A total hysterectomy is the irreversible removal of the uterus (womb) and cervix through surgery. It is carried out to treat a variety of female reproductive issues, such as:
- Unbearable pelvic pain
- Otherwise untreatable heavy periods (menorrhagia)
- Fibroids - benign (non-cancerous) tumours
- Gynecologic cancer - of the female reproductive organs including the ovaries, uterus and cervix
- Endometriosis - a painful condition where the tissue that lines the uterus begins to grow on the other reproductive organs
- A complete uterine prolapse - when non-surgical treatments have been unsuccessful
It is a major pelvic operation, performed through the vagina or abdomen (open or minimally invasive robot-assisted/laparoscopic). It is one of the most common gynecological surgeries, and has many similarities to other pelvic operations in terms of its effect on the pelvic floor.
What Happens to Your Pelvic Floor During a Hysterectomy?
During a hysterectomy, all effort will be taken by the surgical team to preserve the abdominal and pelvic floor muscles. However, it is not uncommon for tissue and nerve damage to occur as the muscles are separated and moved out the way of the procedure.
Often a hysterectomy is required as a result of the pelvic floor already being weak or damaged, therefore the surgery may also include a procedure to increase the support of the pelvic floor. However, it is important to note that no surgery can improve the strength of the pelvic floor. Only pelvic floor / Kegel exercises are able to do this.
To reduce the risk of a pelvic organ prolapse occurring, you may also undergo a sacrospinous fixation surgery (sacrocolpopexy). Where the top of the vagina is stitched to the sacrospinous ligament, near the tail bone, for support. A synthetic mesh may be used to provide additional support, however this is currently only recommended within the context of research whilst further studies are completed into the risk of mesh erosion.
What Happens to Your Pelvic Floor After a Hysterectomy?
When the uterus and cervix are removed, a void is left which the other pelvic organs can droop and prolapse into. If your pelvic floor is damaged or weak as well, then it will be unable to sufficiently support the other pelvic organs and you will likely experience one or more of the pelvic floor disorders listed below. Sadly, these disorders are so common that the improved quality of life expected from the hysterectomy is often not initially realised.
If you undergo a oophorectomy at the same time as your hysterectomy, where your ovaries are also removed, you will also experience a change in hormones and the onset of the menopause (if you haven't already experienced it). The reduction of oestrogen will result in a natural weakening of your pelvic floor muscles, further increasing your risk of developing one of the following pelvic floor disorders:
- A vaginal/pelvic organ prolapse - There is a 40% chance of developing a vaginal vault prolapse as the uterus is no longer present to support the other pelvic organs.
- Urinary incontinence - As a result of damage to the bladder or urinary tract during surgery, or the prolapse of the bladder as the uterus is no longer there to support it. There is a higher risk if your surgery was performed vaginally.
- Frequent urinary tract infections - As a result of damage to the urethra.
- Faecal incontinence - As a result of damage to the bowel or rectum.
- Damage to pelvic organs and tissue - As with any pelvic surgery, your surgeon will enter your pelvis through the vagina or abdomen. This allows for a risk of accidental damage to the other pelvic organs and tissue by the instruments.
Can I Reduce My Risk or Reverse the Damage to My Pelvic Floor?
To reduce the risk of experiencing a pelvic floor disorder as a result of undergoing a hysterectomy, you will need to look after your pelvic floor both before and following the procedure. To make your exercises even more efficient you can use an electronic pelvic toner, which has specific programmes to help concentrate on the different issues you may face:
- Exercise your pelvic floor daily - Do your Kegels! Like any muscle you need to keep exercising your pelvic floor to keep it in tip top shape. You may be able to begin your exercises as early as six weeks after your surgery, speak to your doctor if you have any questions.
- Stop smoking and treat chronic coughs - This will reduce the pressure put on your pelvic floor.
- Maintain a healthy weight - The National Institute for Heath and Care Excellence (NICE) recommend keeping your BMI under 30 to avoid putting excess weight on your pelvic floor.
- Avoid high impact exercise - Once you have recovered from the surgery, swap out running for swimming and cross fit for cycling. High impact exercises are those where you land heavily on your feet, shooting pressure up your legs and to your pelvis. Yoga and Pilates are also very good at helping you break a sweat whilst reducing the pressure on your pelvic floor. They can also be modified to balance your weight more evenly.
- Avoid carrying large weights - When it cannot be avoided, learn how to lift large weights safely from the National Health Service (NHS); hold the load close to your waist and avoid bending your back.
- Avoid constipation and straining - Its widely known that eating a high fibre diet keeps you regular. But did you know that the best position for going to the toilet is to have your knees high in a squat? You can use a toilet stool to get it just right.
Watch the video below where renowned Australian Physiotherapist, Michelle Kenway, explains the best pelvic floor exercise routine to do following a hysterectomy:
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