Pelvic Exercises Physiotherapy

Lose Belly Fat After Hysterectomy – 10 Min Physio Abdominal Exercise Routine and Weight Loss Guide

Lose belly fat after hysterectomy with this Pelvic Floor Physiotherapist information and safe abdominal exercise routine for hysterectomy recovery.

This guide supports your weight management and hysterectomy recovery with:

  • 10 Minute Abdominal Exercise Routine (video)
  • When to start abdominal exercises after hysterectomy
  • Hysterectomy recovery diet 
  • Best weight loss exercises to choose after hysterectomy

10 Minute Abdominal Exercise Routine After Hysterectomy

This gentle routine of deep abdominal exercises is suitable for most women after:

  • Abdominal hysterectomy
  • Vaginal hysterectomy
  • Laparoscopic hysterectomy
  • Combined hysterectomy and pelvic organ prolapse surgery

These abdominal exercises should feel completely comfortable for your body. Always cease any exercise associated with increased physical discomfort during your hysterectomy recovery.

When to Start Abdominal Exercises After Hysterectomy

Gentle abdominal activation exercises are usually suitable for most women who are permitted to move in and out of bed at home during their hysterectomy recovery (drains and drips removed) unless medically advised otherwise.’

Most women are usually advised to avoid traditional abdominal exercises involving the upper/outer abdominal muscles to reduce the risk of straining incisions and sutures, especially internal sutures that are unseen and sometimes overlooked for this reason. Intense abdominal exercises to avoid during hysterectomy recovery include: situps, abdominal curls, bike or cycle legs, double leg raises, planks, table top position both legs raised (Pilates) and intense abdominal Yoga poses e.g. V sits.

The appropriate time to recommence general exercise can vary depending on many factors including your rate of recovery and the type of hysterectomy surgery performed. 

Most women see their surgeon at 6-8 weeks after hysterectomy surgery. The post operative consultation with your doctor is usually the best time to discuss when it’s appropriate for you to return to general exercise.

Benefits of Deep Abdominal Exercises After Hysterectomy

Physiotherapist-guided gentle deep abdominal exercises after hysterectomy train the deep abdominal core muscles. These abdominal muscles can become weak and floppy after a hysterectomy.

Activating and training the deep abdominal muscles can:

  1. Flatten and tone the appearance of the lower belly (‘swelly belly’ or ‘abdominal pooch’)
  2. Protect hysterectomy wounds (incisions and sutures) from strain with intense abdominal exercises
  3. Reduce abdominal discomfort when standing and walking
  4. Improved core support the lower back3, pelvis and hips; lower back pain after hysterectomy is a common problem
  5. Promote good upright posture when sitting and standing

Pelvic Floor Safe Abdominal Exercises After Hysterectomy

This routine does not include intense core abdominal exercises e.g. abdominal curls. This is because research has shown that these intense abdominal exercises increase pressure on the lower abdomen, abdominal wall and the pelvic floor 1.

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

Starting Position and Technique for Safe Abdominal Exercises

    • Start lying down comfortably on a firm mattress 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 ‘neutral position’ ie midway between completely flattened and fully arched. This is the best position to train your deep abdominal core muscles.

    • Breathe normally in and out and very gently draw in your lower belly using the muscles below your navel that sit beneath your briefs

    • Start with three gentle deep core abdominal activation 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.

Deep Abdominal Exercise Muscle Activation Tips

  • If you have difficulty performing this deep abdominal muscle activation technique, you may instead like to try the same activation pattern lying on one side with a pillow resting between your thighs supporting the front of your body (when you feel comfortable in sidelying).

  • Alternatively, gently contract your pelvic floor muscles by performing a pelvic floor exercise or Kegel exercise2. When you squeeze and lift your pelvic floor muscles, you may notice gentle tension develop in your lower belly.  Pelvic floor exercises (Kegels) can activate the inner deep abdominal muscles in some women.

Belly Toning Exercises After Hysterectomy

The abdominal exercises demonstrated in the video above are safe effective belly toning exercises for women during hysterectomy recovery and preparation for returning to regular activity.

Sample Daily Abdominal Exercise Routine

Beginners start with the number of exercises that feel comfortable to perform. Gradually progress the number of abdominal exercises in one session up to 10 repetitions (exercises in a row) per exercise, using the correct core abdominal activation and exercise technique. 

1. Single leg heel slides on the bed 

2. Single knee roll out to one side (bent knee fallouts) core abdominal exercise)Knee lifts

3. Single foot lifts (small range foot just off the bed)

How to Lose Belly Fat After Hysterectomy

Intense abdominal exercises will not help anyone lose belly fat after a hysterectomy.

Abdominal exercises can tone the abdominal muscles sitting beneath belly fat, however abdominal exercises don’t preferentially burn abdominal fat. 

The natural solution to lose belly fat is by decreasing fat from your whole body.

Some very lean women may have the appearance of ‘6-pack’ or very toned abdominal muscles. Women with low levels of total body fat don’t have much abdominal fat covering their abdominal muscles. As a result, their abdominal muscles can have a ‘toned’ appearance.

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

What Causes ‘Swelly Belly’ 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.

Weakened 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.

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 modificationcombined 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.

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.

Mediterranean diet

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.

Best Safe Hysterectomy Recovery Exercises for Weight Loss

During early hysterectomy recovery, the focus is on weight management rather than weight loss. Early hysterectomy recovery is not a good time to embark on a diet (or or exercising for weight loss).

Managing body weight post-operatively involves 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.

This  time-based approach involves measuring how long you walk for and increasing the time spent 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 a 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

1. Thompson JA, O’Sullivan PB, Briffa K, Neumann P, Court S. Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. Int Urogynecol J Pelvic Floor Dysfunct. 2005 Jul-Aug;16(4):285-92. doi: 10.1007/s00192-005-1308-3. Epub 2005 Mar 22. PMID: 15782286.

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.

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