical practice guidelines for the diagnosis and management of endometriosis.

  • Australian Institute of Health and Welfare. (2023). Endometriosis in Australia 2023. https://www.aihw.gov.au/reports/chronic-disease/endometriosis-in-australia-2023

  • Mettler, L. et al. (2003). Accuracy of laparoscopic diagnosis of endometriosis. JSLS, 7(1), 15-18.

  • Wykes, C. B. et al. (2004). Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic review. BJOG, 111(11), 1204-1212.

  • Abbott, J. et al. (2004). Laparoscopic excision of endometriosis: a randomised, placebo-controlled trial. Fertility and Sterility, 82(4), 878-884.

  • Sutton, C. J. G. et al. (1994). Laser laparoscopy for pelvic pain with minimal to moderate endometriosis: a randomised controlled trial. Fertility and Sterility, 62(4), 696-700.

  • Gubbels, A. L. et al. (2020). Occult microscopic endometriosis in clinically negative peritoneum. Int J Gynaecol Obstet, 151(2), 260-266.

  • Levett, D. Z. H. & Grimmett, C. (2019). Psychological factors, prehabilitation and surgical outcomes. Anaesthesia, 74(S1), 36-42.

  • Kalogera, E. & Dowdy, S. (2019). Prehabilitation: enhancing Enhanced Recovery after Surgery. Int J Gynecol Cancer, 29(8), 1233.

  • Molenaar, C. J. L. et al. (2023). Multimodal prehabilitation and colorectal cancer surgery: the PREHAB RCT. JAMA Surgery, 158(6), 572-581.

  • Gu, X. et al. (2023). Preoperative anxiety and postoperative outcomes in laparoscopic gynaecological surgery. J Clin Med, 12(5).

  • Varallo, G. et al. (2022). Sleep disturbances and chronic postsurgical pain: systematic review and meta-analysis. Sleep Med Rev, 63, 101630.

  • Pedersen, M. B. et al. (2023). Digital technologies for home-based prehabilitation: systematic review. Surgeon, 21(6), e305-e316.

  • Gkaintatzi, E. et al. (2022). Cost analysis of a digital multimodal cancer prehabilitation. Current Oncology, 29(12), 9305-9313.

  • Barberan-Garcia, A. et al. (2019). Cost-consequence analysis of prehabilitation in high-risk abdominal surgery. Br J Anaesth, 123(4), 450-456.

  • Pronk, Y. et al. (2020). Mobile eHealth app for pain control after knee replacement: RCT. JMIR Mhealth Uhealth, 8(3), e16415.

  • Gillis, C. et al. (2017). Patients as partners in Enhanced Recovery After Surgery: a qualitative study. BMJ Open, 7(6), e017002.

  • Temple-Oberle, C. et al. (2023). Smartphone app monitoring after oncologic surgery: RCT. JAMA Surgery, 158(7), 693-699.

  • Ljungqvist, O. et al. (2017). Enhanced recovery after surgery: a review. JAMA Surgery, 152(3), 292-298.

  • Risco, R. et al. (2023). Factors supporting scalability of prehabilitation: cohort study. Ann Surg, 278(2), e217-e225.

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Improving Regional Endometriosis and Pelvic Pain Care: Reflections from Our Sunset Sessions in Broome