Several weeks ago, I had a complete, laparoscopic hysterectomy. This means that my uterus, cervix and fallopian tubes were removed (with the assistance of robots) via my vagina.
Leading up to the surgery, I was highly interested in maintaining my strength and fitness during recovery. After all, I am not someone who has spent a lifetime enjoying fitness. I’m a relative newcomer, with perhaps 5 or 6 years of routine activity, and my identity as a “fit person” still feels very much tentative. I did not want weeks of suddenly sedentary life to create a lack of fitness hole too large for me to climb out of again.
The general guidelines for any woman after hysterectomy is to avoid lifting anything “heavy” for several weeks, avoid leaning over or bending, picking things up off of the floor, or “straining.” The goal is to give the abdominal muscles a break, since they’ve been cut through in several locations, and to avoid downward pressure on the pelvic floor, which will be more susceptible to prolapse without the structure of the uterus to help hold organs up and away from the vagina and bowels.
But what does “heavy” mean? And how do I know if I’m putting pressure on my pelvic floor? What does normal healing feel like and what does it feel like when something goes wrong? How long should I wait before I get back to normal activities? After doing a lot of research, including a pre-surgical appointment with a physical therapist, I conclude that science doesn’t have clear cut answers to these questions.
So I, and women like me, are left to our own devices and the individual inclings of our doctors, to come up with a plan. One of the resources I found spoke to the fact that surgeons aren’t given a lot of information about recovery either, so each surgeon does what they think is best based on personal experience and anecdote. They’re stuck with their best guess, too. And since they don’t want to get in trouble later, they are inclined to be very conservative in their recommendations, to be on the safe side of things.
Well, that’s just not how I roll. I want to be careful, yes, but I also don’t want to do more harm than good by being unnecessarily sedentary. Sitting around, losing my strength and stamina, it seems to me, could create as many problems as I am attempting to avoid. So, I made a fitness plan for myself, with some guidance from the aforementioned physical therapist, and I am working on following it until I feel ready to get back into the gym.
Weeks 1 and 2–”Take it easy”
During these weeks it is ok to get up and move around as much as I feel inclined to do so, but no intentional workouts. Short walks are ok. Avoid straining, including during bowel movements. (Superfun video on how to move your bowels correctly without risking/exacerbating prolapse here.)
How do I know I’ve done too much? I’m especially tired. My abdominal area hurts. There’s a pressing feeling in my vagina like it’s full. Apparently, however, it is normal to feel some shifting of pressure in the abdomen as the bowels “figure out” their new position in your belly. This sensation will come and go as things move around. You know you’re in the danger zone if it feels like something is going to fall out of your vagina or if there’s a tearing feeling or sudden, heavy bleeding.
Weeks 3-6–”Messing around with light weights”
I bought some quality resistance bands, and I’ve figured out some programming that allows me to do moves without feeling like I’m putting tension on my abdominal cavity or pelvic floor. Since it is very light resistance (compared to my strength level–these things are all relative), I am doing a resistance workout most days (4-6 days/week). Also, since the resistance is low, I’ve kept the volume high, starting with 3 sets of 10-20 reps (per side, if applicable) and increasing up to 5 sets as I feel up to it. I am doing each move slowly, exhaling during the challenging part of the move to help my pelvic floor relax.
In addition to this “lifting” program, I take a walk every day I feel up to it, aiming for about 10,000 total steps at the end of each day.
workout 1: Full body workout
- Seated single-leg extension (with leg weights strapped to my ankles)
- Standing, supported (leaning on a chair) single-leg hamstring curl
- Seated double chest press (with bands anchored to a door)
- Seated double row (with bands anchored to a door)
workout 2: Full body workout
- Supported, shallow static lunge
- Narrow stance, mini squats with resistance (band looped under my feet)
- Seated double press-up (with resistance band anchored under my feet)
- Seated double pull-down (with band anchored to the door)
workout 3: This day is a mix of “physical therapy” exercises from my various previous injuries (shoulder and glutes) and a little bonus “guns” work, to help feed my ego a bit.
- Double-leg glute bridges
- Single-leg glute bridges (when they feel ok–sometimes it feels like too much abdominal engagement)
- Banded monster walk
- Lying double biceps curl (with band anchored to the door)
- Lying double triceps extension (with bands anchored to the door)
- Internal and external shoulder rotations (with bands)
Weeks 6-8–”Back at the Gym, light weights”
I haven’t entered into this stage, yet. The PT I consulted said I should probably start at about half of whatever my weights were pre-surgery and slowly work myself up to those weights again. She predicted it would take me 4 months to get back to my pre-surgery strength.
Week 12–Back to “normal”
This is when my surgeon predicts I can get back to my “usual activities” without much risk of interfering with healing.
I’m trying to listen to my body, and honestly, what feels good one day doesn’t always feel ok the next, so each day’s plan is a moving target. But I generally feel better when I have some kind of plan and a program to work with, and I feel pretty good about this one for now. Based on how I feel right now, I’m going to be surprised if I feel up to going back to the gym 6 weeks after the procedure. I’m not going to force it, if I don’t feel ready, and knowing that I have a well-rounded program at home helps me not be impatient to enter that next stage in recovery. I will keep you posted on how it’s going!
Do you have experience with returning to exercise after hysterectomy? I’d love to hear from you below!
If you found this article while looking for resources along these lines, here’s a few more that I found along the way that seemed reliable and helpful. I read several articles on lifting and prolapse, as that seems to be the largest risk specifically for returning to lifting heavy post-hysterectomy.
–Michelle Kenway Physiotherapy (in Australia): exercises to do in preparation for hysterectomy. I also appreciated (and borrowed from) her exercise video here. She also has videos and ebooks you can order, which I was tempted by but ultimately decided not to purchase myself. I’d be interested to hear from you, if you did!
–Sparks People article on getting back into exercise after hysterectomy
—Guide to Lifting with Prolapse from Core Exercise Solutions
Marjorie Hundtoft is a middle school science and health teacher. She can be found picking up heavy things and putting them back down again in Portland, OR.