A Week-by-Week Guide to Hysterectomy Recovery

Healing after a hysterectomy is different for everyone — beyond the immediate and long-term effects on your body, you may have so many mixed emotions that it can be hard to know how you feel. You might be relieved to finally be free of pain and other symptoms that have been making your life miserable. You may also be mourning the loss that comes along with removing a large part of your reproductive system. It doesn't help that people typically go through this process with little to no information aside from some basic wound-care instructions. No wonder it can be overwhelming.

As a women's health physical therapist who helps people recover week-by-week, it's my job to not just ensure proper healing and rehabilitation but to also provide insight and support that makes this complex transition easier to manage. One thing is for sure: the more information you have, the better.

Below is an extensive guide to what to expect when recovering from a hysterectomy, as well as some self-care strategies that you can use immediately after surgery. I'll start with the basics. Know all that stuff already? Scroll down for week-by-week recovery details.

What is a hysterectomy?

As one of the most frequently performed gynecologic procedures in the United States, a hysterectomy is the surgical removal of one’s uterus. There are a variety of reasons why someone may need, or want to have their uterus removed.

Here are some of the top reasons for hysterectomy:

• Painful, heavy, or abnormal periods or bleeding that has not been responsive to other treatments
• Leiomyomas (also known as uterine fibroids), which are non-cancerous tumors in the uterus
• Uterine prolapse (when the uterus drops down into the vaginal canal and becomes bothersome)
• Cervical or uterine cancers, or conditions that are known to lead to cancer such as hyperplasia
• Uterus related chronic pelvic pain that is non-responsive to conservative treatments

6 types of hysterectomy surgery

Although the term ‘hysterectomy’ is often used generally to describe all types of the procedure, there are several types of hysterectomies, depending on how much of the internal reproductive anatomy is removed, including:

• Total hysterectomy is when the entire uterus, including the cervix is surgically removed.
• Supracervical hysterectomy is when the top portion of the uterus is surgically removed. The cervix is the lower portion of the uterus that opens into the vaginal canal, and during this type of hysterectomy, it is left in place.
• Radical hysterectomy is when the uterus, cervix, and the supportive structures of the uterus are removed, often including the round, broad, and cardinal ligaments, and sometimes even lymphatic tissue in the area.
• Oophorectomy is when one or both of the ovaries are removed.
• Salpingectomy is when one or both of the fallopian tubes are removed.
• Salpingo-oophorectomy is when both the ovaries and fallopian tubes are removed.

Hysterectomy and induced or early-onset menopause

Once your uterus is removed, you no longer have the capacity for pregnancy. If your ovaries are also removed and you're already in menopause, you will experience what is known as induced menopause. That said, even when the ovaries are left intact, a hysterectomy is associated with early onset menopause.

How is a hysterectomy performed?

For those assigned female at birth, the internal reproductive anatomy consists of a uterus, and right and left fallopian tubes and ovaries. These organs sit in the “true pelvis” — in other words, inside the bony bowl that the pelvis forms — along with the bladder, rectum, and portions of the lower colon.

The uterus, fallopian tubes, and ovaries, fit like puzzle pieces at the center of it all, with the bladder in front (tucked behind your pubic bone) and the rectum resting behind it. Depending on the reasons for your hysterectomy, the uterus (and any other required tissue) can be surgically removed from between the bladder and bowel either through the abdomen, the vagina, or laparoscopically.

Abdominal hysterectomy procedure:

When the hysterectomy is performed through a surgical opening in the abdomen (also known as a laparotomy), it is known as an abdominal hysterectomy. The incision can be either made vertically or transversely, and can even change during the course of surgery depending upon how much of the internal reproductive anatomy needs to be removed, circumstances encountered during the surgery, and the patient’s health and medical history — including prior abdominal incisions. Abdominal incisions are usually closed with either staples, non-absorbable sutures, absorbable sutures and Steri-strips, or skin glue.

Although a necessary option in certain instances, the abdominal hysterectomy has the highest risk of complications, and tends to have the longest recovery time. However, it may be a safer option if cancer is suspected (or already confirmed), or when an enlarged uterus is too difficult to remove by other means.

Vaginal hysterectomy procedure:

Performed through the vaginal canal, the minimally invasive vaginal hysterectomy is one of the safest approaches, and has a shorter recovery time than the abdominal hysterectomy. However, it isn’t the best approach for everyone, particularly if scar tissue (from prior cesareans, abdominal surgeries, or endometriosis, for example) complicates this approach, or if the uterus is too large to remove vaginally.

After a vaginal hysterectomy, or anytime the full uterus is removed, the top of the vagina is closed to create what is called a vaginal cuff, using absorbable sutures that do not typically need to be removed.

Laparoscopic hysterectomy procedure:

Through small holes in the abdomen, the necessary parts of the internal reproductive anatomy are removed in small pieces during a laparoscopic hysterectomy. There are also instances in which approaches are combined — for example, a laparoscopic-assisted vaginal hysterectomy may be an option if the uterus is too big to remove laparoscopically. As the least invasive, a laparoscopic hysterectomy tends to have the shortest recovery time.

Laparoscopic incisions are typically closed using sutures that may or may not need to be removed, or skin glue.

What are common post-hysterectomy complications?

As always, surgery will come with some risks and post-surgical complications to be aware of during recovery.

The major complications of hysterectomy include:

• Hemorrhage
• Infection
• Thromboembolic disease such as deep vein thrombosis (DVT) or pulmonary embolism (PE) for example
• Urinary tract injury or dysfunction
• Bowel injury or dysfunction
• Vaginal cuff injury (dehiscence and/or evisceration)
• Early menopause
• Scar tissue adhesions

While these major post-surgical complications happen less than 6% of the time after an abdominal hysterectomy, it is important to take care of yourself during your recovery in order to help minimize complications, and encourage proper healing.

When to call your doctor after a hysterectomy

After any gynecologic surgery including a hysterectomy, it is recommended that you call your physician if you note any of the following:

• Severe abdominal pain or bloating that lasts for one hour or more, and is not relieved by recommended pain medication
• Shortness of breath or chest pain
• Heavy vaginal bleeding (which is considered as heavier than a menstrual period or completely soaks a large sanitary pad) and lasts for more than one hour
• Persistent (> one day) nausea or vomiting, or which makes eating or drinking impossible
• Fever > than 101°F
• Changes in your incision that includes redness, drainage of fluid or pus, or opening of the incision
• Swelling in an extremity (leg or arm) which is worse on one side compared to the other
• Vaginal discharge that is foul-smelling, green, or dark yellow
• Difficulties emptying your bladder, or burning with urination
• Constipation for three days
• Loose or watery stools for two or more times a day, you develop bloody stools

Hysterectomy Recovery: The First Few Days

The first few days after your hysterectomy are important for setting a foundation for your healing. It is helpful to focus on pain management, protecting your wound, gentle movement, and getting your bladder and bowel function back on track.

You may or may not need to stay in the hospital for a few days depending on the type of surgery you had, your pre-existing medical conditions, if you have sufficient care at home, and if you encountered any circumstances during your surgery. It is common to stay a few days in the hospital after an abdominal hysterectomy, but unless your health or physician determine otherwise, it is common to go home on the same day after a laparoscopic, or vaginal hysterectomy.

Tips for the First 2-3 Days

You will likely have tenderness and swelling surrounding any of your incision sites after a hysterectomy. First aid in the first few days can be really helpful in minimizing swelling, getting you moving safely, and helping you to manage any pain.

• Soothe pain with ice. Ice packs or frozen vegetables are essential in keeping swelling at a minimum, and calming pain. Every couple of hours, consider icing over your abdominal incision(s) for about 10 minutes. Make sure there is a towel, layer of clothes, or a pillowcase under the ice pack so that it is not in direct contact with your skin.
• Check your scar daily. Always keep your incision clean and dry and look for changes in your scar such as increased redness, heat, swelling, or bleeding from your incisions — these would be reasons to check back in with your healthcare provider.
• Get high-waisted. Gently compressive, high-waisted undergarments can support wound healing, and improve your comfort as you heal. Choose fabric that is breathable so sweat doesn't create moisture in the area.
• Start moving. If your doctor says it’s safe, you can begin on the day of surgery. Movement will help with blood circulation, swelling, and to get your bowels moving better to help you relieve gas. Walking around the hospital is such a great way to start, or around your living room and kitchen if you are home. Walk slowly at first, focusing on upright posture, and increase your speed as you feel comfortable.
• Chew Gum. Gas and bloating are common especially after an abdominal or laparoscopic hysterectomy when air gets trapped during the procedure, or when slowed colonic function causes constipation and bloating. Lingering gas and bloating can cause temporary shoulder pain, and even increase strain on your incision. In addition to walking, there is some evidence that chewing gum will speed up your ability to pass gas and have a bowel movement.

Hysterectomy Recovery: Weeks 1-6

As you continue to rest and heal, the first 6 weeks are crucial for you to support your wounds as you heal, learn optimal pressure management strategies, body mechanics, and gently begin to rebuild strength and confidence in your body again.

During the first 6 weeks, it's recommended that you:

• Get back to your normal routine as soon as you are comfortable
• Limit lifting to no more than 13 lbs, or as much as you can comfortably hold with one arm
• Maintain pelvic rest (avoiding sex or inserting anything into your vagina)
• Limit increases in intra abdominal pressure to protect abdominal and vaginal cuff healing.

Full recovery timelines vary depending on the type and procedure of your hysterectomy, so make sure to check in with your physician for recommendations specific to you.

Caring for your bowels and bladder:

It can be challenging to empty your bladder and bowels after a hysterectomy. But it’s important to encourage normal bowel and bladder function as early as possible, in order to protect healing incisions, and to reduce unnecessary strain in your pelvic floor muscles. Consider the following:

• Focus on water & fiber intake. Remember to hydrate and eat plenty of fruits and vegetables.
• Try peppermint. Try adding a few drops of peppermint to your toilet water before you pee to help you start your flow of urine.
• Prop your feet up. When on the toilet, try putting your feet up on a squatty potty, a small stool, or even a trash can turned on to its side. This will help relax the muscles that need to lengthen to release stool.
• Push out poop effectively. Good pushing technique is important when having a bowel movement. This involves relaxing your pelvic floor muscles while gently pushing with your abdominals. Try not to hold your breath while you're pushing, instead exhale like you are blowing out a birthday candle. Effective pushing will help reduce strain on your vaginal cuff, or any abdominal incisions.
• Hug a pillow while you poop. If you have any abdominal incisions, even laparoscopic ones, take a small pillow into the bathroom with you, place it on your lower abdominals to cover the incision, and then gently hug the pillow while you are pushing. This may be helpful for sneezing and coughing as well!

Reactivating your abs & pelvic floor:

Properly using your abdominals and pelvic floor muscles after a hysterectomy will protect healing tissues, support your posture, improve blood flow and minimize swelling. You can begin using these muscles gently, right away after your surgery by tightening and relaxing them several times in a row, many times throughout the day:

• Do some kegels. For your pelvic floor muscles, try squeezing the muscles around your vaginal and anal openings as if you are trying to hold back gas and stop the flow of urine at the same time. Try contracting them while you are exhaling, and releasing them fully as you inhale.
• Strengthen your abs. To activate your abdominals, try pulling your belly button back toward your spine on an exhale. You may feel the abs lift slightly toward your head as though you are zipping up a tight pair of pants. Trying this while on your hands and knees may make it easier to feel yourself pull your tummy in, without arching your back.

Taking care of your hysterectomy scar:

To best support your wound healing process, check out these tips to improve blood flow, reduce swelling, and protect your tissues from injury.

• Cushion your abdominal scar. If you have any abdominal incision, they may be very sensitive initially and can feel irritated by the pressure of your clothes. Place a small towel between your scar and pants to decrease irritation from your clothes.
• Start indirect scar massage. Gentle massage of the skin surrounding the scar can be helpful to improve blood flow, encourage healing and improve comfort: About 3-6 inches from your incision(s), use your fingertips with light pressure, and make circles towards your incision (never pull away from your scar), working your way around the entire scar.

The biggest risk factors for developing vaginal cuff complications include increased intra abdominal pressure (excessive and prolonged or chronic straining for example), or infection after sex. The best way to protect your vaginal cuff wound is to follow your pelvic rest recommendations and minimize straining/increases in intra abdominal pressure. Try following these recommendations for at least 6 weeks or until cleared by your physician to prevent any cuff complications including dehiscence or evisceration.

Hysterectomy Recovery: After 6 Weeks

Chances are, the decision to have a hysterectomy did not come lightly. It’s more likely the decision is made after suffering pain, heavy bleeding, pelvic floor dysfunction, and health complications for years without successful treatment. After your initial healing, and once you have been cleared by your doctor for activity, you'll want to return to the activities that you have been missing out on.

Things to keep in mind as you return to activity post-hysterectomy:

• Once your wound is fully healed, scar massage can help to reduce excessive scar tissue growth, or formation of abdominal or pelvic adhesions.
• Focus on proper body mechanics, and work to make them a forever habit — good body mechanics during bending, lifting, or any movements throughout your day will never go out of style, and will help you with long-term intra-abdominal pressure management.
• Check in on your pelvic floor muscles. Muscle tension and pain are common for many with a history of chronic pelvic pain or endometriosis, and poor pelvic support or muscle weakness is common for those with a history of pelvic organ prolapse. Long term pelvic health is essential to minimize the effects of menopause, promote sexual health, and maintain a healthy bowel and bladder function.
• Just because you’ve had a hysterectomy does not mean you need to limit exercise or stick to a 13 pound weight limit for the rest of your life. With smart exercise progressions and proper guidance, you can regain strength and control in your body, and get back to your exercise goals.

With all of that said, it’s easy to feel overwhelmed going through recovery on your own — but physical therapy can help. The pelvic physical therapists at Origin are experts in the pelvic anatomy, understanding of the surgical impact of gynecological surgeries, and are able to provide expert guidance and support during your recovery including helping you understand scar tissue management, pelvic floor recovery, and rehabilitation to support your bowel, bladder and sexual health. Schedule a consultation with one today. Whether in person, or virtually from the comfort of your own home, they will be here to support you every step of the way.

The above information is meant to be a general guide to help you understand what to expect as you recover from a hysterectomy, and recognize or avoid common complications. It should not be considered individualized medical advice. For specific information on your condition and instructions on post-operative recovery, contact your physician, who will have details about your health and surgery that are necessary for personalized care.