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Caring for Your Pelvic Floor after a Hysterectomy

While it is true that women undergo a hysterectomy for a variety of reasons, including severe cases of pelvic organ prolapse (POP) also known as genitourinary prolapse—it is also true that having a hysterectomy can contribute to the development of prolapse. More than 10 percent of women who have a hysterectomy experience varying degrees of prolapse symptoms.

Removing the uterus can affect the surrounding tissues and organs, which all work together to maintain proper placement in the pelvis. Prolapse occurs when the pelvic organs are not adequately supported by the pelvic floor and shift downward, out of position.

If prolapse symptoms are mild, women may not require treatment. Women with severe symptoms of prolapse may experience pain or pressure in the abdomen or low back, incontinence or constipation, pain during sex, the inability to insert or keep a tampon in place, or the presence of prolapsed pelvic organs protruding into the vagina. These symptoms often require surgery.

Vaginal Vault Prolapse

The pelvic organs and tissues are linked by connective, supportive tissues that attach them to the pelvic bone structure. When a hysterectomy is performed and the uterus is removed, this structure becomes vulnerable, as weakening support tissues pull away and other pelvic organs, like the bladder, cervix or rectum, start to collapse into the vagina.

Women who have had a hysterectomy are prone to a specific type of prolapse known as vaginal vault prolapse, which refers to the top portion of the vagina (vaginal vault) collapsing into itself. When vaginal vault prolapse is severe, the vagina begins to turn itself inside out, something that is both palpable and visible for women.

Surgery can repair the pelvic floor and ease the symptoms of prolapse. A device called transvaginal mesh has been used in many pelvic floor repairs. Unfortunately, it has been linked to painful complications like mesh erosion, organ perforation and sexual dysfunction that can require multiple revision surgeries to correct.

The Food and Drug Administration (FDA) has stated that procedures that do not use mesh can be equally effective in repairing the pelvic floor and reducing prolapse symptoms. All surgery has risks, and women should discuss the safest surgical options with their doctor.

Non-Surgical Treatments

After a hysterectomy, women may wish to consult a physiotherapist who specialises in pelvic health. Physiotherapists use techniques like biofeedback therapy to help women isolate the pelvic floor muscles and learn how to properly strengthen them.

Physiotherapists may also use pelvic massage, manual stimulation and special weights. Most will suggest that women begin a daily routine of Kegel exercises. These contractions of the pelvic floor muscles together and upward are one of the most effective ways to strengthen the pelvic floor.

High-impact activities can further weaken the pelvic floor, but exercise is important. Women should consider exercises like yoga or Pilates, which strengthen the pelvic floor, build core strength and correct posture.

After a hysterectomy, women should do their best to avoid excessive coughing, heavy lifting or frequently straining to produce a bowel movement, as these can weaken the pelvic floor. Being overweight or obese increases pressure on the pelvic floor, so women should take steps to manage body weight.

Doctors may suggest the use of a vaginal pessary. A pessary is a small device fitted and inserted by a doctor to act as support for the vaginal vault and pelvic floor.

Linda Grayling is a content writer for Drugwatch.com. She educates the public about dangerous prescription drugs and defective medical devices.

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Linda Parkinson-Hardman

Transformational coach and founder of the Hysterectomy Association. Professionally I'm an information scientist who specialises in the adoption and engagement of digital technologies. I am a writer and author of nine books to date, and I've edited a further seven; phew what a lot for a Thursday afternoon :-)

This Post Has 25 Comments
  1. I’m 2 weeks post vaginal hysterectomy with a fixation and have the same feeling. Like a dull ache more than pain on my left lower abdomen but it makes me feel a bit sick and have no appetite. I too am wondering whether I have been stood up too long or damaged myself somehow. I though I had been taking it easy but now I’m not too sure. Toileting seems to be getting harder too. Never feel like my bladder completely empties and it’s a struggle to get the stream started!
    Ive been doing pelvic floor exercises in an attemt to tighten things up yp there! Any advise would be greatly received.

  2. Hey Julie,
    I just had the exact procedure you did, I am also 4 weeks post. Starting today I am having same symptoms you describe, not sure if I over did it? What did you find out? Is it better?
    I’m feeling very anxious and worried about it.

  3. I am 4 weeks post op vaginal hysterectomy and pelvic floor repair. I am slowly improving but since the surgery I have experienced pain in my lower stomach bladder area when I sit and stand taking pressure off. I still have this and it doesn’t seem to be getting any better is this normal? This is making me get quite down as I wasn’t in pain before I had the surgery and I am scared I may have to put up with this pain.

  4. I am 3 weeks post op vaginal hysterectomy and bladder, bowel pelvic floor repair. I feel ok in my self but am still having pain in my bladder area, is this normal?

  5. I had a complete hysterectomy 2007, I had an 8pound tumor and two small ones. I had cysts on my ovaries and cervix. But lately I notice that when I try to urinate it seems difficult. I have to sit as straight as I possibly can when doing that. I do however feel a lump on the inside, last night I was woken with severe pain in my vaginal wall closer to the exit. Also, I have noticed an odor when I pee. Is it to late for exercise?

  6. There are several ways to do and perhaps the most common might be a vaginal ring of some description. You’d need to see your GP though to find out if that’s suitable for you.

  7. I had hysterectomy 19 years ago. About a year and a half ago I experienced beginning of vaginal prolapse, though I noticed it coming time before that (and did not see my physician then). When I did see my gynecologist she said it would take major surgery to repair it; I tried to live with it since but it gets progressively worse – does not retract completely even over night. I do yoga and did Pilates, am healthy 71 years old, married. Sex is out of question now because of my condition, so my question is: is there a relatively simple way to hold this prolapse back? Thank you.

  8. It is very common and for the vast majority of women it does clear, but it can take weeks or months rather than days. If it doesn’t get any better then you will need to see your GP about pain management.

  9. I am 18 days post-op. I had a total hysterectomy which also included taking my appendix, 8 lymph nodes, and some of my omentum. Three days after the surgery I had numbness in my thighs, which I was told was very normal, after I freaked out about it because no one warned me it could happen. The following day I had sever burning in my thighs around the numbness and pelvis area. I again was told this is very common and it is good because it means my nerves are healing. I was also told this could be a permanent side effect. Are they serious, this could be permanent?
    If this is so common how come I’m not finding any information on on it and ways to help relieve some of the pain? Thank goodness it is summer and I can wear sundresses because I can’t wear pants or panties, they rub on my legs and pelvic bone and it becomes unbearable. Here are things we have done and tried: chiropractor, numbing cream, massaging, ice, and heat. These give some relief but it is still there and it is painful. Is there something else we haven’t tried that could help?

  10. You need to see your GP to get a diagnosis for what the problem might be.

  11. I am 5 weeks post abdominal hysterectomy – everything removed. I have ride sided pain in lower back, buttock, around my hip and right side of my scar. I have a small hematoma on my abdomen on the right side. What is causing the pain? It is exhausting me. I have been using Bio Oil to rub in circular motions on the scar as directed by my consultant. What else can I do to help….?

  12. I had an abdominal hysterectomy and bi-lateral salpingo oophorectomy nearly two years ago. Physically I made a very swift recovery. I was put on HRT after my surgery but following a DVT scare nine months later, my gynaecologist advised me never to take HRT again and instead to take alternative forms of HRT like red clover. Although I am slim and reasonably active, I have been rather lax about my pelvic floor excercises. Strangely I find it easier to hop onto a treadmill than sit there holding in my abdominal muscles. Having read the comments above, I am now worried whether I may have damaged my pelvic floor by not doing the excercises and whether I can still redeem myself! How frequently do I need to do these and is this for life? How will I know if I have caused my pelvic floor harm by not doing my excercises?

  13. I had a bladder lift 7/2011 because of incontinence. A hysterectomy – all female reproductive organs removed 12/2013 because of pain caused by severe ‘wall to wall’ endometriosis and pelvic congestion syndrome. Started taking estrogen before I left the operating room. I have never felt this good. Pain free all day long and during intercourse. My memory works again and my mood is stable. About 6 months ago I started to notice pressure in my vaginal area and can feel something pushing out on the bottom side, towards rectum. This doesn’t cause pain. Is this something that should be examined by physician?

  14. Hi Stacey. You are going to have a lot of internal bruising following surgery and also with your other problems and this may account for some of the pain. However, you might also have a minor infection still and it would be worth getting it all checked out with your GP too.

  15. Hi i had a hysterectomy 6 weeks ago and it hurts on my scare when i wee is this normal? Also when will i feel back to my normal self? I am 27 years old. And had the surgery as i was bleeding all the time and in alot of pain. Also 14 days after my op i had to have a 7cm by 2cm clot removed from my volt. I also had a blood tranfusion. Since then i am not able to do a big wee and if i do it hurts alot.

  16. I am having an abdominal hysterectomy for a fibroid the size of a 20 week pregnancy. I have a choice to keep my Fallopian tubes and ovaries, what should I consider and why when making my choice to remove then or not? I am 50
    Gilly

  17. I had a radical hysterectomy with bilateral opherectomy 6 months ago for precancerous situation. (Hope I got that right) . Anyway sex has been painful for 3 months ish but strangely not before then. I presumed that maybe everything was numb initially hence not feeling any discomfort. I went for my 6 month smear test and nearly jumped off the couch in pain and the doctor said I have a lump on the scar. Another doctor had a look and they both said whatever it is it needs to come out. So a hospital referral has been done. I don’t for a second believe this is sinister because all was precancerous and my surgeon took everything that looked even remotely suspicious. My question is, what could this possibly be?
    Thank you for your time. X

  18. I had a hysterectomy for a prolapsed womb 18 months ago as well as a cystocele repair for a prolapse front vaginal wall. Only a few weeks after this surgery the back vaginal wall prolapsed and I had to have another major operation to repair this. It was not severe at the time of the hysterectomy but this surgery caused it to worsen. I was badly damaged after 2 ventouse deliveries and an 8lb baby. The retrocele surgery was excrutiatingly painful and even now a year later sex is still painful, apparently it can take upto 18 months for this pain to go away. Psychologically it has been the hardest thing to deal with and the affects on my sex life at times devastating. I had no choice but to have this surgery but nobody warned me just how awful it would be. I kept my ovaries but they failed within months of the surgery and HRT has not been straightforward causing breast pain and high blood pressure. I also completely lost my sex drive which was very upsetting and this was due to non existent testosterone levels. Treatment for this is not licensed on the NHS and I still see my lovely private consultant who also did both of my operations. It has been a very tough journey and I have had many low times but slowly I am getting there.

  19. It isn’t a given by any means Deborah and prolapse can occur for many reasons, having a hysterectomy may just be one. However strong pelvic muscles will help to prevent this from happening.

  20. I have just read your article on caring for your pelvic floor after a hysterectomy and am quite shocked at what i have read. I was operated on in 2010 as I had both a vaginal and rectal prolapse but no problems with my womb. My womb was so highly positioned that at one point a doctor asked me if i had already had a hysterectomy! However I was given a hysterectomy at the same time as the the prolapses were seen to as the consultant informed me that as i had had prolapses the womb was also likely to prolapse at some time in the future. There was nothing to indicate that this was or would happen as i had no problems with my womb but this was decided so that i did not have to undergo surgery again at a later stage. However reading your article you suggest that there is a chance that I will prolapse due to the womb being removed – horror!!! Why don’t they tell you this? I did not enter into my surgery willingly and had discussed my reasons for not wanting an uneccessary hysterectomy but was still informed that this would be best for the future!!

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