A hysterectomy is a surgical procedure involving the removal of the uterus, often performed to treat conditions like fibroids, endometriosis, or certain cancers. The recovery period allows the body to heal from this major operation. Pelvic floor exercises, known as Kegels, involve contracting and relaxing the muscles that support the bladder, bowel, and vagina. These exercises are an important part of post-surgical rehabilitation, aimed at strengthening the pelvic floor muscles to enhance bladder control and support pelvic organs.
Pelvic Floor Changes After Hysterectomy
The uterus normally serves as a central support structure within the pelvis, helping to anchor surrounding organs like the bladder and intestines. Its removal alters the structural dynamics of the pelvic region. This change in pelvic architecture can cause remaining organs to shift slightly, filling the space where the uterus once resided.
This adjustment increases the need for robust support from the pelvic floor muscles. The physical trauma of the surgery, including tissue manipulation and potential nerve or muscle damage, can temporarily weaken the pelvic floor. Strengthening these muscles mitigates the risk of developing issues like urinary incontinence or pelvic organ prolapse in the long term.
The Initial Recovery Phase and Restrictions
The initial weeks following a hysterectomy are dedicated to internal and external wound healing. Regardless of the surgical approach, there is a significant area of internal healing, particularly at the vaginal cuff where the top of the vagina is sutured closed. This internal site is vulnerable during the early recovery period.
Any form of strenuous activity, including forceful Kegel exercises, is strictly prohibited to prevent undue stress on the internal stitches. Premature straining or heavy exertion risks complications such as delayed healing, hemorrhage, or the breakdown of the vaginal cuff. The focus during this phase is on rest and avoiding any activity that increases pressure within the abdomen or pelvis. This waiting period provides the tissues time to regain strength.
When It Is Safe to Start Kegel Exercises
You can begin Kegel exercises only after receiving explicit clearance from your surgeon or primary care physician. The standard timeline for this milestone is typically around six to eight weeks post-surgery. This period allows sufficient time for the internal surgical site to achieve a baseline level of healing and stability.
A post-operative checkup is required, where the physician assesses the healing progress, which often includes an internal examination to ensure the vaginal cuff is fully healed. Starting Kegels before medical clearance could compromise the healing process. In some cases, a woman may be referred to a specialized pelvic floor physical therapist, especially if she had pre-existing issues or difficulty identifying the correct muscles. The goal is to ensure the body is structurally ready.
Proper Technique for Post-Surgical Kegels
Once medical clearance is secured, the approach to performing Kegel exercises must be gentle and progressive to protect healing tissues. Begin by finding the correct muscles, which involves gently contracting the muscles used to stop the flow of urine or hold back gas. The contraction should feel like a “squeeze and lift” sensation inside the pelvis.
Avoid straining the abdominal, thigh, or buttock muscles during the exercise. Breathe normally and do not hold your breath, as this increases downward pressure on the pelvic floor. Start with short holds, squeezing the muscles for a few seconds, then completely relaxing for the same duration. Progress gradually to longer holds, but stop immediately and consult a physician if any pain or discomfort is felt.