The pelvic floor is a group of muscles and connective tissues that stretch like a hammock across the bottom of the pelvis. These muscles provide support for the organs resting above them, including the bladder, rectum, and, before surgery, the uterus. The pelvic floor’s continuous resting tone keeps organs properly positioned and helps maintain continence by controlling the openings of the urethra and anus. Maintaining the strength of this muscle group prevents issues like urinary leakage and pelvic organ prolapse.
Why Hysterectomy Affects Pelvic Floor Support
A hysterectomy, the surgical removal of the uterus, disrupts the intricate support system of the pelvis. The uterus is suspended by ligaments and fascia intertwined with the pelvic floor muscles. When the uterus is removed, these stabilizing structures are detached or altered, changing the anatomical configuration and reducing supportive tension within the pelvic cavity.
This anatomical shift means remaining organs, such as the bladder and rectum, lose the uterus as a physical anchor. The top of the vagina (vaginal vault) must be reattached to other ligaments, which can leave it less secure. The entire burden of organ support falls more heavily onto the pelvic floor muscles, increasing the risk of pelvic organ prolapse over time. The surgical process itself can also cause temporary nerve or tissue damage, further weakening pelvic floor function.
The Importance of Initial Post-Operative Rest
The initial recovery phase, typically the first four to six weeks following a hysterectomy, is for internal healing, not active strengthening. During this time, the surgical site is mending, and unnecessary strain can impede healing and increase the risk of complications like a surgical hernia. Avoid activities that significantly increase intra-abdominal pressure.
Avoid heavy lifting (over 10 pounds), intense core exercises, and high-impact activities until cleared by the surgeon. Focus on gentle movement, such as short walks to promote circulation and prevent blood clots. Gentle deep breathing exercises, which naturally engage the deep core and pelvic floor muscles, are safe and help coordinate muscle function. Before starting any formal pelvic floor strengthening regimen, receive explicit clearance from your healthcare provider.
Step-by-Step Guide to Pelvic Floor Exercises
Once you have received medical clearance, typically around six weeks post-surgery, you can begin Kegel exercises. First, correctly locate the muscles by imagining you are trying to stop the flow of urine and prevent passing gas. You should feel an internal lifting and squeezing sensation, distinct from the muscles of the abdomen, buttocks, or thighs.
Practice two main types of contractions: long holds for endurance and quick flicks for responsiveness. For long holds, slowly squeeze and lift the muscles, holding the contraction for three to five seconds while breathing normally. Release completely, allowing a relaxation period at least as long as the hold.
For quick flicks, rapidly squeeze the muscles and immediately release them, focusing on the speed and intensity of the contraction. Aim to perform three sets of 10 to 15 repetitions of both types, spread throughout the day. A common mistake is tightening surrounding muscles, which puts downward pressure on the pelvic floor and negates the benefit. Start the exercises lying down to eliminate the effects of gravity, and gradually progress to performing them while sitting or standing.
Long-Term Habits for Maintaining Strength
Long-term pelvic floor health requires incorporating supportive habits into your daily routine to minimize strain. One effective technique is the “knack,” which involves contracting your pelvic floor muscles immediately before and during activities that increase abdominal pressure, such as coughing, sneezing, or lifting. This preemptive squeeze acts as a protective brace against downward force.
Managing chronic straining from constipation is important, as excessive pushing weakens tissues over time. Maintain a balanced diet rich in fiber and ensure adequate daily fluid intake (1.5 to 2 liters) to promote soft, easy-to-pass stools. When emptying your bowels, use a proper toileting posture, such as elevating your knees slightly above your hips, to relax the pelvic floor muscles and straighten the passage.
Consulting a Physical Therapist
For personalized guidance, consulting a specialized pelvic floor physical therapist is beneficial. These professionals use biofeedback technology to confirm correct muscle contraction and tailor an exercise program to your specific needs and long-term goals. They also provide advice on proper body mechanics for lifting and posture.