Hysterectomies happen. Whether for fibroids or cancer or other concerns, about a third of American women will have a hysterectomy by age 60.
A hysterectomy for any reason is serious surgery, but according to our Doctors of Physical Therapy, many women don’t allow themselves enough time for full recovery.
Of course, not every woman has the ability to take the time to fully recover – and even if we’re able to take time off work, just performing the functions of daily life can impact recovery.
According to Meagan and Bri, the time to start thinking about recovery is before your surgery. In the weeks prior, get a recommendation from your surgeon to see a physical therapist.
“I tell patients that they’re going to be really restricted in their mobility and activity for at least a couple of weeks after surgery,” says Meagan. “But a PT can help you learn how to get up out of bed or out of a chair properly so you don’t put pressure on the incision. We can teach you diaphragmatic breathing, which is really good for healing.”
“When someone is scheduled for knee or hip replacement, they’ll often be sent to a PT first, to learn what to do and what not to do after surgery,” says Bri. “This should be the same — learn how to do all your daily activities that you have to do, so you don’t make your recovery period longer, or worse, injure yourself.”
Also, do what you need to do to be sure your bowels are working properly: add fiber to your diet, hydrate better. Get your body into a nice, natural rhythm of elimination. And stock up on stool softeners, as pain meds and anesthesia can both be hard on the digestion.
Finally, engage your support network. Have friends and family on call to help with things, even small things like cooking or feeding the dog. As Bri says, we often don’t want to advertise that we’ve had a hysterectomy because we’re embarrassed or want to protect our privacy. That’s fine, just be sure you have the help you need.
Use what your PTs taught you! When you get out of bed, “use the old-fashioned log roll method,” Bri says. “Don’t just pop up, putting pressure on an area that’s just started healing.”
“When you see your PT before surgery, learn about the pelvic brace breathing. You use your breath to gently contract the pelvic floor, and you engage the abdominal muscles. This way, when you move, you’re not generating too much inter-abdominal pressure, which can compromise the surgery, scar tissue and sutures,” Meagan says.
Bri agrees, adding: “Usually we only see people a few weeks after surgery when they’ve been doing things incorrectly for a while. Then it may be too late to avoid injury or pain, and we have to pay catch-up. It’s so much better if we can educate them when they’re not already in pain or on medication.”
Use ice and heat as part of your pain management. These are effective ways to help with pain without adding to constipation issues. “Don’t be afraid to put it on the incision and sore spots, just be sure it’s well wrapped and the skin is protected,” Meagan advised. “It’s a conservative, easy healing method. It promotes vascular dilation and contraction to keep blood and oxygen moving into the area, and ice can reduce pain and inflammation.”
Be cautious and mindful of your healing body’s limitations. “Respect the lifting restriction,” says Meagan. “Lots of women lift heavy things too soon, which can really compromise healing.
When your body is recovering, it’s creating scar tissue. You have these windows of vulnerability as far as 8 to 12 weeks out when the body is still trying to integrate this new, healed area into the existing system of connective tissue. You might feel better, the swelling is down, your energy is coming back — but that’s not a green light to jump back into activity because the tissue is still quite vulnerable.”
Also, Meagan adds, really be conscious of hydrating. Your insides are different, she says: “The uterus is a sort of keystone between the bladder and rectum, and yes, things are tethered into place, but the space has changed. Keep the bladder and kidneys flushing and healthy as things settle. Also, drinking more helps expedite elimination of some of the anesthesia. Keep the system pumping. Have good bladder habits right away and it should help with bowel health too.”
Practice that diaphragmatic breathing your pre-surgery PT taught you. As Meagan says, “Learn this kind of breathing, because it’s really effective for healing. Allowing the abdomen to expand when breathing rather than gripping through the midsection will help create scar tissue that’s more elastic, rather than tight and cinched down. Also it promotes better healing because the diaphragm works to pump the lymphatic system, flushing out cellular gunk. It helps promote better bowel function because it produces a sort of massaging action on the diaphragm. Start Day 1.”
Think about your clothing, says Bri. “Don’t focus on wearing regular clothes that may put pressure on incisions and tender areas. Consider loose, soft things like sweat pants for a little while to prevent irritation.”
Also, get up, say our DPTs. Don’t hunker into your recliner for 4 weeks. Move gently, at least once an hour, even if you’re only walking to the bathroom or to get more water. “Don’t lift more than the weight of a gallon of milk for a while,” says our Wisconsin gal Meagan.
“You’ll need to be thoughtful about bending, twisting, lifting activities, probably for the rest of your life,” says Meagan. “It sounds like a burden, but really, we all should be conscious of that, hysterectomy or not, male and female! It’s just better for our bodies to pay attention to how we move.”
When you bend, like to put on socks and shoes, don’t hold your breath. We do this without thinking about it because it’s harder to breathe when we’re creased in the middle. But think about a can of soda: if you bend it in the middle without opening the top, what happens? Often the liquid pops out the bottom because of the pressure. So as you fold over to put on shoes, exhale to relieve internal pressure.
Help your long-term healing by helping the scar tissue form properly, Meagan says. This can be hard – touching the incision, even when it no longer hurts, can be a real challenge. But start early by gently touching the bandage. As you heal, you can wash the incision with a warm washcloth. Then you can slowly progress to more intense work: massaging, touching, rubbing, moving. These can help with sensitivity and tenderness now as well as with deeper mobility issues down the road. Again, guidance from a PT can help you do this correctly.
And finally, Bri says, think about your mental health. Whether you chose a hysterectomy or life forced one on you, be cognizant that there may be real impacts on your emotions as well as on your body, Bri says, and consider lining up help for this before surgery, just as you would for the physical challenges.
We’ll talk more about how to re-engage in exercise and more vigorous activity in a future blog, so stay tuned!
Have you had a hysterectomy, or are you preparing for one? Other women would love to learn from your experience, so please feel free to share your story in our community forum.
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