Hysterectomy and Your Pelvic Floor: A Guide to Preparation and Recovery

What is a hysterectomy?

Every year approximately 600,000 hysterectomies are performed in the U.S., making it the second most common surgery for those assigned female at birth. The number one most common surgery is a cesarean section.  Preparing for and recovering from a hysterectomy involves a holistic approach that addresses the medical, lifestyle and pelvic health aspects. 

By definition a hysterectomy is the surgical removal of the uterus (hyster - uterus and ectomy - surgical removal).  

There are many reasons one can undergo a hysterectomy including:

• Fibroids: Non-cancerous growths in the uterus that cause pain, heavy bleeding, or pressure
• Uterine Prolapse:  The uterus sags or drops into the vagina.
• Cancer:  Uterine, cervical, ovarian, or endometrial cancer.

How is a hysterectomy performed? 

There are three different types of hysterectomies and four different surgical approaches:

• Total Hysterectomy: Removal of the entire uterus and cervix. 
• Partial/Subtotal Hysterectomy: Removal of the uterus only, leaving the cervix in place. 
• Radical Hysterectomy: Removal of the uterus, cervix, part of the vagina, and surrounding tissues (usually done for cancer). 

In some cases, other reproductive organs like the ovaries and fallopian tubes, or both, are surgically removed. A hysterectomy can be performed in one of four ways and you and your doctor will determine which is the best surgical approach for you.  

• Abdominal Hysterectomy:  An incision is made in the abdomen (either vertically or horizontally).  
• Vaginal Hysterectomy:  The uterus is removed through an incision in the vagina.  
• Laparoscopic Hysterectomy:  Small incisions are made in the abdomen and surgical instruments are used to remove the uterus.
• Robotic-Assisted Laparoscopic Hysterectomy:  Similar to laparoscopic hysterectomy, but the surgeon uses a robotic system to control the instruments.  

How does a Hysterectomy Impact the Pelvic Floor?

The function of the pelvic floor is to support the pelvic organs - bladder, urethra, vagina, uterus, anus, rectum and general support of the intra-abdominal contents. As well as contribute to continence of urine, feces and gas and to the sexual functions of arousal and orgasm. Having a hysterectomy can potentially weaken the pelvic floor muscles which may lead to an increased risk of vaginal, bladder or rectal prolapse.  Additionally, scar tissue can form after surgery, which can restrict movement and cause pain or discomfort in the pelvic area. Also surgery can sometimes affect bladder and bowel function,

How to successfully prepare and recover?

Medical Preparation

Your doctor will review all necessary examinations, diagnostic tests, needed lab work and medications preoperatively. Be sure to inform your doctor about all medications including, supplements,  herbal remedies and topical creams. Postoperatively, your doctor will provide you with discharge instructions including early mobility guidelines and activity restrictions, such as avoiding heavy lifting (nothing more than 10 pounds), strenuous activities, such as running, aerobics, and swimming and avoiding sexual intercourse for 6-8 weeks. Additional instructions on  pain management, wound care and information regarding signs of infection and when to contact the office will also be provided. 

Lifestyle Modifications

Lifestyle modifications include smoking cessation, weight management,  regular movement/physical activity and proper nutrition are all an important part of this journey. Work in conjunction with your provider to obtain resources on how to safely decrease or stop smoking, how to manage your weight and safely initiate exercising and best nutritional guidelines. It is equally as crucial to be mentally and emotionally prepared. Speak with your family and/or a therapist about any anxieties or concerns you have before and after the surgery. Plan for recovery by arranging for help with household chores, transportation and setting up your home for a safe and comfortable space where  everything you need is within easy reach. Journaling your preoperative symptoms, including bladder and bowel patterns, physical mobility and emotions are important on this journey.

Pelvic Health

Addressing your pelvic health is a crucial aspect of both pre-operative preparation and post-operative recovery, as the surgery can significantly impact the pelvic floor and surrounding structures. It is best to  consult a Pelvic Health Physical Therapist prior to your surgery.  A Pelvic Health PT will be able to assess the strength, endurance, and coordination of your pelvic floor muscles.  It's important to learn how to lengthen and contract your pelvic floor muscles.  Performing kegel exercises may not be the most appropriate intervention. They can also address any existing pelvic floor issues such as urinary or fecal Incontinence, prolapse and pelvic pain.

Post-operatively, your Pelvic Health Physical Therapist will also teach you proper posture, ergonomics and lifting techniques with daily activities to  protect your pelvic floor. Additionally,   you will learn how to safely mobilize in and out of bed, how to perform diaphragmatic breathing and use effective breath work with transitional movements. As you recover, they can develop a personalized program to  strengthen your core and back muscles and improve pelvic stability and support.

By understanding the preparation, procedure, and recovery process, you can be better prepared for your hysterectomy and have a smoother, more successful experience. This is a significant surgery, and knowing what to anticipate can help you navigate the recovery process more effectively. Give you body grace and rest as a full recovery can take up to a year. Work together with your healthcare team, Gynaecologist, Pelvic health Physical Therapist, Behavioral Health Therapist and your personal support system.