Lose Belly Fat after Hysterectomy | 10 Min Physiotherapy Abdominal Exercise Routine and Weight Loss Guide

Seek your doctor’s approval to recommence general exercise before starting any exercises after a hysterectomy.

This core abdominal exercise routine is suited to most women who have received medical approval to return to general exercise which is usually around 6-8 weeks after hysterectomy surgery. The appropriate time to commence can vary depending on many factors including your rate of recovery and the type of hysterectomy surgery performed.

Benefits of Deep Abdominal Exercises after Hysterectomy

There are many benefits to be gained from appropriate abdominal exercises after a hysterectomy including:

• • Toning and flattening the appearance of the lower belly

• • Protecting the pelvic floor and avoiding potentially unsafe intense abdominal exercises after hysterectomy surgery.

• • Improving core abdominal muscle support that strengthens the lower back³, hips and pelvis. Lower back pain after hysterectomy is a common problem. Abdominal core exercises usually form part of the overall Physiotherapy management for relieving lower back pain.

• • Promoting good standing and sitting posture.

Abdominal Exercises after Hysterectomy Suitability

These abdominal core exercises are suited to most women following:

• • Abdominal hysterectomy

• • Vaginal hysterectomy

• • Laparoscopic hysterectomy

• • Combined hysterectomy and pelvic organ prolapse surgery

These abdominal exercises should feel pain free during and after exercise. Cease any exercises that cause physical discomfort during hysterectomy recovery unless they have been medically advised.

Abdominal Exercise Routine for Hysterectomy Recovery

This routine does not include intense core abdominal exercises e.g. abdominal curls because research has shown that these types of exercise place pressure downwards on the lower abdomen and pelvic floor ¹.

Try to focus on using the correct deep abdominal exercise technique rather than intensity, especially during early hysterectomy recovery because during this time, your healing internal tissues are vulnerable to strain and long-term damage.

Starting Position and Technique for Safe Abdominal Exercises

• • Lie down comfortably on a firm mattress or on the ground with a pillow or cushion to support your head and neck

• • Slide one leg at a time to move your heels towards your buttocks so that your knees are both bent and feet flat

• • Commence with three gentle pelvic tilts flattening the curve of your lower back into the supporting surface

• • Move your lower back into the midway position between completely flat and arched. This is the best position to train your deep abdominal core muscles.

• • Breathe normally in and out and then as you breathe out gently draw in your lower tummy using the muscles below your navel (beneath your briefs)

• • Start with three gentle deep core abdominal exercises by imagining you’re drawing or pulling your two pelvic bones towards the midline (i.e. towards your navel). You should feel gentle tension develop in your lower abdominal wall when doing this correctly.

If you have difficulty performing this deep abdominal muscle activation technique, you may instead like to try this same activation pattern lying on your side.

Alternatively, contract your pelvic floor muscles by performing a pelvic floor exercise or Kegel exercise². Pelvic floor muscle contraction can activate the deep inner abdominal muscles in some women.

Belly Toning Exercises after Hysterectomy Routine

Outline of the exercise routine demonstrated in the video shown above.

Use the modifications suggested if you find the exercises too challenging at first.

Daily Exercise Routine

Gradually progress towards completing 10 toning exercises with 3-5 pelvic tilts between each core abdominal exercise according to your level of personal comfort.

1. Leg extend above ground (or modify by sliding foot long the ground wearing a sock)

2. Pelvic tilts

3. Knee lifts

4. Pelvic tilts

5. Knee lift, leg out to side (or modify with bent knee fallout core abdominal exercise)

6. Pelvic tilts

How to Lose Belly Fat after Hysterectomy

Unfortunately many still believe the myth that abdominal exercises will help them lose belly fat after hysterectomy.

Abdominal exercises can tone the abdominal muscles lying under your belly fat, however abdominal exercises will not ever help you lose belly fat after hysterectomy or in the long-term.

The only natural way to lose belly fat is by losing fat from your whole body.

Does a Hysterectomy Cause Weight Gain?

Some women gain weight including belly fat after hysterectomy.

This can happen when:

• • The ovaries are removed during the hysterectomy causing early onset of menopause

• • Physical inactivity and overeating during hysterectomy recovery

Causes of Increased Belly Size after Hysterectomy

Belly size can increase after hysterectomy. Increased belly size after hysterectomy can happen for a number of reasons aside from weight gain including:

Internal Swelling

The belly is often swollen after a hysterectomy which can lead to the mistaken belief of having gained belly fat after surgery. Internal lower abdominal and pelvic swelling can take a number of months to subside after a hysterectomy.

Weak Deep Abdominal Muscles

Abdominal hysterectomy and abdominal incisions can cause the deep abdominal muscles to stop working. When these muscles stop working, this can make your belly look floppy and larger in size.

The Best Way to Lose Belly Fat after Hysterectomy

The best way to reduce your weight and lose belly fat after hysterectomy surgery is to incur an energy deficit. To incur an energy deficit you need to use up more energy than you consume.

An energy deficit can be achieved through:

• • Dietary modification to reduce the calories or energy you consume

• • Dietary modification COMBINED WITH appropriate pelvic floor safe exercise The combination of diet and appropriate exercise is the best weight loss strategy for most women.

It’s almost impossible to lose belly fat after hysterectomy through moderate exercise. It takes a large amount of exercise to incur an energy deficit and during your hysterectomy recovery your exercise capacity is reduced.

1. Hysterectomy Recovery Diet

Your diet includes everything that you eat and drink and this is an essential part of weight loss and weight management after surgery.

The Mediterranean style diet is an excellent hysterectomy recovery diet. This diet helps you manage your weight, lose weight and includes nutrients,⁴ fibre and protein. Protein is essential for tissue healing and this is why including protein rich foods on a daily basis during your hysterectomy recovery diet is important.

• • Rich in a range of plants (vegetables, fruits, legumes*, grains and seeds) and seafood especially fish

• • Healthy fats (e.g. olive oil)

• • Chicken, eggs, cheese and yogurt in moderation

• • Low in processed foods and sugar

• • Red meat twice a week

While the Mediterranean diet is low in red meat some women have iron deficiency before and after their hysterectomy. If you suffer from extreme fatigue or know that your iron levels are low then you may need to increase your consumption of red meat or alternatively use iron supplements as directed by your medical practitioner.

* Legumes can sometimes cause abdominal bloating or gas after a hysterectomy so beware of increasing your legume intake during initial hysterectomy recovery.

2. The Best Hysterectomy Recovery Exercises for Weight Loss

During your early recovery focus on weight management rather than weight loss. Your early hysterectomy recovery is not a good time to be dieting or doing too much exercise. Rather, the focus for most women should be managing body weight post-operatively through healthy eating and gentle exercise such as walking.

The best weight management exercise for most women during initial hysterectomy recovery is walking. Mobilising out of bed and walking improves physical recovery after surgery⁵.

Progress your hysterectomy walking program gradually using a time-based approach. The time-based approach involves measuring how long you walk for and increasing the time you spend walking on a weekly basis, rather than increasing the speed or distance walked. Use a time-based approach for walking during the first 6-8 weeks after hysterectomy.

When you are given permission to return to general exercise by your doctor, the best exercises to choose are low impact exercises where at least one foot is in contact with the ground at all times.

Appropriate low impact exercises for losing belly fat after hysterectomy and overall weight loss include:

• • Stationary bike

• • Elliptical machine

• • Low impact aerobics

• • Cycling outdoors

• • Low impact dancing

References

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2. Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31-42. doi: 10.1002/1520-6777(2001)20:1<31::aid-nau5>3.0.co;2-p. PMID: 11135380.

3. Lynders C. The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain. HSS J. 2019 Oct;15(3):214-220. doi: 10.1007/s11420-019-09717-8. Epub 2019 Aug 29. PMID: 31624475; PMCID: PMC6778169.

4. Tosti V, Bertozzi B, Fontana L. Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms. J Gerontol A Biol Sci Med Sci. 2018 Mar 2;73(3):318-326. doi: 10.1093/gerona/glx227. PMID: 29244059; PMCID: PMC7190876.

5. Varadhan KK, Lobo DN, Ljungqvist O. Enhanced recovery after surgery: the future of improving surgical care. Crit Care Clin. 2010 Jul;26(3):527-47, x. doi: 10.1016/j.ccc.2010.04.003. PMID: 20643305.