Are you returning to Yoga after hysterectomy or prolapse surgery? Perhaps you’re thinking about trying Yoga for the first time.
This Pelvic Floor Physiotherapy video and information help you safely modify Yoga after hysterectomy or with prolapse problems.
Read on to learn:
- How to modify Yoga after hysterectomy or prolapse surgery (video)
- Potential benefits and risks of Yoga after hysterectomy or prolapse surgery
How to Modify Yoga after Hysterectomy or Prolapse Surgery
Modifying some commonly performed Yoga poses may help you reduce some potential risks after gynecological surgery.
Gynecological surgery can increase the risk of some ongoing pelvic floor problems. After prolapse surgery women are at increased risk of recurrent or repeat prolapse 1. Some research also suggests that there is an increased risk of prolapse after hysterectomy 2.
This video shows you how to modify common Yoga poses after hysterectomy or prolapse surgery.
Video duration: 9 minutes
Suitability: Women seeking to modify Yoga poses after prolapse or hysterectomy surgery
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Potential Benefits of Yoga after Hysterectomy or Prolapse Surgery
Increased Physical Strength and Endurance
A decline in physical strength and endurance is a common side effect of bed rest and decreased activity after a hysterectomy or prolapse surgery recovery.
Yoga may benefit some women with their long-term physical recovery. Some forms of Yoga such as Hatha have been shown to improve muscle strength and endurance following three months of Yoga training 3.
Comment – Some forms of Yoga may be beneficial for some women for improving general strength and endurance.
Resting in bed and general inactivity during surgical recovery can contribute to muscle and joint inflexibility.
Hatha Yoga has been shown to improve lower back and hamstring flexibility 3. When these muscle groups become less flexible with prolonged rest they can contribute to lower back pain and injury which is a common problem after gynecological surgery.
Comment – Yoga may help some women improve their flexibility.
Restoring pelvic floor strength and support are usually part of routine Physiotherapy after a hysterectomy and/or prolapse surgery. Diaphragmatic breathing is important for good core muscle function including the pelvic floor and deep abdominal muscles. The abdominal and pelvic floor muscles work with the diaphragm 4 and these core muscles work best when breathing patterns are corrected 5.
Many forms of Yoga teach diaphragmatic or Yoga breathing (Pranayama). The improved breathing awareness and control that can accompany Yoga may help some women with their long term pelvic floor and abdominal muscle function after pelvic surgery.
Comment – Yoga exercises that improve breathing awareness may benefit overall core muscle control.
Good upright posture is important for the pelvic floor muscles to function well 6. After a hysterectomy or prolapse surgery some women slump forward and slouch owing to abdominal pain and protective guarding of the abdomen.
Yoga may assist some women with their posture rehabilitation after gynecological surgery. Research suggests that Yoga poses that train the back extensor muscles improve upright posture in mature adults 7. Posture re-education has been shown to cure urinary continence in some women 8 however quality randomized studies are required.
Comment – Posture retraining may benefit core muscle control in some women after some forms of gynecological surgery.
Relief from Prolapse Symptoms
Inversions or upside down postures are sometimes promoted as effective prolapse treatment.
Inversion postures may temporarily relieve uterine prolapse symptoms (such as pelvic heaviness) by positioning the pelvis upside down i.e. head or shoulder stand positions.
Pelvic floor symptom relief with inversions is only temporary at best because the stretched prolapse tissues are not repaired in this process so that when normal upright posture is resumed, gravity returns the prolapsed tissues to their former position and symptoms return.
Inversion postures may provide temporary relief however they should never be confused with permanent prolapse repair.
Comment – Yoga does not repair pelvic organ prolapse.
Pelvic Floor Rehabilitation
Kegels are usually part of routine physical therapy for restoring pelvic floor strength and function after a hysterectomy or prolapse surgery.
Some forms of Yoga incorporate Kegels or pelvic floor exercises in the technique commonly referred to as Mula Bandha. In Yoga practice these exercises focus on engaging the anal sphincter and pelvic floor muscles.
There’s currently insufficient evidence to support Yoga as a form of pelvic floor training 9. Despite this there are often claims about the benefits of Yoga for pelvic floor problems including prolapse repair.
A recent Cochrane review investigated whether Yoga is effective for treating urinary incontinence in women 10. The researchers reported that the available research was inadequate to determine any benefit for women with urge or stress incontinence.
Yoga instructors have been identified in a group of fitness instructors as having increased prevalence of urinary incontinence 11. These researchers suggest that more training regarding urinary incontinence is required for fitness instructors.
Comment – There is no current evidence supporting the benefit of Yoga for pelvic floor rehabilitation.
Potential Risks of Yoga After Gynecological Surgery
Pelvic Floor Overload
Some Yoga poses may increase the risk of overloading the pelvic floor. This can cause pelvic floor strain, tissue weakness and pelvic floor problems such as pelvic organ prolapse and incontinence.
Yoga poses that can increase the risk to women after gynecological surgery include:
- Intense abdominal exercises that force the pelvic floor downwards 12 e.g. The Hundred, Plank, V sit and Garland pose in Yoga
- Poses that compress the abdominal contents forcing them downwards onto the pelvic floor e.g. Deep Forward Bend
Core Muscle Imbalance
The strength and activity of the abdominal and pelvic floor muscles needs to be well balanced.
When the abdominal muscles become stronger than the pelvic floor muscles, they can overload the pelvic floor by creating ongoing downward force onto the pelvic floor. In order to achieve well balanced core muscles some women need to learn to relax their abdominal muscles and reduce the load on their pelvic floor while strengthening their pelvic floor muscles.
Modifying some commonly performed Yoga poses may help women participate in Yoga after hysterectomy or prolapse surgery and reduce their risk of pelvic floor overload and core muscle imbalance.
1. Balmforth J, Robinson D. (2015) Pelvic Organ prolapse. In: Berghmans, B, Van Kampen, M, Berghmans, B, Morkved, S. (Eds) Evidence based Physical Therapy for the Pelvic Floor. Edinburgh: Elsevier, pp. 233 -240.
2. Swift S. (2000) The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. American Journal of Obstetrics & Gynecology 183(2):277-85. Retrieved from https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(00)53840-X
3. Lau C, Yu R et. al. (2015) Effects of a 12-Week Hatha Yoga Intervention on Cardiorespiratory Endurance, Muscular Strength and Endurance, and Flexibility in Hong Kong Chinese Adults: A Controlled Clinical Trial. Evid Based Complement Alternat Med Evid Based Complement Alternat Med. V 2015: 958727. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4475706/
4. Hodges P, Sapsford R. et. al. (2007) Postural and respiratory functions of the pelvic floor muscles Neurourol Urodyn. 26(3):362-71. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/nau.20232
5. Roussel, N, Nijs, J, et. al. (2009) Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: a case control study. Eur. Spine J. 18 (7), 1066e1073. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899579/
6. Sapsford R, Richardson C et al (2008) Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil. Sep;89(9):1741-7. Retrieved from https://www.archives-pmr.org/article/S0003-9993(08)00425-5/fulltext
7. Bansal S, Katzman M et. al. (2014) Review article (meta-analysis)Exercise for Improving Age-Related Hyperkyphotic Posture: A Systematic Review. Archives of Physical Medicine and Rehabilitation Volume 95, Issue 1, pp 129-140. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0003999313005145
8. Fozzatti C, V. Herrmann V, et.al. (2010) Global postural re-education: an alternative approach for stress urinary incontinence? European Journal of Obstetrics, Gynecology, and Reproductive Biology, 152, pp. 218-224. Retrieved from https://www.sciencedirect.com/science/article/pii/S0301211510002897
9. Bø K, Herbert R. (2013) There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. Journal of Physiotherapy Volume 59, Issue 3, September 2013, pp 159-168. Retrieved from https://www.sciencedirect.com/science/article/pii/S1836955313701802#bib0320
10. Wieland L, Shrestha N, et.al.(2019) Yoga for treating urinary incontinence in women. Cochrane Database of Systematic Reviews. No. 2, pps 1465-1858. Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012668.pub2/full
11. Bo K, Solfrid B, et.al. (2011) Urinary incontinence among group fitness instructors including yoga and pilates teachers† Neurourology and Urodynamics Volume 30, Issue 3, pps 370-373. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/nau.21006
12. Barton A, Serrao C. (2015) Transabdominal ultrasound to assess pelvic floor muscle performance during abdominal curl in exercising women. Int Urogynecol J. Dec;26 (12): pp 1789-95. Retrieved from https://link.springer.com/article/10.1007%2Fs00192-015-2791-9