How Pelvic Floor Therapy Can Help Before and After a Hysterectomy
By Alicia Jeffrey-Thomas, PT, PRPC
Introduction
Hysterectomies are among the most common surgical procedures performed on women in the United States. While physical therapy is often incorporated into the preparation and recovery process for orthopedic surgeries, pelvic surgeries do not always receive the same access to supportive care. At Wellest, we believe pelvic floor therapy can play an important role in both preparing for a hysterectomy and supporting recovery afterward.
If you have a hysterectomy scheduled or if your doctor has discussed it as a potential treatment option, continue reading to learn more about how pelvic floor therapy can support you before and after surgery.
Overview of Hysterectomies
A hysterectomy is the removal of the uterus. There are various types of hysterectomies based on which structures are removed or kept. Below are the different types of hysterectomies:
Total hysterectomy: Removal of the uterus and cervix. The ovaries are kept, so premenopausal or perimenopausal women would not go into menopause immediately after a total hysterectomy.
Supracervical hysterectomy: Removal of the uterus without removing the cervix.
Total hysterectomy with bilateral salpingo-oophorectomy: Removal of the uterus, cervix, fallopian tubes (salpingectomy), and ovaries (oophorectomy). If not started already, this surgery would cause menopause to begin immediately.
Radical hysterectomy with bilateral salpingo-oophorectomy: Removal of the uterus, cervix, fallopian tubes, ovaries, the upper portion of the vagina, and some lymph nodes. This surgery is performed when cancer is involved.
The type of hysterectomy recommended will depend on the reason for surgery and will be determined in collaboration with you and your doctor. There are several reasons why someone may undergo a hysterectomy, including:
Abnormal/excessive uterine bleeding
Severe pelvic pain
Endometriosis/adenomyosis
Uterine fibroids
Uterine prolapse
Cervical, uterine, or ovarian cancer
Complications from childbirth
Preparing for a Hysterectomy with Pelvic Floor Therapy
A hysterectomy is a major surgery. As with any surgery, the surrounding nerves, muscles, and connective tissue can be affected by the procedure. In this case, that includes the pelvic floor muscles.
The pelvic floor muscles are located at the base of the pelvis and play an important role in many functions throughout the body. They help support the pelvic organs, stabilize the pelvis, and contribute to bladder, bowel, and sexual function. Pelvic floor therapy prior to a hysterectomy provides an opportunity to assess these muscles and identify any areas of tension, weakness, or impaired coordination that may benefit from treatment before surgery.
Because a hysterectomy involves the removal of at least one pelvic organ, the procedure can impact how the pelvic floor muscles function and coordinate with the surrounding tissues. Optimizing pelvic floor function before surgery can help provide a strong foundation for retraining the muscles and supporting recovery after the procedure.
During an initial assessment with a pelvic floor therapist, you will be asked about your medical history and any concerns related to pelvic floor function. Your therapist may then assess your posture, mobility, and strength. If you are comfortable, they may also assess your pelvic floor, which can include an internal exam with your consent. This allows the therapist to better understand how your muscles are currently functioning. Based on their findings, your therapist will develop a personalized plan of care to help prepare you for your upcoming surgery.
Recovering from a Hysterectomy with Pelvic Floor Therapy
As mentioned above, a hysterectomy can affect the function of the pelvic floor muscles, as well as the nerves that travel through and around the pelvis and lower back. Following surgery, you may experience one or more of the following symptoms:
Abdominal, pelvic, and/or vaginal pain
Bloating, gas, and constipation
Bladder urgency
Urinary incontinence
Painful sex
Pelvic/vaginal heaviness
Pelvic floor therapy can help relieve and manage these symptoms. Your surgeon will provide guidance on when it is appropriate to begin therapy following your surgery. At Wellest, we typically see patients between 4-6 weeks after their surgery date.
Pelvic floor therapy typically involves a combination of manual therapy, neuromuscular re-training of the pelvic floor, and guidance on safely returning to exercise or other activities. Everyone’s recovery following surgery is unique, so therapy is tailored to each individual to address their specific symptoms, needs, and goals.
Returning to the Activities You Love
Returning to all of your previous activities after a hysterectomy is absolutely possible. Pelvic floor therapy can help you return to the activities you enjoy comfortably, confidently, and safely.
Every person’s recovery is different, and knowing what to expect can make the process feel less overwhelming. With the right support, you can work toward feeling more comfortable in your body and rebuilding confidence in your movement.
If you’re preparing for a hysterectomy or navigating recovery afterward, pelvic floor therapy may be an important part of your care. At Wellest, we’re here to help you understand your options, address your concerns, and create a personalized plan to support your recovery. Reach out to our team to learn more about how pelvic floor therapy can support you before or after hysterectomy.
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