Recovering From a Hysterectomy: Reflections From a Physio Who Became the Patient

Getting a diagnosis and treatment plan for a hysterectomy can be scary. Clinically, you can be assured that the odds of a good outcome are in your favour; your doctors know exactly what the problem is and how to treat it. However, few medical professionals address the psychological aspect of loss and the fear that accompanies this journey.

As a physiotherapist who recently went through a hysterectomy, I found myself experiencing the exact physical and emotional challenges I treat every day. Here are my thoughts, strategies, and practical tips on recovering from abdominal surgery, straight from a clinical and personal perspective.

Overcoming the Fear and Grief

Knowledge definitely helps reduce some of the fear, even if it doesn’t remove it completely.

• Listen to Stories: Seek out people who have done it before you and listen to their experiences. Their stories will vary widely—some more optimistic than others—but realising you are not alone and that this procedure is quite normal helps ease the anxiety.
• Process the Loss: Hearing recovery stories will also help you process the grief of impending loss.
• Find Your Middle Ground: Since everyone has a different physiology and unique beliefs about pain and recovery, your own journey will likely fall somewhere in between the most optimistic and pessimistic stories you hear.

1. Loss of Functional Capacity

The effects of post-surgery on the body in terms of muscles and joints—and your ability to do regular activities—are significant and swift.

Getting out of bed, turning in bed, walking, picking up a flask of water, sitting to standing, and opening doors will suddenly become effortful++. You will quickly realise just how much the abdominal muscles are involved in these seemingly effortless activities.

• Get Help: It is perfectly okay to get your family members to do these tasks for you. It won’t be forever.
• Be Creative: Use other muscles in your body, like your arms and legs, to help out.
• The 4-Week Rule: Use these compensatory strategies for the first 4 weeks post-op. After this, start gradually incorporating your abdominal muscles back into these activities and reduce the compensations.

2. Deconditioning

Because of the pain, your activity levels will reduce significantly. You will move less, your exercise levels will drop, and your muscles will get smaller and less strong since you aren’t providing the stimuli to maintain or grow them.

This deconditioning happens from your shoulders (since you can’t lift) and your abdominals (as you protect the surgical site) to your lower limbs—specifically your butt, quads, and legs—since you cannot walk or load them much.

• The Strategy: Do walking as tolerated, balance standing, and sit-to-stand exercises that do not increase too much load on the abdominals.

3. Stiffness

Due to the loss of mobility, particularly during the first 10 days, your body will start feeling stiff and achy. Interestingly, these are areas that aren’t even near the surgical site.

Your shoulders, upper back, lower back, and hips will start feeling stiff, and the surrounding muscles will feel tight. To get relief, you must maintain mobility and flexibility in these areas.

4. Muscle Guarding

Because of the experience of pain, the psychological need to protect the surgical area is very intuitive. Thus, even after it is no longer clinically necessary, our brain continues to train our abdominals, back muscles, and hip muscles to protect the area.

This creates a lot of unnecessary tension and discomfort. To relax these muscles, focus on:

• Deep Breathing: Practice deep breathing, letting the abdominals expand on inspiration.
• Mindful Walking: Deliberately let go of the abdominal muscles when walking to promote relaxation.
• Meditation: Use meditation to help quieten the nervous system and release muscle tension.

5. Practical Comfort Strategies

• Abdominal Bracing: Using an abdominal brace to support the abdominals in the early stages is highly useful for wound support and pain management. However, it does get cumbersome and sweaty when used for walks.
• Supportive Bike Shorts: An excellent alternative is using very supportive bike shorts. Not only does it feel better, but it also doesn’t make you feel like you are unwell.
• Lightweight Trainers: Wear lightweight trainers that provide good shock absorption. This reduces the amount of work the abdominals have to do (because the shoe is light) and the shock absorption quality reduces the jarring force entering your pelvis and abdominal area.
• Pacing Your Walks: Walk short distances more frequently, rather than trying to aim for one long walk.

6. Cognitive Capacity

Concentration and mental work are much more difficult during this period, especially during the first 3 weeks.

Whether this brain fog is caused by medication, fatigue, pain, or the lack of structure during hospitalisation leave, the best approach is to not fight it. Your body and brain really just need more rest while healing.

7. Expect the Unexpected

Recovery is not linear. Do not benchmark your progress with what is rigidly expected. In fact, to avoid disappointment and anxiety, reduce your expectations; if you get better before your expected timeline, that is a bonus.

• Allow 6–8 Weeks: Give yourself a realistic 6 to 8 weeks for recovery. Do not assume you will get there in 4.
• The True Progress Marker: More importantly, if you can do more than you could last week, that is you moving forward in your recovery!

Get a Customised Recovery Plan

In terms of specific exercises to reduce deconditioning, improve abdominal strength, and get your pre-surgery function and lifestyle back, it is best to speak to a physiotherapist. Every individual has a different starting and end point, and a professional can customise an exercise program tailored safely to your body.