Protecting Pelvic Floor Health After a Hysterectomy

How to Protect Pelvic Floor Health After HysterectomyHaving a hysterectomy can bring great relief for some women or sadness for others. Women who suffer from conditions like endometriosis or uterine fibroids may finally be cured of their pain after a hysterectomy. Others may not see it as such a blessing—women who had a hysterectomy after they received a cancer diagnosis, for example, can feel quite a loss after the surgery, especially those who wanted a child or more children.

It’s true that having a hysterectomy can bring about many physical and emotional changes. Not to panic, however. If you had a hysterectomy or will soon undergo the procedure, know this: While some women do experience significant changes after surgery, such as the sudden onset of menopause, others experience few if any noticeable changes. Counseling, medications, lifestyle changes, and physiotherapy can help women manage any symptoms they experience.

Below, we’ll look at some common issues women experience post-hysterectomy and, importantly, how you can protect your pelvic floor—the hammock-like system of muscles that holds your pelvic organs in place—after surgery.

Hormonal Changes After Hysterectomy

One of the most common aftereffects of a hysterectomy is hormonal changes. The ovaries are the epicenter of estrogen and progesterone production (the adrenal glands also produce these hormones, to a lesser degree), and hysterectomy can reduce the production of these hormones significantly; this can be true even in cases where a woman’s ovaries were not removed.

A hysterectomy that removes the uterus, the fallopian tubes, and the ovaries, for example, will push a woman’s body into menopause immediately, but the removal of the uterus and cervix only (called a total hysterectomy) can also decrease hormone levels and cause some menopausal symptoms.

Reduced hormone levels can lead to changes in mood, vaginal thinning and dryness, and other unpleasant issues. The extent to which a woman will experience these symptoms varies from one person to the next and depends largely on which organs were removed.

Hormone replacement therapy (HRT) can be a tremendous help to women who experience a significant drop in hormones after surgery, helping reduce or eliminate menopausal symptoms, which can include:

  • Mood swings
  • Hot flashes
  • Night sweats
  • Irritability
  • Anxiety
  • Vaginal thinning
  • Vaginal dryness
  • Lower sex drive
  • Headaches

Pelvic Organ Prolapse After Hysterectomy

Pelvic Organ Prolapse After HysterectomyPelvic organ prolapse (which is when an organ in the pelvic region, such as the bladder, slips from its normal position in the pelvis) is a common problem among women, with a prevalence of between 30% and 40%.1

Women are at an increased risk for prolapse after a hysterectomy. A basic understanding of pelvic anatomy helps explain why: The organs inside your pelvis are attached to the pelvic wall by tissues and ligaments. When the cervix and uterus are detached and removed from the vagina during a hysterectomy, for example, the surgeon must then reattach the vagina to ligaments in the pelvis, which can leave it less “secure” and vulnerable to prolapse.

Additionally, the newly “vacant space” in the pelvis (where organs used to be) can leave remaining organs, like the bladder and rectum, more vulnerable to slipping out of place. Several types of prolapse can occur after a hysterectomy, including:

  • Vaginal vault prolapse, which occurs when the top section of the vagina collapses into the bottom section. In severe cases, the vagina turns “inside out” and can even protrude outside of the body. It is a common complication of hysterectomy.2 To be clear, though, let’s phrase it another way: Of the relatively small percentage of women who experience complications after hysterectomy, vaginal vault prolapse is a fairly common one.
  • Cystocele, which occurs when the supportive tissue between the bladder and vaginal wall becomes weakened, allowing the bladder to bulge into the vagina.
  • Rectocele, which occurs when the tissue that separates the rectum from the vagina weakens, creating a bulge against the back wall of the vagina.
  • Enterocele, which occurs when the small intestine descends into the lower pelvic cavity and presses against the upper part of the vagina. Rectocele and enterocele sometimes occur together in women who have had their uterus removed.

All of this sounds really scary, we know, but it’s important to understand that having preexisting pelvic floor problems prior to surgery is the single greatest risk factor for prolapse.2 In other words, women who didn’t have problems with prolapse prior to surgery are at a much lower risk of developing problems after surgery. It’s also important to note that prolapse after a hysterectomy is more common in women who have had multiple children and already have weakened pelvic floor muscles.

So, what can women who have had a hysterectomy do to prevent pelvic floor problems down the line? Being proactive is the key, and that’s where we turn our attention now.

Protecting Your Pelvic Floor After Hysterectomy

Get Constipation Under Control

Repeated straining from constipation, or even a single episode of intense straining, can damage the pelvic floor muscles. If you’re prone to constipation, it’s especially important to use a correct bowel emptying technique and position, eat a high-fiber diet that promotes softer stools, and use gentle vegetable laxatives or an enema, when needed, to promote bowel movements. Talk to your doctor if you have persistent constipation.

Address Frequent/Chronic Cough

Coughing causes your abdominal muscles to press downward against the pelvis. Forceful or repeated coughing can weaken the pelvic floor muscles and lead to prolapse over time. If you have a chronic cough, it’s important to manage it (talk to your doctor about how) and do pelvic floor exercises daily (more on that later) to keep your muscles strong. Quitting smoking can help prevent coughing, and it goes without saying that the health benefits of quitting go far beyond pelvic floor health alone.

Eat a Healthy Diet Tailored to Your Needs

Follow These Suggestions to Protect Your Pelvic Floor After HysterectomyChoosing nutritionally-replete, minimally-processed whole foods diet is one of the best things you can do for your body. A diet rich in fruits, vegetables, whole grains, nuts, and healthy proteins can help you manage your weight and get your nutritional needs met. Avoid foods that cause abdominal bloating, constipation, or diarrhea, which can lead to straining during defecation or make it difficult to pass wind; these things can contribute to prolapse over time.

Manage Your Weight

Excess weight can create additional strain on your pelvic floor muscles, which can contribute to pelvic organ prolapse over time. It also puts pressure on the bladder, which can cause or worsen a common problem in women: urinary incontinence (UI). A surprising one in three women will deal with UI at some point in her life. Being overweight can put extra pressure on the bladder, causing a particular form of UI called stress incontinence. Losing weight can significantly reduce episodes of incontinence, according to a study published in the New England Journal of Medicine.3

Exercise Regularly

We won’t lecture you on the importance of exercise for cardiovascular health—we know you’ve heard it before, but consider this: Having good strength and muscle tone reduces your risk of strain from everyday activities (lifting, pulling, pushing, etc.) and that, in turn, reduces your risk of prolapse and UI. Just be sure to avoid exercises that put excessive strain on your pelvic floor, such as intense core exercises, unsafe strength training, and high-impact aerobics and running, especially if you already have weak pelvic floor muscles.

Do Your Kegels!

Last, but definitely not least, doing pelvic floor (also called “Kegel”) exercises is one of the most important ways you can protect your pelvic floor health. Forming a broad sheet or “hammock” of muscle that stretches across the pelvis, the pelvic floor muscles are part of our core muscles and are vital for posture, intra-abdominal pressure and for holding our pelvic organs in place. Kegel exercises help strengthen these important muscles, helping to prevent urinary incontinence (or reduce or eliminate existing symptoms), as well as prolapse.

Many women find using a Kegel exerciser device like PeriCoach helpful. A vaginally insertable biofeedback device, PeriCoach is fitted with sensors that detect when you squeeze against the device. What makes Pericoach one of the best pelvic floor trainers on the market today? It pairs with your smartphone and guides you through pelvic floor exercise routines, and you can see your muscles working in real-time!

Most women don’t perform Kegels correctly with written instructions alone, and this is where PeriCoach can really make a difference. Hear what women are saying and try it for yourself. Also, check out our guide on how to properly exercise your pelvic floor muscles.

Caring for your pelvic floor is especially important after a hysterectomy. Taking the steps outlined above can help. Cheers to your good health, now and in the future