Bladder and Bowel Health Before and After Endometriosis Surgery
Bladder and bowel dysfunction are frequently under-recognised components of the endometriosis experience, yet they are often among the most distressing.
As a pelvic health physio, I’ve supported hundreds of people through this journey, and I often hear the same questions:
“Is what I’m experiencing normal?”
“Why is my bladder acting up?”
“What can I do to avoid bowel issues after surgery?”
Understanding what constitutes normal bladder and bowel function is key to identifying dysfunction early and supporting recovery.
What’s Normal?
Bladder Function
The bladder is a hollow muscular organ, whose role is to store and then expel urine when socially appropriate. Think about it like this- the bladder is a stretchy balloon that fills up. As it fills, it sends messages to the brain to let it know how full it is. The brain then decides if it is socially appropriate to go to the toilet, before sending the signals to empty the bladder.
Clinically, normal function includes:
Voiding every 3–4 hours during the day
Nocturia ≤ 1 time per night
Urine flow that is uninterrupted, painless, and complete
No urgency, hesitancy, or post-void dribble
Indicators for referral may include frequency <2 hrs, night-time waking >1x regularly, urgency, pain with urination, or feelings of incomplete emptying.
Bowel Function
The rectum stores stool, and emptying should occur in a coordinated, relaxed manner. Think of the rectum like a car-parking lot where the stool sits until the brain says it is ok to relax and empty.
Normal bowel health includes:
Stool that is soft and formed (if in doubt, check out the Bristol Stool Chart below- type 3-4)
Emptying your bowels 3 x day- 3 x week
No straining, pain, or prolonged toilet time (>10 minutes)
No urgency, incontinence, or incomplete evacuation
Patients with endometriosis often report constipation, diarrhoea, bloating, or pain with bowel movements, all of which may be due to location of endometriosis lesions, nervous system changes, pelvic floor dysfunction, and/or dietary triggers.
Before Surgery: Set Yourself Up for Success
Leading up to surgery, your bowels and bladder might already be sensitive, especially if you live with pelvic pain and/or endometriosis, or pelvic floor tension.
Here’s how to prepare:
Hydrate well in the days leading up to surgery
Increase fibre gradually with fruits, veggies, and whole grains (unless advised otherwise).
Avoid “pushing” on the toilet- a footstool under your feet can help support better alignment (see below)
Don’t hold on for too long- regularly empty your bladder during the day.
Bristol stool chart and optimal toileting posture
After Surgery: What to Expect
It’s common for your bladder and bowels to take a little time to settle after surgery.
You may notice:
A slower return to normal bowel movements (due to anaesthetic, pain meds, or inactivity)
Increased sensitivity or urgency with urination
Gas pain or bloating as your gut “wakes up”
Top Tips:
Start with gentle movement (even walking around the house helps!)
Prioritise hydration and small, regular meals
Use a heat pack if you feel gassy or crampy
Take prescribed stool softeners if needed
Don’t panic if things feel “off” for a few days, but do reach out to your team if you’re in pain or things don’t improve
Long-Term Pelvic Health Support
If bladder or bowel issues continue weeks or months after surgery, you’re not alone — and it’s not something you need to just “put up with.”
Some things to consider:
Ongoing bloating or difficulty passing stool may relate to pelvic floor tension or dietary triggers
Leaking, urgency, or pain when peeing may improve with pelvic physio
Nerves and muscles sometimes need retraining after inflammation or surgery
Final Thoughts
Bladder and bowel symptoms are incredibly common in people with endometriosis — and they deserve attention, just like any other part of your care.
Whether you’re preparing for surgery or are weeks into recovery, listening to your body and giving it the right support can make a big difference.
Your bladder and bowels aren’t just an afterthought. They’re part of the picture, and part of your recovery.
— Jo x
Woman sitting on the toilet