Pelvic Floor Physical Therapy plays a crucial role in an individual's healing journey following a hysterectomy to rebuild strength, provide assistance in safely returning to activity/exercise, and eliminate discomfort or pain.

First, let’s cover what a hysterectomy is:
A hysterectomy is a surgical procedure that involves the removal of one’s uterus. There are different types of hysterectomies that vary depending on the extent of what is removed along with the uterus. 

So, what does that have to do with the pelvic floor?
One of the functions of the pelvic floor muscles is to support the uterus, bladder, and rectum. Therefore, it makes sense to consider what would happen to those muscles (along with the cervix, ovaries, vagina, etc.) after the removal of the uterus. Where those muscles once supported an organ and other structures, they now, well, don’t. With the absence of the uterus, the dynamics of that pelvic space can then shift. This can result in things like urinary incontinence, bowel symptoms or pelvic organ prolapse. Pelvic Floor PT can help in rehabbing those muscles that now have to adapt to a space that no longer supports the uterus.

Management of scar tissue post operatively is also something to consider. Scar tissue forms after a surgery, and with it can develop symptoms of pain, tightness, or limitations in movements and/or function of the muscles. Pelvic Floor PT will help to reduce adhesions of this scar tissue, improve blood flow to the pelvic space, and improve overall flexibility of the tissues.

Bowel and Bladder function can be impacted following a hysterectomy. Again, with the removal of the uterus, the bowel and bladder now are occupying a space without it. This can result in symptoms like urinary incontinence or constipation. Pelvic Floor PT with help to identify the source of these symptoms so that appropriate treatment can be provided to reduce tension, strengthen or coordinate the pelvic floor muscles.

Optimizing recovery involves increasing circulation and reducing swelling in the pelvic region to enhance tissue healing. 

Also, a pelvic floor PT will help in assessing posture, abdominal strength, hip mobility, muscle imbalances, and breathing techniques/pressure management, as all of these things can affect the pelvic floor.

We typically recommend beginning pelvic floor PT 6-8 weeks following a hysterectomy. Whether your surgery was recent or years prior, pelvic floor PT will provide you the support to meet your goals!

Oliver is almost one month old! That is crazy to even think about. 

I am happy to report that I am feeling great physically! My stitches have all healed (and there were many of them) and I do not have any of the signs or symptoms that would warrant me to be extra careful. This doesn’t mean I can start back at Orange Theory Fitness, but it does mean I can get an exam from a pelvic health physical therapist and start increasing my exercises. I have started walking quicker (19 min mile pace instead of 30 min mile pace) and I have added core exercises in. These are very low impact core stability exercises that focus only on the “true core” which included transverse abdominis (TrA), pelvic floor, diaphragm, and multifidus (low back muscle). I will post a video of the exercises below. In the video I am doing 3 exercises, the first exercise is focusing on the TrA. I am engaging this muscle as I lift my foot off the couch about an inch. My goal is to see if I can limit the amount of him drop on the side I am lifting my leg. (DO NOT HOLD YOUR BREATH). The second exercise I am letting my leg gently fall to the side and using my TrA to bring my leg back to neutral. The third exercise, I am engaging my TrA as I let my leg go out straight. These 3 exercises look very simple, but I am still sore from doing them! As you can see I am always breathing and not "sucking in". 

So, when can you get evaluated by a pelvic health physical therapist? What the heck is pelvic health physical therapy? And what do they look for? 

What is pelvic health physical therapy? 

Pelvic health is a sub-specialty of physical therapy. Pelvic health therapists are trained beyond the scope of PT to do internal pelvic floor examinations to asses for anything pelvic health related. Reasons for seeing out a pelvic PT could include anything from pelvic pain, leakage, lack of pelvic floor control, prenatal, postpartum, diastasis recti, post surgical. 

When can an evaluation be done? 

Honestly, the rule of thumb is 6 weeks for vaginal delivery and 8-12 weeks for C-sections. But, like many things in our healthcare system..we do them to “save our butts”. We could be evaluating sooner so that individuals have “tools in their toolbox” to help them immediately. If you had any stitches, tearing, repairs done then it is best to hold off on an internal evaluation until after they have healed. However, a pelvic health PT can help educate you on ways to help your body recover immediately. 

Signs/symptoms to look out for post-partum:

-core weakness
-instability in the pelvic region
-pelvic pain
-urinary issues (leakage, pain, frequency)
-bowel issues (leakage, pain, constipation)
-pelvic pressure
-low back pain
-hip pain
-pubic bone pain
-separation of the abdominals
-postural difficulty

What is a pelvic health exam? 

I get this question a lot! In simple terms, it is just like a musculoskeletal exam of any other body part. It just seems scary because it includes an examination of your vaginal and/or rectal musculature. This is not scary. Ask anyone who has had a pelvic health exam and they will tell you that their provider made it very comfortable and not painful/scary. During the exam your PT will examine everything from posture, breathing, strength, soft tissue, walking, and basic functional movements. They will then discuss the findings with you and go over proper body mechanics, give you a home program to begin working on, and will answer ALL questions related to pelvic health, exercise, and daily tasks. We have heard it all, so ask anything! 

Please, comment below with questions regarding pelvic health physical therapy. And, if you have had pelvic health PT in the past, I encourage you to pass along your experience and open up about how it helped you. Many people are fearful of saying they had pain with sex postpartum, that they leaked urine every time they walked up the stairs, or that they felt a water balloon exiting their vagina….these are all things that so many women suffer with and although they are all common symptoms, they ARE NOT NORMAL. There is help out there. You can look on the APTA (American physical therapy association) website and go to the women’s health section and search their area. You can also go to google and type in pelvic health/women’s health physical therapy to find therapists in their area.