Hysterectomy

How can my Pelvic Health Physio support my pre and post hysterectomy recovery?

Making the decision to have a hysterectomy can be both an emotional and physical experience. You may have come to this decision quickly depending on results of tests or more gradually and finally decided that this is the option that is best for you and your body moving forward.

Reasons you may have a Hysterectomy

When we look at the statistics around why women have hysterectomy, the most common reason with be for endomestriosis, removal of a fibroid uterus or painfulr/ heavy periods. If you have a uterine prolapse or you having a repair for a bladder prolapse you may be offered hysterectomy as an option that may only com up during surgery. Ten percent of women witll have a hysterectomy for cancer of the cervix or uterus.

Methods of Surgery:

Total Hysterectomy which involves removal of the uterus and cervix +/- bilateral salpingo-oophrectomy which is removal of the ovaries, a Supracervical hysterectomy which involves removing the uterus but leaving the cervix or finally a Radical hysterectomy where they remove the uterus, cervix, top of the vagina, ovaries, fallopian tubes, lymph nodes and tissue surrounding the cervix.

Emotional Impact of Hysterectomy

Many women attending me have had years of heavy bleeding through perimenopause, possibly painful periods all of their life and others make decisions based on the mood changes that a monthly menstrual cycle has imposed on them for many years is just not feasible any longer. Either way, whatever way you have arrived at this juncture in your female life, I know it can bring with it a myriad of feelings of worry, apprehension, anxiety aswell as feelings of relief and satisfaction. The role of the Pelvic Health Physiotherapist is to support you through this physical and of course naturally, the mental and emotional changes.

Prehabilitation;

In the months leading up to a hysterectomy it can be a good idea to make a booking to get pelvic floor muscles assessed to assess your baseline core strength and fitness. We know that the stronger you are going into surgery the better chance you have of reducing symptoms afterwards. Surgical intervention, be it a vaginal or laparoscopic hysterectomy, may cause adaptive reactivity in your pelvic floor and sometimes women will have a prolapse repair and hysterectomy together which affect the landscape further. It is our goal to bring back your overall function after hysterectomy making sure you don’t have incontinence by working on lift and release of the pelvic floor, increasing abdominal strength afterwards and optimising mobility while guiding back to where you want to be in terms of exercise.

Post-operative Rehabilitation

0-6 weeks

Rest and good food in the early stages post surgery. For tips on how to reduce discomfort and learn how to slowly move in and out of bed click here.

• Soothe pain with ice. Ice packs or frozen vegetables are essential in keeping swelling at a minimum, and calming pain. Every couple of hours, consider icing over your abdominal incision(s) for about 10 minutes. Make sure there is a towel, layer of clothes, or a pillowcase under the ice pack so that it is not in direct contact with your skin.

• Check your scar daily. Always keep your incision clean and dry and look for changes in your scar such as increased redness, heat, swelling, or bleeding from your incisions — these would be reasons to check back in with your healthcare provider.

• Have a small rectangular cushion to hold across the abdomen to reduce pressure on the scarlines and pelvic floor if you have to cough and when moving this can be helpful to make you feel more comfortable.

• Get high-waisted. Gently compressive, high-waisted undergarments can support wound healing, and improve your comfort as you heal. Choose fabric that is breathable so sweat doesn't create moisture in the area.

• Start moving. If your doctor says it’s safe, you can begin on the day of surgery. Movement will help with blood circulation, swelling, and to get your bowels moving better to help you relieve gas. Walking around the hospital is such a great way to start, or around your living room and kitchen if you are home. Walk slowly at first, focusing on upright posture, and increase your speed as you feel comfortable.

• Drink peppermint or ginger tea to alleviate bloating/ gas after the surgery which can lead to shoulder pain.

• Breathe, breathe, breathe: wide 360 degree umbrella breathing into the lower ribcage , 10 breaths every hour

• Ankle pumps in sitting and standing for circulation

  Walking Programme after Surgery:

  Please refer to this really nice guideline and this video on you tube for how to return to early exercise.

  For more individualised advice and free download pop over to my instagram page and make sure to make an in person appointment here for a prehab and postoperative assessment.