Hysterectomies are the second most common surgical procedure for women, right behind C-sections. Removing an organ can feel daunting, and there are many things to consider before and after surgery. As pelvic floor physical therapists, we walk alongside women every day who undergo hysterectomies for a variety of reasons. This guide is designed to help you understand your options, prepare well, and recover with confidence.
Definitions
Before diving in, it’s important to define the different types of procedures:
- Partial (or Subtotal/Supracervical) Hysterectomy – Removal of the upper portion of the uterus while sparing the cervix.
- Total Hysterectomy – Removal of both the uterus and the cervix, while leaving the vagina, ovaries, and fallopian tubes intact.
- Radical Hysterectomy – Removal of the uterus, cervix, and upper portion of the vagina (sometimes also surrounding tissues and lymph nodes, typically done in cancer cases).
Related Procedures
Sometimes additional procedures are performed alongside a hysterectomy. You may hear these terms:
- Oophorectomy – Removal of one or both ovaries (done separately from a hysterectomy).
- Salpingectomy – Removal of one or both fallopian tubes.
- Bilateral Salpingo-Oophorectomy (BSO) – Removal of both fallopian tubes and ovaries.
- Left Salpingo-Oophorectomy (LSO) – Removal of the left ovary and fallopian tube.
- Right Salpingo-Oophorectomy (RSO) – Removal of the right ovary and fallopian tube.
Common Reasons for a Hysterectomy
There are a variety of medical and personal reasons why a woman (or person with a uterus) may consider a hysterectomy. Some of the most common include:
- Cancerous or Pre-cancerous Conditions – Removal of cancer in the uterus, cervix, ovaries, or other reproductive organs, or prevention if abnormal cell changes are detected.
- Adenomyosis (ad-uh-no-my-O-sis) – Occurs when the tissue that normally lines the uterus (endometrium) grows into the muscular wall of the uterus. This tissue still responds to hormonal cycles, which can result in an enlarged, painful uterus, heavy bleeding, and very painful periods.
- Fibroids – Non-cancerous growths (tumors) within the uterus. Fibroids can be asymptomatic, but larger ones may cause heavy or prolonged periods, pelvic pain, pain during intercourse, abdominal bloating, or pressure on nearby organs like the bladder or rectum.
- Menorrhagia (men-or-RAY-juh) – Excessively heavy or prolonged menstrual bleeding. This may be caused by fibroids, hormonal imbalances, blood clotting disorders, or (less commonly) side effects of certain birth control devices.
- Gender Affirmation Surgery – Some individuals pursuing gender-affirming care may choose to undergo a hysterectomy and removal of other reproductive organs as part of their transition.
- Uterine Prolapse – In the past, hysterectomy was often considered the main surgical option for uterine prolapse (when the uterus descends into or outside of the vaginal canal). However, research now shows that a hysterectomy alone does not correct prolapse. Today, this procedure is usually paired with additional repairs (such as a sling or connective tissue support procedure) to address the root cause.
Potential Risks
When an organ is removed, it inevitably disrupts the connective tissues and support structures that help hold everything in place. In the pelvis, the uterus, vagina, bladder, and rectum are all suspended much like objects caught in a spider web. Ligaments connect these organs to the bones of the pelvis, and together with abdominal and pelvic floor strength, bowel habits, and pressure-management strategies, they keep our pelvic organs supported and functioning well.
When these organs shift from their intended positions, we can experience pelvic organ prolapse. Prolapse occurs when an organ sits lower than normal and bulges into the vaginal wall. Common symptoms include feelings of pressure, heaviness, or vaginal bulging, and sometimes urinary or bowel leakage.
Because the uterus plays a key role in pelvic support, removing it changes the dynamics of these connective tissues and ligaments, making women more susceptible to prolapse. This is why some surgeons place restrictions on lifting or strenuous activity in the early weeks after a hysterectomy to protect healing tissues.
Thankfully, prolapse risk isn’t determined by connective tissue alone. Pressure management, breathing mechanics, bowel habits, posture, and core strength all play a major role. Instead of permanently restricting women from lifting, we encourage:
- Deep core and pelvic floor training
- Learning proper lifting and breathing techniques
- Understanding how to manage abdominal pressure
This is why we strongly recommend pelvic floor physical therapy both before and after a hysterectomy. With education and guided training, women can build strong, coordinated core systems that protect against prolapse and support long-term pelvic health.
Surgical Options
There are three main surgical approaches that your surgeon may consider when performing a hysterectomy. The choice depends on the reason for surgery, the size/position of the uterus or fibroids, your overall health, your surgeon’s experience, and your personal preferences. Each option has its own pros and cons:
1. Abdominal Hysterectomy
- How it’s done: An incision (similar to a C-section) is made in the lower abdomen.
- Advantages: Provides the best visibility and access, making it the preferred approach when removing large fibroids or when cancer is suspected.
- Considerations: Recovery time is longer due to the larger incision, and post-operative pain may be greater compared to less invasive options.
2. Vaginal Hysterectomy
- How it’s done: The uterus is removed through the vaginal canal, with no abdominal incisions.
- Advantages: Typically shorter recovery time and less visible scarring.
- Considerations: Limited visibility for the surgeon, and not an option for very large uteri or fibroids. A small number of women may experience changes in intimacy, though pelvic floor therapy can often help restore comfort and function.
3. Laparoscopic (or Robotic-Assisted) Hysterectomy
- How it’s done: Small “keyhole” incisions are made in the abdomen for a camera and surgical instruments. Sometimes robotic assistance is used for greater precision.
- Advantages: Minimally invasive, shorter hospital stay, quicker recovery, and lower risk of certain complications. This approach tends to best preserve sexual function and pelvic support afterward.
- Considerations: Requires longer anesthesia time, and women may experience more temporary post-op soreness from gas used to inflate the abdomen and manipulation of tissues through the small incisions.
No matter which approach is chosen, outcomes are best when paired with proper recovery strategies, including gradual return to activity and pelvic floor rehabilitation.
How to Best Prepare for Your Hysterectomy
As with any surgery, preparation makes a huge difference. Research shows that when women prepare ahead of time, they often experience less stress, less pain, and a smoother recovery. Educating yourself now helps you recognize potential symptoms early—before they become bigger problems—and allows you to feel confident going into your procedure.
Here are some of the most effective ways to set yourself up for success:
1. Focus on Nutrition
The physical task of cooking can be challenging in the first days after surgery, so having 2–3 weeks of meals prepped and ready in your freezer is one of the best gifts you can give yourself. Beyond convenience, what you eat truly impacts recovery:
- High-Fiber Foods – Aim for at least 30 grams of fiber daily to keep bowel movements regular. Constipation is common after surgery and can cause pain and pressure at your surgical site.
- Anti-Inflammatory Foods – Incorporating foods rich in turmeric, omega-3s, and selenium (like Brazil nuts) can help reduce inflammation, lower cortisol, and speed healing.
- Protein – After surgery, protein synthesis slows for 3–7 weeks. Without intentional protein intake, muscle mass can decline. Prioritize high-quality protein (lean meats, legumes, nuts, and plant-based sources) to support tissue repair, gut health, and strength.
- Vitamin C – Essential for wound healing and immune support. Simple ways to boost intake include citrus fruits, carrots, sweet potatoes, bell peppers, and even a squeeze of lemon in your water.
While not an exhaustive list, these are great starting points for supporting your body during healing.
2. Support Bowel Health
Smooth, easy bowel movements after surgery are a top priority. But bowel health takes time to improve—it’s like turning a big ship. Start good habits before surgery so your digestive system is already in a healthy rhythm:
- Get at least 30 grams of fiber per day.
- Drink a warm beverage first thing in the morning (coffee or tea).
- Try natural aids like prunes if needed.
- Use stool softeners if recommended by your provider.
- Aim for one bowel movement per day that looks like soft-serve yogurt or a ripe banana (smooth, soft, and easy to pass).
3. Build Strength Through Exercise
Simply put: stronger people recover better. The stronger your arms and legs are before surgery, the less strain you’ll put on your healing core and pelvic floor afterward. Strength training in general for women provides a wealth of impact and positive results!
We recommend:
- Resistance training 2–3 times per week.
- 2–3 sets of 10–15 reps per exercise.
- Choose a weight that feels heavy—where you could only do 1–2 more reps beyond your set.
This type of training builds resilience, making daily movements easier as you recover.
4. Begin Pelvic Floor Therapy
Meeting with a pelvic floor physical therapist before your surgery is one of the most impactful things you can do. Pre-surgical therapy focuses on:
- Learning how to activate your deep core (pelvic floor + transverse abdominis).
- Strengthening your abdominals.
- Practicing pressure-management strategies.
- Preparing for what to expect after surgery.
Tapping into your pelvic floor after surgery can be harder due to pain, swelling, and inflammation. By learning these skills beforehand, you’ll already know what to do, making your recovery smoother and more effective.
Recovery & Return-to-Exercise Timeline
Every woman’s recovery after a hysterectomy looks a little different, but having a roadmap can take away some of the guesswork. Most post-operative guidelines are broad, often saying things like “rest for 4–6 weeks” or “take it slow” when returning to exercise. While rest is crucial, avoiding movement for too long can actually delay recovery—leading to muscle loss, increased risk of prolapse, and even hernias.
Interestingly, everyday activities like coughing, sneezing, or getting out of bed can put just as much stress (if not more) on tissues as lifting a 20-pound object. That’s why a balanced plan of early rest, gradual movement, and progressive strength training is key for long-term healing and resilience.
Here’s a general recovery framework we use with our patients:
Days 1–14: Rest & Gentle Recovery
- Focus: Healing, circulation, and gentle movement.
- Suggested activity:
- Light walking around your house (increase distance gradually, below symptom level).
- Deep core connection exercises (breath work, pelvic floor + transverse abdominis awareness).
- Gentle bed or mat-based mobility to prevent stiffness and blood clots.
- Rehab focus: Breathing mechanics, hip/shoulder/spine mobility, and a guided walking program.
- Incision care: Depending on your surgical approach, incision management may also be included.
Weeks 3–6: Reintroducing Movement
- Focus: Begin gently loading tissues to stimulate healing and strength.
- Suggested activity:
- Progress to bodyweight movements (squats, bridges, sit-to-stands) with proper bracing.
- Continue deep core work to build a foundation for future exercise.
- Light household activity and meal prep, using safe lifting techniques.
- Rehab focus: Teaching proper lifting strategies, reinforcing pressure management, and gradually expanding your movement toolbox.
Weeks 6–12: Building Your Foundation
- Focus: Progressive strength and endurance training.
- Suggested activity:
- Gradual return to cardiovascular exercise (walking, stationary bike, low-impact cardio).
- Targeted strength work, now including more outer abdominal and functional movements.
- Reintegration of safe lifting for daily activities.
- Important note: Even if your surgeon gives you “the all clear” at 6 weeks, this does not mean an immediate return to pre-surgery workouts. Think of this stage as steadily laying the foundation for long-term resilience.
12+ Weeks: Returning to Full Life
- Focus: Long-term strength, function, and confidence.
- Suggested activity:
- Higher-level strength training (progressive weights).
- Impact training and plyometrics (jumping, jogging) as tolerated—important for bone health, hormone regulation, and overall longevity.
- A full fitness routine designed to support the life you want to live.
- Rehab focus: Ensuring you can move without pain, pressure, or prolapse symptoms so you’re not just “back to normal,” but stronger than before.
The goal isn’t just to recover from surgery, but to build a strong, confident body that supports you for a lifetime.
A hysterectomy is more than just a surgery—it’s a major life event that can stir up emotions, fears, and questions. The unknowns of surgery, recovery, and the loss of an organ are significant, and it’s completely normal to feel overwhelmed. Our goal is to take some of that weight off your shoulders by giving you the knowledge, tools, and support you need to prepare, heal, and return to life with confidence.
With the right nutrition, movement strategies, and pelvic floor therapy, your recovery doesn’t just have to mean “getting back to baseline.” It can be a time to rebuild strength, prevent long-term complications, and feel even more connected to your body than before.
If you’re preparing for a hysterectomy—or already navigating recovery—you don’t have to do it alone. PeakRx can give you the personalized guidance and support you need every step of the way.