Beyond repair, beyond Kegels: a pelvic physiotherapist’s reflection on working with surgeons

As a pelvic health physiotherapist, I’ve spent my career standing at the intersection of two worlds—where conservative rehabilitation meets surgical expertise. Working alongside surgeons has taught me not only about anatomy and surgical outcomes, but about perspective: how each of us sees only part of the patient’s journey until we start talking to one another.

In pelvic health, the human story is rarely linear. Patients may arrive years after a traumatic delivery, a hysterectomy, an endometriosis excision, or a prostate surgery—often having navigated layers of medical interventions before anyone asked, “How do you feel in your body” and “Can you use it how you’d like to?”

While a surgeon’s focus is often the success of a procedure—optimal resection, reduced pain, restored structure—mine is on function, integration, and lived experience. Where the surgeon works with a scalpels, cautery and sutures, I work with breath, skilled touch, and purposeful movement—restoring awareness, slowly unwinding guarded tissue and fear. Our work is complementary.

When I collaborate with surgeons who view physiotherapy as an integral part of the care plan— before and after surgery— this often leads to outcomes that are both clinically strong and more attuned to the patient’s whole experience.

Many surgeons aren’t fully aware of the breadth of tools and treatments pelvic health physiotherapists offer. And it’s not their fault—surgical training is vast, time-compressed, and understandably focused on pathology, decision-making, and operative skill. Meanwhile, our world includes everything from pelvic floor muscle re-education to scar mobilization, from sexual health aids to rectal balloon training, from genital desensitization to complex movement re-integration. When surgeons discover this range, I often see a spark of relief cross their faces: suddenly their patients have options that don’t involve another prescription, waitlist, or invasive solution. It’s a reminder that collaborative care doesn’t just benefit patients—it expands the possibilities for everyone on the medical team.

Before the first incision, there is an opportunity to build confidence, clarity, and readiness. Preoperative physiotherapy—what we now call prehabilitation - is increasingly recognized as an essential component of optimal surgical outcomes.

Because the pelvic floor is largely autonomic, it responds instantly to pain, stress, and emotional load, often defaulting into a persistent protective contraction. Left unaddressed, this can intensify pelvic or abdominal myalgia, disrupt bladder and bowel function, and contribute to central sensitization. Prehabilitation helps modulate these patterns, reduce hypertonicity, and establish a more optimal neuromuscular baseline for surgery and recovery.

Teaching a patient to connect with their pelvic floor before surgery, to understand the role of breath and alignment, to strengthen and relax intentionally—these are not minor details. They are foundations for recovery.

Patients prepared, wake from surgery not as passive recipients of care, but as active participants in healing. Their muscles “remember” what to do, they know how to move safely, and their mind knows that discomfort is not danger. That shift changes everything.

Postsurgical rehabilitation is where surgical outcomes meet lived reality. I think of the man recovering from prostatectomy—cancer-free yet suddenly foreign to his own body, unprepared for incontinence and the emotional weight of erectile dysfunction. Or the young mother confused and discouraged by dyspareunia and vaginal fissures, having believed that a caesarean should spare her vagina, only to reveal clear signs of connective tissue restriction pulling from the perineum toward her scar. And the once-gregarious patient who retreated from social life after a single episode of anal incontinence post-rectopexy, their resulting stress now disrupting the very bowel habits needed to relearn retention.

In these moments, physiotherapy bridges the medical and the personal. We guide patients through the gradual restoration of continence, sexual function, and pain management while also validating the emotional terrain of recovery.

I am so fortunate to work with surgeons who recognize this continuum. They don’t simply discharge a patient after procedural success; they transition them to a partner who will continue the work. Together, we ensure that recovery extends far beyond the surgical site.

I have deep admiration for the surgical mind. Surgeons often operate in moments of immense pressure—deciding in minutes what the rest of us may deliberate for days. Their decisiveness is both a skill and a burden.

In contrast, physiotherapy is a slow art. We observe, listen, and iterate. Yet when I speak with surgeons about complex pelvic cases, I find that our perspectives complement each other withsurprising ease. They remind me of anatomy in motion; I remind them of anatomy in function.

One of the most valuable lessons I’ve learned from surgical colleagues is the power of precise language. When a surgeon describes repairing a sphincter complex, performing a laparoscopic sacrocolpopexy, or excising deep infiltrating endometriosis, I know exactly where sensory retraining, pressure management, and tissue mobility must begin. In turn, I share what the patient feels—where they protect, compensate, or disconnect. Together, we rebuild not only tissue, but trust.

Pelvic health challenges—whether endometriosis, prolapse, or post-cancer recovery—demand multidisciplinary thinking.

A surgeon who asks, “When should my patient start pelvic floor work?” opens the door to shared success. A physiotherapist who asks, “What exactly did you see intraoperatively?” enhances precision in rehab. When I work with my surgical colleagues, I bring not only manual skills but a perspective—a reminder that long after the incision heals recovery remains a dialogue between tissues, emotions, and experience.

The future of healthcare lies not in silos, but in synergy.

In the end, we all share the same mission: to restore function, dignity, and confidence. Working alongside surgeons has shown me that there is no hierarchy in healing—only shared purpose. When the precision of surgery meets the expertise and problem solving of physiotherapy, we create something extraordinary: healthcare that feels human again…without ever mentioning a Kegel.