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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