How to avoid the side effects of a hysterectomy – what every woman should know

Hysterectomy recovery can be accompanied by some unexpected and unwanted physical side effects…

The more informed you are about the potential problems that may arise, the better you will be able to anticipate and avoid them. The practical strategies outlined in this article will improve your vaginal or abdominal hysterectomy recovery.

Potential side effects of a hysterectomy include:

• chest problems and difficulty coughing
• decreased circulation in your legs
• discomfort moving
• difficulty emptying your bladder
• constipation
• wind pain
• back pain
• decreased strength and fitness
• weight gain after hysterectomy
• fatigue

You can minimise or avoid these hysterectomy post op problems altogether with simple exercises and techniques.

Let’s have a look at each potential problem and the simple practical steps you can take to avoid or minimise them.

Chest problems and difficulty coughing after hysterectomy

After a hysterectomy it can be difficult to breathe deeply and to clear your chest effectively. You can reduce the effects of the anaesthetic on your lungs and prevent chest problems by commencing your deep breathing exercises as soon as you wake up after your operation. Try to aim for four to five deep breaths every hour. Breathe slowly and deeply into the base of your lungs, making your rib cage move outwards as you breathe in. This technique is demonstrated in your free hysterectomy recovery training video. Practice your deep breathing exercises regularly during the first six weeks of your hysterectomy recovery, especially when you are not up and moving about.

It can also be daunting to cough for fear of straining your stitches and the potential for increased discomfort especially during recovery from abdominal hysterectomy. To reduce the pressure on your vaginal wound and your abdomen, sit rather than stand when you feel the need to cough. If you are recovering from a vaginal hysterectomy use your hand over your pad to support your vagina when your cough. If you have had an abdominal hysterectomy use a pillow over your abdominal stitches to reduce the pressure on your wound and potential discomfort or use a specifically designed abdominal support binder.

Circulation problems after hysterectomy surgery

After a hysterectomy the circulation or blood flow in your legs is reduced. You will probably be aware this can increase your risk of a blood clot in the deep veins in your legs — what is commonly known as a DVT (deep venous thrombosis). Simple calf muscle exercises will help you improve your lower leg circulation when you are recovering.  With your legs straight bend your ankles up and down ten times every hour, especially when you are resting and not walking. These exercises are also demonstrated in our hysterectomy recovery training video and you can watch this now. Slide one heel at a time towards your bottom along the bed, bending your knee and then straighten your leg. Perform a couple of these heel slide exercises every hour. Most importantly avoid crossing your legs, especially during the first six weeks of recovery from abdominal hysterectomy or vaginal hysterectomy. Crossing the blood flow in the veins in your legs, increasing the likelihood of a DVT.

Discomfort moving after a hysterectomy

You are likely to feel more discomfort moving during recovery from abdominal hysterectomy than vaginal hysterectomy owing to your abdominal wound. Many women find that using a post operative abdominal support binder provides support for better movement. Regardless of the type of hysterectomy surgery you have, you can minimise discomfort when moving in bed by keeping your head down on the pillow, sliding your feet one at a time towards your buttocks and then lifting your bottom up off the bed. This technique uses your buttocks not your abdominal muscles and most women find that they can move easily in bed with minimal discomfort and also minimise downward strain on their vaginal wound. Avoid sitting up forwards using your abdominal muscles immediately after your hysterectomy as this uses your abdominal muscles and will increase downward pressure on your internal stitches and your pelvic floor.

Most women are moved out of bed the first day following their hysterectomy surgery. If you can get out of bed correctly you will reduce the strain on your wound and also reduce discomfort. Firstly bend your knees one at a time and then roll onto your side like a log, by bringing your arm across your body and keeping your knees together. Try to avoid twisting through your abdomen especially during recovery from abdominal hysterectomy. Once you are on your side, push your body up sideways as you lower your legs over the side of the bed. Getting back into bed is just the reverse of this technique and you can watch this now at How to get in and out of bed after a hysterectomy .

Bladder problems after a hysterectomy

Using your bladder after surgery is not usually a major problem after hysterectomy surgery. Sometimes however the flow of urine can be slowed or even fully obstructed due to internal swelling and bruising from your surgery. Often a catheter (or thin tube) is used to drain your bladder and this is usually removed after the first day or two following your surgery according to your surgeon’s instructions. There are a couple of easy strategies to help you empty your bladder after your catheter is removed:

• Avoid drinking too much too quickly on the morning your catheter is removed - aim to drink around 1/2 cup of water per hour providing for some medical reason you have been advised otherwise
• Sit on the toilet and lean forward with your hands resting on your thighs
• Bulge your abdomen forward as you empty – never strain to empty your bladder
• If you feel you have not emptied fully stand up, rotate your hips and then sit down and try again. This simple strategy can help you fully empty your bladder.

You can watch this technique for emptying your bladder now in our free video series.

Constipation after hysterectomy

Constipation is a fairly common problem after a hysterectomy. This can be due to a combination of factors including: pain medication, lack of movement, swelling and fear of pain with bowel movements. Using the following technique will help you to empty your bowels without straining. You can also watch this technique now to learn how to use your bowels without straining your wound.

• Sit and lean forwards
• Rest  your hands or elbows on your knees to support your upper body
• Keep your back straight
• Make your waist wide and say “MOO”, your abdomen should bulge forwards at the same time (this opens up your anus to help you empty)
• You may wish to support your vagina with some toilet paper or a pad in the early days following your surgery.
• Never strain to empty your bowels - straining can potentially injure your pelvic floor and strain your wound.

Some other strategies to help you avoid constipation when recovering from hysterectomy surgery:

• Choose to eat bowel friendly foods after your surgery – especially those foods that usually help you to keep soft well formed bowel movements. Usually these are foods that are high in fibre and not heavily processed including: fruit and vegetables and whole wheat/multi grain products.
• Drink adequate fluids – for most of us this means 1.5-2 litres of fluid per day.
• Mobilise regularly to help promote bowel movements.
• Try a warm drink first thing in the morning and a short walk around the house.
• Take your time to use your bowels, don’t rush.
• When you feel an appropriate urge to empty, head to the toilet and don’t defer this urge.
• Some specialists advise their patients to take mild laxative remedies and these need to be discussed with your specialist before taking them.

Wind pain

Wind pain can be one of the particularly uncomfortable side effects of a hysterectomy, especially when recovering from abdominal hysterectomy surgery. In order to alleviate wind pain move around and change position regularly. Gentle knee rolling exercises can also help to move wind and alleviate associated discomfort. Some women find that warm drinks including peppermint tea help to alleviate wind pain. You can also reduce the potential for wind pain by decreasing your intake of wind producing foods – remember these are the cruciferous or green vegetables such as cabbage and beans, in addition to other foods you know that can give you wind. Dried fruits and prunes can be big wind producers for some women. Wind pain usually settles for most women a couple of days after surgery.

Back pain after a hysterectomy

It is quite common for women to feel back pain after a hysterectomy. This can be due to the position your surgery is performed in (with your legs held up in the air while you are under anaesthetic). It can also be due to a lack of movement, unfamiliar hospital bed or even the position you rest in after your surgery.

Reduce or avoid back pain when you return home after hysterectomy by:

• Resting flat on your back with a pillow under your knees to decrease pressure on your back.
• Alternatively lie on your side with a pillow between your knees to support your body.
• Avoid spending too much time lying on the lounge – remember the cushions are probably soft and often provide little support for your spine.
• Moving in your bed (sliding alternate heels towards your bottom or small knee rolls from side to side with your knees together). These exercises are demonstrated on our video teaching you how to exercise after a hysterectomy.
• Taking regular short walks.

Decreased strength and fitness after a hysterectomy

It is almost inevitable that you will lose some strength and fitness during your recovery period. What is vital is that you undertake regular exercise during your recovery to minimise the potential for some of the unwanted side effects of a hysterectomy already mentioned. Regular appropriate walking exercise that is gradually progressed during your recovery will also help you to maintain some fitness and physical strength.

Walking is the best exercise for you to promote your physical recovery after a hysterectomy. Ideally commence with short walks of around five minutes each, progressing the duration of your walking gradually as your condition improves. Follow the exercise guidelines set down by your specialist. Usually most women can increase the time they walk by about five minutes per week however this can vary from woman to woman. What is important is that you take things slowly and don’t overdo it. If you feel uncomfortable after walking, you may have done too much and you may need to reduce how far and how fast you walk. Stick to walking slowly on flat surfaces wherever possible for the first six weeks. Wearing supportive underwear when you walk can also be beneficial in supporting your abdomen. As you recover you will gradually be able to increase the speed of your walking too, usually after the first six weeks of your hysterectomy recovery.

If you intend to return to a fitness or strength training program when you have your specialist’s approval – you need to be very careful about the exercises you choose and the techniques you use in exercise classes and in the gym. There is evidence to suggest that women are at increased risk of vaginal prolapse after a hysterectomy! Exercise that places strain on your pelvic floor will increase your risk of prolapse problems after a hysterectomy. Remember this includes abdominal ‘core’ exercises and weight loaded exercises that are a feature of many exercise programs. See our article “Expert tips and guidelines for safe abdominal exercise after a hysterectomy or bladder prolapse surgery” for details of exercises to choose and to avoid.

For practical strength and fitness workout exercises and instructions for exercising safely and protecting your pelvic floor after hysterectomy surgery refer to Inside Out – the essential women’s guide to pelvic support (by Michelle Kenway Physiotherapist and Professor Judith Goh Urogynaecologist). This user friendly hand book is full of illustrations, exercises and techniques for fitness classes, gym programs, Pilates and Yoga classes and many more to help you return to exercise safely and with confidence.

Weight gain after hysterectomy

Weight gain after a hysterectomy is definitely not an inevitable side effect of hysterectomy surgery. Weight gain after hysterectomy surgery will in fact increase pressure on your pelvic floor. Carrying too much weight has been identified as a risk factor for incontinence and vaginal prolapse in women and after a hysterectomy surgery your risk of pelvic floor dysfunction may already be increased from just the surgery alone. It makes good sense to then manage your weight really well after your surgery.

Unfortunately with decreased mobility and being house bound after hysterectomy surgery, some women are inclined towards weight gain during their recovery. The key to maintaining your weight during hysterectomy recovery is a combination of eating sensible well balanced, low fat meals in addition to progressively increasing your general exercise walking program as you recover (see above). Choose foods that are high in fibre to minimise constipation and give you a sense of fullness in addition to protein to help your body repair and recover. Minimise processed foods that are high in fat and carbohydrates such as cakes, pastries and many take away foods.

After your six week check-up with your specialist you may be keen to commence some weight loss exercise and once again ensure that you are fully informed regarding the most appropriate exercises to help you manage your weight.  A goal of 0.5-0.9kg/week weight loss is safe and realistic for most women. Those cardiovascular exercises that help you to burn fat and minimise pressure on your pelvic floor are low impact exercises including:

• cycling (stationary bike at first – recumbent cycle is ideal)
• walking
• treadmill walking (flat not inclined)
• water walking
• cross trainer
• dancing

High impact exercises to avoid after hysterectomy surgery include:

• running/jogging
• jumping
• group fitness classes that involve running/jumping
• netball/basketball
• competition tennis or squash

Weight loss exercise after a hysterectomy also includes strength training exercises. Strength training can help you increase your lean muscle, decrease your fat and increase your strength and endurance after a hysterectomy. For detailed guidelines and strength training exercises designed for women after vaginal surgery refer to Inside Out – the essential women’s guide to pelvic support(by Michelle Kenway Physiotherapist and Professor Judith Goh Urogynaecologist).

Fatigue during hysterectomy recovery

One of the most commonly reported side effects of a hysterectomy is fatigue. You will probably find that you become tired readily and this is usually the case over the first six weeks after a hysterectomy. Some women will already have low iron stores leading up to their surgery, further increasing their fatigue with small amounts of activity.

To overcome fatigue after hysterectomy surgery:

• take the time to lie down, rest and recover every day, especially over the first six weeks
• sit rather than stand when you have the opportunity, especially over the first six weeks (this will also reduce the amount of pressure on your wound when compared to prolonged standing)
• eat regular balanced meals
• exercise in manageable intervals and amounts and rest after your exercise
• break up your tasks or activities into small manageable amounts
• return to activities gradually as you feel well enough
• don’t compare yourself or your recovery rate to that of anyone else – many factors will determine your recovery time after a hysterectomy which takes a total of three months for full healing for most women and very woman will recover and return to activity at their own individual rate
• don’t expect too much of yourself
• recruit the help of family members and friends – remember they can’t see your wound and they may not understand you tiring easily
• discuss your return to work plans with your employer – some women find that a graduated return to work helps them ease back into work
• most importantly listen to how your body feels - you are the best person to know whether you are doing too much and whether or not you need to take extra rest.

Summary to side effects of hysterectomy surgery

As you can see there are a number of potential side effects after a hysterectomy. Most of the physical side effects mentioned in this article are unexpected by most women. The better you understand the potential side effects, then the better you can prepare for and manage them if they do arise. As you can see there is in fact an enormous amount you can do to avoid or minimise unwanted physical side effects of hysterectomy surgery and improve your overall hysterectomy recovery.

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information  about your particular condition.
While every effort has been made to ensure that the information is accurate, the author accepts no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation.

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