Hysterectomy: Removing The Uterus

September 17, 2025

The Role of Pelvic Floor Physiotherapy After a Hysterectomy

A hysterectomy is a significant surgical procedure, and while it can be necessary for a range of medical conditions, recovery requires careful consideration. The pelvic floor and core do not automatically restore their previous function following surgery. Regardless of whether the procedure was performed via an abdominal, vaginal, or laparoscopic approach, targeted rehabilitation is often essential.

Pelvic floor physiotherapy provides evidence-based strategies to optimise healing, restore function, and support long-term pelvic health. Below is an outline of how a physiotherapist may assist across the different stages of recovery.

Early Recovery (0–6 Weeks)

Focus: Education, Protection, Gentle Awareness

During the initial post-operative phase, the priority is to protect healing tissues and establish safe movement patterns. A physiotherapist may provide:

  • Pelvic floor education — guidance on how surgery has altered pelvic support, biomechanics, and bladder/bowel function.
  • Breathing and core coordination — gentle diaphragmatic breathing techniques to reduce tension, support circulation, and minimise swelling.
  • Safe movement and postural strategies — instruction on bed mobility, transfers, and walking to avoid unnecessary strain.
  • Scar and tissue healing advice — information to optimise scar recovery, reduce the risk of adhesions, and monitor for signs of complications.

Mid Recovery (6–12 Weeks)

Focus: Activation, Strengthening, Confidence

Once surgical healing is established, rehabilitation progresses to restoring muscle activation and movement control. This may include:

  • Pelvic floor muscle retraining — graded internal or external exercises focusing on coordination, endurance, and strength.
  • Core muscle activation — re-education of deep abdominal muscles, particularly the transversus abdominis, in synchrony with the pelvic floor.
  • Postural alignment and movement retraining — addressing compensatory patterns or protective guarding to optimise pelvic loading.
  • Scar mobilisation — manual therapy to improve tissue mobility, circulation, and sensitivity.

Later Recovery (3+ Months)

Focus: Return to Function, Fitness, and Lifestyle

The longer-term phase of rehabilitation supports a safe return to higher levels of activity and addresses ongoing pelvic health needs. This may involve:

  • Exercise progression and return-to-sport planning — individualised advice for safely resuming walking, lifting, gym training, Pilates, or sport while minimising risk of prolapse or core dysfunction.
  • Bladder and bowel retraining — management of urgency, leakage, or constipation, which may present post-surgery.
  • Support for intimacy and pelvic pain — rehabilitation for dyspareunia, vaginal tightness, or scar-related discomfort.
  • Prolapse prevention and long-term pelvic health — strategies to manage intra-abdominal pressure and maintain pelvic organ support.

Why Consult a Pelvic Floor Physiotherapist?

Pelvic floor physiotherapists are trained to assess not only the muscles, but the integration of breath, core, scars, posture, and daily movement patterns following surgery. This holistic assessment allows for a tailored rehabilitation plan to support both short- and long-term recovery.

Importantly, it is never too late to commence pelvic floor physiotherapy. Whether a patient is six weeks or six years post-hysterectomy, physiotherapy can assist in improving function, comfort, and quality of life.


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