Pelvic Floor Physical Therapy Pre and Post Hysterectomy

A hysterectomy is the surgical removal of the uterus and cervix. Hysterectomies are the second most frequently performed surgical procedure (after cesarean section) for U.S. women who are of reproductive age, and by the age of 60, more than one-third of all women in the US have had a hysterectomy. Over 600,000 women annually elect for this procedure. That is a large number of women having major abdominal and pelvic surgery! 

Avoid Unnecessary Streneous Activity

Following a hysterectomy, the recommendation is no strenuous activity, no lifting over 10 pounds, and “pelvic floor rest” (no sex or penetration) for 6 weeks. These guidelines are meant to allow the surgical tissues time to heal, and to limit the strain on the pelvic floor muscles, which could irritate or tear sutures. They also allow for the woman to rest, recover from a major abdominal surgery, and gently ease back into normal activity following those 6 weeks. 

Visit Your Pelvic Floor Physical Therapist

One recommendation that is often missing, is a pre- or post-op visit with a pelvic floor physical therapist. It is common for women in need of a hysterectomy to have symptoms such as pain, lower abdominal pressure, prolapse, or incontinence. These are common complaints, but they are not normal. Pelvic floor physical therapy can address all of these concerns. 

There is considerable pelvic irritation and inflammation following a hysterectomy. This can affect the pelvic floor muscles (PFMs) ability to produce significant force with contraction, or to fully relax after a contraction. It can also cause the PFMs to tighten, and guard the area, in an attempt to protect the injured tissues.

Even after the body has healed from the surgical procedure, it is not uncommon for the PFM to continue to have these dysfunctions, which can have long term effects for the woman, often presenting as pelvic pain or incontinence years later. As with any injury, early intervention often results in shorter recovery time and fewer altered behaviors or compensatory movement patterns. A pelvic floor PT can identify dysfunctions in the PFMs and prescribe appropriate exercises and provide treatment for these dysfunctions. 

Post-Surgery Recovery

Immediately following surgery, it is common for women to have GI irritation or constipation. This is likely a result of the perfect storm: anesthesia and decreased activity level of the patient resulting in decreased GI motility, pain meds causing constipation, air and inflammation in the abdomen. Regardless of why, it can be one of the most difficult post operative symptoms. Proper toileting techniques can make the early post-operative weeks much more manageable.

Traditional toilet seats place our knees at or below hip level, which is not the most effective posture for voiding the bladder, or emptying the bowel. Using a “squatty potty” or step stool, placing the knees above the hips, and relaxing forward with forearms on thighs, allows the pelvic floor muscles to relax, and places the rectum in a better alignment for passing stool. 

Proper sitting posture for a relaxed pelvic floor.

Proper sitting posture for a relaxed pelvic floor.

As a pelvic floor physical therapist, and a post hysterectomy patient, I see the need for better pre and post hysterectomy care. A one time pre-op visit, with additional visits as necessary following the 6 week post-op check with your Doctor, is an excellent way to accomplish that goal. 

  • Kara Neil, Physical Therapist at Great Northern PT

  • 406.586.4678

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Breathing and Your Pelvic Floor

The pelvic floor is certainly a hot topic of conversation for many men and women. Specifically, people begin to focus on their pelvic floor when they are having incontinence, urgency/frequency, prolapse, or pain associated with going to the bathroom or having sex. These are all issues related to pelvic floor dysfunction. But, what many don’t realize, is that your pelvic floor is also integral in one of our most basic functions: breath.

The diaphragm, our respiratory muscle, is located at the bottom of the ribcage. At rest, the diaphragm is a domelike shape, and with inhalation the diaphragm muscle contracts and drops downward toward your pelvis. This downward motion is followed by a shifting downward of internal organs, into the pelvic bowl. The pelvic floor muscles and fascia make up the bottom of the pelvic bowl. So, with this downward force during inhalation, the pelvic floor muscles also descend or stretch slightly downward. Immediately following inhalation and pelvic floor descent, is exhalation, and similarly, the pelvic floor follows the diaphragm as it rises upward to a resting position. This synchronous rising and falling of the diaphragm and pelvic floor is often referred to as the “piston effect”.

Not to be left out, the lower abdominal muscles (transverse abdominis) also contribute to this synchronous movement pattern. Working together by relaxing and stretching with inhalation and a “belly breath”, and tightening and drawing inward slightly with exhalation. In this way, the diaphragm, abdominals, and pelvic floor make up an abdominal cylinder that modulates intra-abdominal forces and pressure changes.

When this cylinder isn’t coordinating well together, or if there is tightness or weakness within the system, we see common musculoskeletal complaints: low back pain, SIJ pain, poor stability through the back and pelvis, hip pain, pelvic pain, incontinence, urgency/frequency of urine or stool, prolapse, poor posture, balance issues, and intolerance to exercise.

Our pelvic floor physical therapists can help evaluate these movement patterns and coordination of these systems, and create a treatment approach specific to you and your individual challenges.