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!
(See my updates to this post here (on returning to lifting) and here (on returning to running.)
1-year later: Sex and Trauma after Hysterectomy
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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!
–Girls Gone Strong has many articles regarding women’s physiology and lifting, including on working around prolapse here and here
–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. You can now read her at Progressive-Strength.com .
I haven’t had this done. I remember my sister in law did though. She did the exercises and recovered superbly.
I pray yours is a quick and easy road to recovery.
Ps, im so glad i read this.
I don’t feel so scared about the procedure like I used to. 🌺 🌸
Good to hear your sister-in-law recovered well!
I hear what you’re saying about being afraid of the procedure–nearly everyone I know who’s had it is significantly older than myself, and recovery was a lot more dramatic even 10 or 15 years ago. Of course, everyone is different (as doctors so love to say while avoiding answering questions!), but so far, my recovery has been totally fine. I struggle with boredom a lot more often than with pain. 😊
I like your spirit Marjorie. Your attitude is spot on. I’m SO glad i read this today. 🌺 🌸
That sounds like a tough thing to deal with. I hope it gets better for you soon! It sounds like you have a great exercise plan though.
Thanks, Betina! As organ removal goes, it’s not so bad . . . 😜
I’m very impressed with your effort to learn about the best way to recover. I relied on all the resources you list for my post csection recovery and pelvic floor rehab. I had great results, better than in person pt, with Sarah from Core exercise solutions. I wonder, given the pelvic floor pressure changes, would incorporating breathing exercises be beneficial? Retraining breathing patterns is supposed to help with pelvic floor pressure, as far as I understand it.
Hello, Martochka! I have seen several references to breathing exercises, but it wasn’t clear to me what that means in practice. There’s a portion of the lifting world that believes strongly in utilizing breath during lifts to maintain form and increase power, but it’s not an aspect of lifting that I’ve explored. What I *have* been doing is coordinating my breathing with my lifts–inhaling on the essentric movement (lowering) and exhaling on the concentric movement (lifting).
Do you have resources you can share?
I’m really impressed by your plan and, most importantly, caution. After my partial hysterectomy I wanted to get back to my previous cardio fitness level (I wasn’t doing much else besides running at that point). I remember going to a personal trainer at our university to ask for a referral to trainer who specialized in older women’s health issues. She asked around, but couldn’t come up with any names. I was flabbergasted. Like you, I devised my back-to-fitness plan based on my own feelings of comfort and discomfort. Clearly there’s a huge need in the fitness industry here!
I really do find it completely unacceptible that there’s so little information out there for recovery from this and other “women’s” health issues. As a lifter, I am so accustomed to research being done on 20 year-old males, I *always* take the findings with a huge grain of salt before I try to apply them to myself! But this is an area of research that can’t be done on young cis-males, so you would think they’d fill in these gaps a least! And hysterectomy is so common. . .
That’s it! I’m quitting my day job to become a “women’s health” trainer. Want to join me? 😉
Love your plan of attack and appreciate the need to do thorough research here. I’m about to have a lumpectomy, and although, not nearly as invasive as your surgery, I’m finding conflicting information on exercise, lifting weights etc. The definition of of “healed” varies greatly. Good luck with your regimen, and continued recover.
Thank you, Keri, and luck to you, as well!
I’m sorry there doesn’t seem to be good, straight-forward advice for you to follow! I felt best about the information I got from the physical therapist. She could customize the usual advice to what she could observe about me and my body. If you have the opportunity, it may be worth an office visit to a PT to be evaluated and to help put a plan in place.
Thanks for sharing your acquired resources, experiences and observations here. It is infuriating and utterly commonplace that health providers have very little to say and researchers have very little to show for about recovery from such major surgery that men don’t happen to undergo. So we do this– we rely on people we trust (like good physical therapists), compare notes, be open-minded and experimental, and take it day by day. Keep up posted as you move through different stages of recovery. We’re all hoping for good outcomes for you!
Thank you, Catherine, for the well wishes! And I agree, it seems totally absurd that we don’t have more reliable information to guide us through these common health scenarios! I will keep you posted on how my little n=1 experiment goes!