What Causes Pelvic Pain Years After Hysterectomy latest 2023

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How to Identify Unsafe Abdominal Exercises After a Hysterectomy

After hysterectomy surgery, it is essential to understand how to identify inappropriate abdominal or core strength exercises. Many women unknowingly perform abdominal exercises that can lead to serious pelvic injuries when they return to their workouts and fitness classes after a hysterectomy. Unfortunately, many well-meaning fitness instructors are also unaware of this problem, leaving women uninformed, vulnerable, and confused about proper exercise after pelvic surgery. These guidelines for physical therapists are designed to help you identify dangerous abdominal exercises after a hysterectomy.

Exercises involving the upper abdominal (or “six pack”) muscles pose the most risk to your pelvic floor. Ultrasound studies show that basic abdominal curl exercises force the pelvic floor down in women with poorly functioning pelvic floor muscles. The more intense the abdominal or core exercise, the greater the pressure on the pelvic floor and the greater the risk of overloading the pelvic floor and reduced pelvic support.

A decrease in pelvic support can lead to a range of serious pelvic floor problems including; vaginal prolapse, incontinence, pelvic pain and anorectal disorders. Hysterectomy surgery involves stitching the upper part of the vagina back inside the woman’s pelvis to support the vagina and prevent vaginal prolapse (i.e. the vagina descending and sometimes out of the body of wife). Research suggests that the risk of vaginal prolapse is increased after a hysterectomy.

This means that it is imperative that you understand how to avoid overloading your pelvic floor after a hysterectomy with inappropriate abdominal exercises. The following abdominal exercises all have the potential to overload the pelvic floor and should therefore be avoided after a hysterectomy;

  1. Abdominal curl exercises involve raising the head and shoulders from a lying position and are also known as seated exercises. Variations include; incline sit-ups, oblique sit-ups (elbow to opposite shoulder), and ball sit-ups.
  2. Double leg raises involves lifting both legs off the ground simultaneously. Variations include; bike legs, double leg raises, Pilates “Table Top” exercise and between leg raises with fit ball.
  3. Intense abdominal exercises such as “Plank” or “Hover” which are performed regularly in gym workouts, yoga and Pilates classes. Never assume that just because an exercise is a “Pilates” exercise, that it is safe and will help build your pelvic support. Some Pilates exercises can put intense pressure on the pelvic floor.
  4. Abdominal muscle machines that exercise the upper abdominal and/or external oblique muscles against resistance. These machines increase the pressure in your abdomen which is transferred directly to your pelvis. In fact, these exercises will make your abdominal muscles even more effective at increasing downward pressure on the floor of your pelvis.

How to identify dangerous abdominal exercises after a hysterectomy?

  • Exercises that involve lying down and raising the head and shoulders, and/or both legs simultaneously above the floor, all increase downward pressure on the floor of the pelvis. These exercises all have the potential to cause injury to the pelvic floor, after pelvic surgery and when the pelvic floor muscles are not working well.
  • Exercises performed in the prone position (lying down facing the ground) and in support on the hands/forearms and feet (with the body raised above the ground) are intense abdominal exercises. These can be modified by kneeling rather than bearing the weight on the feet. Again, never assume that using a fit ball makes the exercise safe for your pelvic floor.
  • Abdominal exercise machines that exercise the abdominal muscles while standing or lying down can overload the floor of the pelvis. These types of machines are generally used for the purpose of “tummy flattening”. It is not possible to reduce abdominal fat with abdominal exercises, but this myth continues to permeate Western society. To flatten your abdomen you need to lose fat all over your body, it is not possible to lose it by exercising from one place.

It is desirable for women to return to exercise after a hysterectomy and ensure their long-term pelvic health by exercising appropriately. It takes three months for most women to fully recover from hysterectomy surgery. During this recovery period, the pelvic floor is most at risk of injury. Women should only return to the types of abdominal exercises listed above with the approval of their medical specialist and when their pelvic floor muscles are strong and able to withstand the significant downward forces associated with those particular exercises. For some women with poorly functioning pelvic muscles, this may mean avoiding strenuous abdominal exercises altogether and opting instead for more appropriate gentle abdominal exercises that are more suited to their pelvic health and longevity.

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