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Your Pelvic Floor After Hysterectomy

Undergoing a hysterectomy is a life changing experience. 1 in 5 UK women will have a hysterectomy by the age of 60 yet it seems to be one of those taboos that are never discussed! This leads to many women not having the information they need to make the right lifestyle choices. Here at Kegel8 we believe that women’s health issues aren’t something that should be swept under the rug. Given our specialism in the workings of the pelvic floor, we wanted to create a guide especially for those of you who’ve had hysterectomies. We hope that this information will empower you to feel in control of your body post-surgery and live a full and happy life!


What happens during a hysterectomy?

During a hysterectomy, all effort will be taken by the surgical team to preserve the abdominal and pelvic floor muscles. However, it is not uncommon for tissue and nerve damage to occur as the muscles are separated and moved out the way of the procedure.

Often a hysterectomy is required as a result of the pelvic floor already being weak or damaged, therefore the surgery may also include a procedure to increase the support of the pelvic floor. However, it is important to note that no surgery can improve the strength of the pelvic floor. Only pelvic floor / Kegel exercises are able to do this.

To reduce the risk of a pelvic organ prolapse occurring, you may also undergo a sacrospinous fixation surgery (sacrocolpopexy). Where the top of the vagina is stitched to the sacrospinous ligament, near the tail bone, for support. A synthetic mesh may be used to provide additional support, however this is currently only recommended within the context of research whilst further studies are completed into the risk of mesh erosion.


What happens to your pelvic floor after a hysterectomy?

When the uterus and cervix are removed, a void is left which the other pelvic organs can droop and prolapse into. If your pelvic floor is damaged or weak as well, then it will be unable to sufficiently support the other pelvic organs and you will likely experience one or more of the pelvic floor disorders listed below. Sadly, these disorders are so common that the improved quality of life expected from the hysterectomy is often not initially realised.

If you undergo an oophorectomy at the same time as your hysterectomy, where your ovaries are also removed, you will also experience a change in hormones and the onset of the menopause (if you haven't already experienced it). The reduction of oestrogen will result in a natural weakening of your pelvic floor muscles, further increasing your risk of developing one of the following pelvic floor disorders:

  • A vaginal/pelvic organ prolapse - There is a 40% chance of developing a vaginal vault prolapse as the uterus is no longer present to support the other pelvic organs.
  • Urinary incontinence - As a result of damage to the bladder or urinary tract during surgery, or the prolapse of the bladder as the uterus is no longer there to support it. There is a higher risk if your surgery was performed vaginally.
  • Frequent urinary tract infections - As a result of damage to the urethra.
  • Faecal incontinence - As a result of damage to the bowel or rectum.
  • Damage to pelvic organs and tissue - As with any pelvic surgery, your surgeon will enter your pelvis through the vagina or abdomen. This allows for a risk of accidental damage to the other pelvic organs and tissue by the instruments.


Recovering from a hysterectomy

As women we can quite often be expected to be everything to everyone, all of the time. If you have a partner, husband, kids – even just a cat! – there can be a never-ending list of tasks that somehow always fall to you. Try not to put too much pressure on yourself; many women feel that they are the only ones who can take care of household duties and get tempted to ignore their doctors instructions and take on too much before they are ready, risking their pelvic floor. Make sure that your partner realises just how serious what you’ve been through is and how important it is that you get proper rest. It’s not the end of the world if your home gets a bit messy, and it will be good for those you care for to learn how to take care of themselves for a change!

If you live alone, see if nearby friends or family can help you to take care of things like cooking and basic cleaning while you are recovering. Consider investing in a ‘grabber’ tool to help you avoid bending over or reaching for things.

What to avoid post-hysterectomy

It is really important that you avoid lifting anything heavier than 2kg for your first six weeks of recovery; consider getting your food shopping delivered. If there’s nobody who can help with cooking and cleaning, prepare basic meals that only require limited time on your feet and only do simple cleaning for the first six weeks – no vacuuming, gardening, or anything else that requires lifting or bending.


What to do after a hysterectomy 

Whether total or partial; abdominal, vaginal or laparoscopic, a hysterectomy is major surgery with major implications. This can be a scary time and you are most likely still in pain and wondering how you will ever get back to your normal life. Consider buying Sue Croft’s book ‘Pelvic Floor Recovery’ – it offers amazing advice that will take you step-by-step from before your surgery to post-recovery. Once you’re past the six week mark, you can start thinking about small changes you can make to your lifestyle to optimise your future pelvic health – here are some of the things you should consider during your recovery.

Exercises to avoid after hysterectomy

It’s important to choose the right kind of post-hysterectomy exercises, to avoid unnecessary stress on your pelvic floor.

  • Avoid high impact exercise: Once you have recovered from the surgery, swap out running for swimming and cross fit for cycling. High impact exercises are those where you land heavily on your feet, shooting pressure up your legs and to your pelvis. Yoga and Pilates are also very good at helping you break a sweat whilst reducing the pressure on your pelvic floor. They can also be modified to balance your weight more evenly.
  • Avoid carrying large weights – When it cannot be avoided, learn how to lift large weights safely; hold the load close to your waist and avoid bending your back.
  • Choose low-impact exercise: Sue Croft recommends low impact exercise like walking, cycling (with a good gel seat!) and swimming. Her book also includes a programme of specially designed, low-impact abdominal exercises that are a great alternative to definite no-no’s like sit ups and planks.

Weight gain

You may find that after your hysterectomy you being to gain weight. If you have had your ovaries removed as well, this may be partially due to hormones, but often it happens because you are unable to move around as much during recovery.

The National Institute for Heath and Care Excellence (NICE) recommend keeping your BMI under 30 to avoid putting excess weight on your pelvic floor – eating a healthy diet with plenty of protein and iron will control your weight and optimise your recovery.

Drinking enough water (around 2 litres a day) and making sure you eat plenty of fibre will also ensure that your bowels are healthy and avoid any risky straining on the toilet.

Coughing, sneezing and straining

If you ever have to cough, sneeze or vomit, try to support yourself with your hand or sit on the edge of something to support your pelvic floor and counteract the downwards forces that occur.

You’ll also want to avoid straining your muscles on the toilet a much as possible. Alongside eating plenty of fibre and drinking water, consider how you sit on the toilet. Did you know that the best position for going to the toilet is to have your knees high in a squat? You can use a toilet stool to get it just right.

Kegel exercises after your hysterectomy

Like any muscle, you need to exercise your pelvic floor to keep it strong. You can start doing your kegels again from about 7-12 weeks post-op (clear this with your doctor first). By doing regular pelvic floor exercises, you can make sure that your internal organs are supported, your bladder and bowel function properly and that you are minimising your risk of having a prolapse – all extra important if you have had a hysterectomy.


When to start using a pelvic toner after your hysterectomy

In the first 12 weeks after your surgery, you should perform pelvic floor exercises, but as the body is healing and sensations can be altered, it is not advised to use a muscle STIM device. Instead, perform your Kegels independently. However, after 12 weeks post-op, it is safe to use the Kegel8® Ultra 20 and follow the simple 12-week plan, which promises more effective pelvic floor exercise. The Kegel8 Ultra 20 V2 Electronic Pelvic Toner removes the guesswork and essentially acts as a Sat-Nav for your pelvic floor muscles, correctly targeting and stimulating a contraction within them using a small electric current. These contractions build strength and tone in a matter of weeks! With 20 clinically proven pelvic floor exercise programmes which vary in frequency, intensity and duration, the Ultra 20 is proven to treat a variety of different conditions and has been shown to be effective for rehabilitation post-surgery. And, in addition to tailored programmes, the specific 12-week exercise plans created by Amanda Savage advise exactly how the device should be used, depending upon the user’s specific requirements/condition, to ensure the very best treatment.

You’ll find an easy 12-week exercise plan created by Amanda Savage to aid pelvic floor rehabilitation post gynaecological surgery included with your Kegel8 Ultra 20. It utilises a unique combination of programmes to help the healing process by improving blood circulation to the area, reducing swelling, and strengthening your muscles so they can support you. It subsequently builds up good muscle strength and endurance again, which is needed for secure bladder and bowel control, and it will calm the ‘jumpy’ nerves responsible for a sensitive bladder. This plan will also improve the muscle tone which we need to prevent pelvic organ prolapse, to feel supported.


Tips For A Perfect Pelvis

“For some women, it is like walking a tight rope – balancing between tightening their muscles enough for better bladder, bowel and pelvic floor control and not excessively tightening them which would potentially cause a spiral into chronic pain.”
- Sue Croft, Author & Physiotherapist

In her excellent book, ‘Pelvic Floor Recovery’, renowned physiotherapist Sue Croft emphasises how important it is that you pay attention to your pelvic health not just when you are in recovery, but for the rest of your life. Here are her top tips for optimising your kegel regime to strengthen your pelvic floor after a hysterectomy.

  1. Stand, sit or lie down with a normal curve in your back. Close off and draw up around the urethra, vagina and anus. Hold for 10 seconds, then release. Build up slowly to repeat this action 5 to 10 times, 3 sessions each day. Note that lying down makes this movement easier as you don't have gravity to pull against so lying could be a good place to start; but be sure to challenge yourself as your muscle strength improves and progress to sitting and standing exercise.
  2. Don’t strain – even if all you are able to do is a gentle contraction, this is a great start. Trying too hard to contract your muscles could put too much stress on them and cause damage. The Kegel8 Biofeedback Pelvic Trainer can help with this as it gives you constructive feedback on how hard you are squeezing.
  3. Don’t tense your inner thigh muscles or buttocks, and don’t bear down as this will strain your pelvic floor. Sue suggests that if you’re unsure of whether you are doing kegels correctly, a good option is electrical stimulation - such as that offered by the Kegel8.
  4. If your pelvic floor is particularly weak (which it may well be after hysterectomy) you might struggle to do many kegels at first. Don’t be discouraged! As with any exercise programme, it will take time to build up strength in your muscles. Just take things at your own pace and you will begin to see results.