Easing Back into Exercise after a Hysterectomy

Julia Nichols, an active mother of three from Cincinnati, Ohio, was just 37 when she was diagnosed with breast cancer. Luckily, it was detected and treated early, but because her cancer had tested positive for estrogen, Julia was at a higher risk of recurrence. Her doctor recommended a preventative hysterectomy to remove her estrogen-producing organs. Four years after her cancer diagnosis, Julia had the procedure.

Hysterectomies like Julia’s are not uncommon. According to the Centers for Disease Control and Prevention (CDC), hysterectomy is the second most common surgery among women of reproductive age, with 600,000 of the procedures performed each year. Primary reasons for hysterectomy include pelvic pain, endometriosis, uterine fibroids, shifting of the uterus and cancer of the uterus, ovaries or cervix.

What Is a Hysterectomy?

A hysterectomy is a surgical procedure during which a woman's uterus is removed. There are three different degrees of hysterectomy—total, partial and radical. The doctor will make a recommendation based on the patient's medical condition and history. In Julia's case, her procedure was intended to remove her estrogen-producing ovaries and tubes, but she also opted to have her uterus removed due to other issues she was experiencing.

Recovery time will vary based on the type of surgery performed:

• Abdominal hysterectomy: Most women stay in the hospital for only a couple of days after surgery, but the total recovery time is between six and eight weeks. According to WebMD, there should be no lifting for two weeks, and only walking until around six weeks.
• Vaginal or laparoscopic-assisted vaginal hysterectomy (LAVH): This less-invasive procedure will have a shorter recovery time, typically within two to four weeks. Julia's procedure was an LAVH.
• Laparoscopic supracervical hysterectomy (LSH). This is the least invasive of the three procedures, with a recovery time ranging from six days to two weeks.

In the days and weeks following a hysterectomy, the American College of Obstetricians and Gynecologists recommends getting lots of rest, taking short walks and refraining from lifting heavy objects.

Exercising after a Hysterectomy

When introduced properly, post-hysterectomy exercise is one of the key ingredients in promoting healthy sleep, assisting with weight loss, relieve muscle tension and preventing a range of diseases, from various types of cancer to diabetes and even Alzheimer’s.

Women who were physically fit before a hysterectomy will likely have an easier recovery and will be able to return to regular physical activities sooner. For Julia, who teaches group fitness classes and has always worked out regularly, exercise played a key role in her healing process.

"I believe you bounce back faster the better shape you are in to begin with," she says. "It also helps with mental and emotional recovery. There have always been some emotional issues related to the procedures I’ve had, and exercising has put me in a better place to deal with those challenges."

Although she was already physically fit, Julia's doctor restricted her from lifting anything heavier than five pounds, which is about a half-gallon of milk. "I started out with walking, then progressed to squatting and lunging, but without the weights. I waited the entire six weeks before I picked up a single weight."

Every woman's experience and timetable are different. Pay attention to your body's (and doctor's) cues. When you're ready, ease back into exercise with these activities:

• Walking: With your doctor's approval, you can start walking as soon as you feel up to it. Taking short, frequent walks can help to speed up the healing and recovery process and reduce the risk of blood clots.
• Stretching: Gentle stretches can help to relieve muscle tension and promote healthy blood circulation. You can stretch your upper back and shoulders while lying in bed or on the floor. Bend your knees and reach your arms up over your head, lightly pressing them against the floor or bed, and then release and repeat. As you get stronger and more mobile, you can add more advanced stretches.
• Kegels: Your pelvic floor may be weakened after a hysterectomy, which can cause loss of bladder control, shifting of pelvic organs and other problems. Kegel exercises are quick contractions designed to strengthen the pelvic muscles. They can be performed in any position, anytime, without anyone knowing. Simply squeeze the muscles you would normally use to stop the flow of urine, release and repeat. Aim for high repetitions of varying lengths.
• Pelvic Tilts: This is another exercise that helps to strengthen the pelvic floor. Lying on your back with your knees bent and a pillow supporting your head, lift your bottom up into a bridge position while contracting your stomach muscles and keeping your middle back flush against the floor. Maintain the position for a few seconds, release and repeat.
• Stomach "Vacuums": This move safely strengthens the stomach muscles. Starting from your hands and knees, inhale and then tighten your tummy as you slowly exhale. After a few seconds, release and repeat.
• Head Sit-Ups: If you're not ready for full crunches yet, start with a head sit-up. Lying on your back, bend your knees and cross your arms over your belly. Cinching your stomach muscles with your hands, slowly raise your head off the floor and bring your chin to your chest. After a few seconds, release and repeat.
• Other Abdominal Exercises: It's normal to experience some bloating or loss of abdominal strength after a hysterectomy. Although diet and cardio both play a major role in slimming down the midsection, targeted core exercises such as the ones recommended post-pregnancy, can help strengthen those muscles. Pay special attention to the transversus abdominis (TA) muscle, the deepest layer of your abdominal muscles that wraps horizontally around the core like a corset, holding your organs in place. You can target the TA muscle with planks (start with knee planks and work up to a full), bridges, Pilates moves and forward ball rolls.
• Lower Back Exercises: In addition to alleviating and preventing back pain, lower-back exercises also help to strengthen the core while improving posture and stability, which aid in healing and recovery.
• Breathing Exercises: It's common to experience difficulty breathing in the hours and days following a hysterectomy. Targeted breathing exercises can help you return to a normal, comfortable respiratory pattern. Take long, slow breaths, completely filling the lungs, belly and rib cage before slowly exhaling.

Checklist for Post-Hysterectomy Exercise

• Walk and stretch as soon as your doctor gives you the green light.
• Don't lift anything heavier than five pounds for the full recovery period.
• Engage in abdominal exercises only after the full recovery period.
• Even if you feel good, don't overdo it. If you push too hard, you can strain an incision or cause an internal injury.
• Always check with your doctor before starting or resuming an exercise program.

Julia has some final words of advice for women returning to exercise after a hysterectomy. "Listen to your body. It seems like common sense, but it’s hard to follow. I did not follow it after I had kids—I pushed myself too much and paid for it. This time, I listened to my doctor and my body, and I recovered just as they said I would. If you try to rush it, you'll just extend the process and put yourself at risk of injury."