Side Effects of Hysterectomy
Side effects of hysterectomy are often unexpected and can in some cases even delay hysterectomy recovery.
The following Physiotherapy information, exercises and techniques can help to avoid and overcome some commonly experienced side effects of a hysterectomy. This information applies to recovery from vaginal or abdominal hysterectomy.
Potential Side Effects of Hysterectomy
The side effects of hysterectomy include:
- Gas pain and bloating;
- Back pain;
- Decreased fitness;
- Weight gain;
- Chest problems and difficulty coughing;
- Decreased circulation;
- Difficulty emptying the bladder;
- Discomfort; and
Constipation After Hysterectomy
Constipation is one of the common side effects of hysterectomy surgery. Using the following ‘Brace and Bulge’ bowel emptying technique will help you to empty your bowels and minimise the risk of straining:
- 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; and
- Never strain to empty your bowels - straining can potentially injure your pelvic floor and strain your wound.
You can view this ‘Brace and Bulge’ bowel emptying video now to help overcome bowel movement problems.
Tips for constipation after a hysterectomy
- 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;
- Move regularly to help promote bowel movement;
- 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 during post-operative recovery, speak with your medical care giver for appropriate advice regarding laxative consumption after hysterectomy.
Wind Pain or Gas After Hysterectomy
Wind or gas pain after hysterectomy can be one of the most uncomfortable side effects of hysterectomy, especially when recovering from abdominal hysterectomy surgery. Wind pain usually settles for most women a couple of days after surgery.
Tips to alleviate gas after a hysterectomy:
- Move around and change position regularly – avoid lying on one position without moving.
- Warm packs on the abdomen (never placed over your wound).
- Knee rolling exercise lying on your back and moving your knees together to one side of your body and then the other (avoid rolling too far to avoid straining your wound)
- Consume warm drinks including peppermint tea.
- Decrease your intake of wind producing foods – 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 cause gas in some women.
Pelvic Floor Recovery is a must-read for all women seeking expert information to avoid and overcome side effects of hysterectomy by Australian Physiotherapist Sue Croft.
Back Pain After a Hysterectomy
Back pain after a hysterectomy is a common side effect. 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). Other causes of back pain after hysterectomy include decreased movement, unfamiliar hospital bed or even the position you rest in after your surgery.
Tips to reduce back pain after hysterectomy:
- Rest 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.
- Move in your bed (sliding alternate heels towards your bottom or small knee rolls from side to side with your knees together).
- Taking regular short walks.
Decreased Strength and Fitness
It is almost inevitable that you will lose some strength and fitness during your recovery period. Regular appropriate walking exercise that is gradually progressed during your recovery will also help you to maintain some fitness and physical strength.
Walking after a hysterectomy
- Ideally commence with short walks of around five minutes each;
- Progress the duration of your walking gradually as your condition improves;
- Follow the walking guidelines set down by your specialist;
- Most women can increase the time they walk by about five minutes per week;
- 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;
- Walk slowly on flat surfaces wherever possible for the first six weeks; and
- Wear quality support briefs to support your abdomen.
Please refer to Walking After a Hysterectomy Guidelines for more information about post operative walking.
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.
Fitness and strength exercises to promote 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.
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 not an inevitable side effect of hysterectomy 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.
Fat burning exercises that place minimal pressure on the pelvic floor:
- Stationary cycling (recumbent cycle is ideal);
- Treadmill walking (flat not inclined);
- Water walking;
- Cross trainer; and
- Low impact dancing.
High impact exercises to avoid after hysterectomy surgery:
- Group fitness classes that involve running/jumping;
- Netball/basketball; and
- 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).
Chest Problems After Hysterectomy
Deep Breathing Exercises 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 diaphragmatic 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 spending quite a bit of time lying down.
How to Cough After Hysterectomy
It can also be daunting to cough after a hysterectomy for fear of straining your stitches and pain, 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.
After a hysterectomy the circulation or blood flow in your legs is reduced. 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. 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.
Circulation Tip: Avoid crossing your legs, especially during the first six weeks of recovery from abdominal hysterectomy or vaginal hysterectomy. Crossing your legs decreases the blood flow in the veins of your legs, increasing the likelihood of a DVT (blot clot in the deep veins of the calf).
Pain or Discomfort When Moving
You are likely to feel more discomfort moving during recovery from abdominal hysterectomy than vaginal hysterectomy owing to your abdominal wound.
Technique to Minimise Pain Moving in Bed
To move in bed and minimise discomfort try to keep your head down on the pillow, slide 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. Try to 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.
Technique to Get Out of Bed After Hysterectomy
Most women are moved out of bed the first day following their hysterectomy surgery. If you can get out of bed using the following technique it will help you reduce the strain on your wound and descrease discomfort, you can also watch How to Get Out of Bed After Hysterectomy video now:
- Bend your knees and slide each heel one at a time towards your bottom so both knees are bent.
- 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 with your lower elbow and your upper arm as you lower your legs over the side of the bed.
Bladder Problems After a Hysterectomy
Using your bladder 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.
How to promote bladder emptying after catheter removal:
- Avoid drinking too much too quickly on the morning your catheter is removed.
- Sit on the toilet and lean forward with your hands resting on your thighs.
- Bulge your abdomen forward as you empty the bladder - never strain.
- 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.
Watch How to Empty Bladder video now in our free video series.
Fatigue after Hysterectomy
One of the most commonly reported side effects of hysterectomy surgery in the post operative recovery period 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. If you remain fatigued following recovery, you may need to get your iron levels checked with a blood test.
Tips for overcoming 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
- Try not to compare your rate of recovery 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
- 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.
Sex after Hysterectomy
Sex after hysterectomy can be confronting for many women. This hysterectomy sex postoperative guide teaches you how to avoid discomfort and pain with sex after hysterectomy and overcome problems related to sex and hysterectomy including vaginal dryness, pelvic pain, increased pelvic floor muscle tension or candida infection. Often both women and their partners share hysterectomy sex-related concerns.
Side Effects of Hysterectomy Summary
There are a many of potential side effects of hysterectomy surgery, and some women are caught off-guard by side effects they did not expect or could have prevented. The better you understand the potential side effects, then the better you can prepare for and manage side effects if they do arise. There is a great deal you can do to avoid or minimise unwanted physical side effects of hysterectomy surgery and improve your overall hysterectomy recovery.
ABOUT THE AUTHOR, Michelle Kenway
Michelle Kenway is a Pelvic Floor Physiotherapist and author of Inside Out – the Essential Women’s Guide to Pelvic Support. The Inside Out exercise DVD and book show women how to strengthen the pelvic floor and exercise safely after hysterectomy and prolapse surgery with pelvic floor safe exercises.