A hysterectomy is an operation that removes your womb and often your cervix (neck of the womb) too.
It may be performed to treat many different conditions such as fibroids, endometriosis, pelvic inflammatory disease, uterine prolapse or cancer. A hysterectomy is not undertaken lightly. It’s usually only recommended when other treatments have not succeeded.
A hysterectomy often involves an incision to the pelvic floor. It’ll hopefully improve your quality of life in many ways but it does nothing to strengthen your pelvic tissues themselves.
Incontinence after a pelvic floor surgery or hysterectomy is common and it’s a problem that women shouldn’t have to deal with. That’s why post-hysterectomy physiotherapy is so important.
Recovery from a hysterectomy
Recovering from a hysterectomy takes time. An important part of your body has been removed. Initially, you’re likely to experience vaginal bleeding and some pain, itching or discomfort around your incision sites. You’ll be told to take it easy for a few weeks and not do any heavy lifting. And you might be feeling a bit emotional too – some women experience a sense of loss after a hysterectomy.
So, find a binge-worthy TV series or a good book and follow your surgeon’s instructions to rest and recover. Stay on top of your pain relief too. Your body is gradually healing and it usually does an impressive job. After about 6 weeks, you should be able to start the active phase of your recovery.
Time to strengthen your pelvic floor
The first place to start with post-surgery exercise is strengthening and rehabilitating the pelvic floor. Due to the invasive nature of the procedure, you’re likely to have some scar tissue and weakness in the pelvic floor muscles.
What is the pelvic floor?
Your pelvic floor muscles run from your tailbone (coccyx) at the back of your pelvis through to your pubic bone at the front. As the floor of the pelvic cavity, these muscles have important roles to play in the correct functioning of the pelvic and abdominal tissues.
They support your bowel, bladder, uterus and vagina and play an important role in continence, core strength and sexual pleasure.
Pelvic floor exercises after a hysterectomy
Rehab for the pelvic floor begins with specific, gentle exercises aimed at regaining control and function in the pelvic floor muscles.
Pelvic floor exercises help to improve your muscle tone and your brain’s connection to those muscles. The goal is to strengthen your pelvic floor muscles so that they’re better able to support your internal organs and you feel more in control of your bladder and bowels.
So, when can you start? Usually around 6 weeks after your hysterectomy depending on the procedure and your individual recovery. Any exercise should be cleared with your surgeon first.
If you perform any pelvic floor exercises that cause pain, discomfort or nausea then you should cease immediately. Contact your physician if you are unable to exercise without pain after 8 weeks.
How to do pelvic floor exercises
Kegels are a common exercise for strengthening the pelvic floor. This exercise simply involves contracting and relaxing the pelvic floor as much as possible. It’s the same sensation that you’ll feel if you attempt to stop urinating halfway through. Here’s how to do them.
1. Get in the right position:
a) Lie on your back on a flat surface
b) Bend your knees slightly and keep your feet flat on the floor – this variation reduces the resistance applied by gravity.
2. Focus on controlling and slowly squeezing the muscles around your vagina, urethra, and anus
a) Imagine you’re pulling them up into your belly button as you squeeze
b) Gently contract them as far as you can, clenching gently when you’ve gone as far as you can.
3. Keep breathing in and out, in and out throughout the exercise.
Repeat this 10-12 times (repetitions) then rest briefly and repeat the whole thing 2-3 times (sets). Stop immediately if you experience any pain, discomfort or nausea.
Once you’ve learned how to do pelvic floor exercises, you need to do them several times a day.
Regular, intentional practice is the best way to make progress. For best results, build up to performing 5 sets of 10-12 repetitions 2-3 times per day. This will provide you with more passive and active control, meaning better continence and improved control over your own functions.
As time goes on, your physiotherapist or surgeon may recommend that, in addition to your pelvic floor exercises, you start doing some lower-body strengthening exercises that involve your core muscles and hips. Basic, integrative core exercises such as those seen in yoga and pilates are a great place to start and provide a calming, supportive environment for strengthening.
What about returning to regular exercise? That depends on many different factors, including your overall health and fitness, how consistently and how well you do your pelvic floor exercises.
How can The Brisbane Spine Clinic help?
Recovering from a hysterectomy depends greatly on your individual circumstances. However, a capable, supportive physiotherapist with expertise in women’s health can help a great deal in your recovery after a hysterectomy.
Our physiotherapists have a long track record in supporting women recovering from a hysterectomy and those dealing with other conditions such as pregnancy-related back pain and hip pain and postoperative pelvic organ prolapse.
Your physio can help guide your recovery, teach you how to do your exercises properly and judge when you’re ready to progress to the next level. Working with a physio long-term also offers the opportunity to continuously improve your pelvic floor strength and reduce the risk of future pelvic pain.
Physiotherapy can even start before a hysterectomy. Strengthening your pelvic floor before your operation puts you in a better position to recover afterwards.
If you’ve had, or are planning, a hysterectomy and would like the support of our skilled, compassionate physiotherapists, please book an appointment today.
All information is general and is not intended to be a substitute for professional medical advice. The Brisbane Spine Clinic can consult with you to confirm if a particular treatment is right for you.