Have you had a hysterectomy? Have you thought about having one?

You aren’t alone!

For a lot of people, a hysterectomy takes care of the systemic issue that’s causing ongoing pain, anemia, pressure, etc. I see it most often in people who have been diagnosed with severe fibroids or adenomyosis (when the lining of the uterus grows into the muscular wall of the uterus). Sometimes it is also an element of the surgery to remove endometriosis, though it really depends the surgeon you ask and often varies case by case.

Someone may also have a hysterectomy because of a cancer diagnosis. Others may decide they would like to have a hysterectomy for some other reasons, of which there are many.

There are generally 3 different kinds of hysterectomies:

Partial hysterectomy – this involves removing the uterus only. The cervix, fallopian tubes, and ovaries are spared.

Total hysterectomy – this involves removing the uterus and the cervix. If they add in a salpino-oophorectomy, this means they have removed at least one fallopian tube and ovary

Radical hysterectomy – this involves removing everything. The uterus, the cervix, part of the vagina, the fallopian tubes, and the ovaries.

In the case of some of these causes of pelvic pain (fibroids, adenomyosis, endometriosis), sometimes the pain can persist. Why does that happen?

The chronic pain that someone has been experiencing due to their diagnosis often leads to muscle guarding in the surrounding area: the abdomen, the pelvic floor, the back muscles, and sometimes even the hip.

Just because the trouble maker (or makers) have been removed, does not mean that everyone’s muscle guarding disappears. This can lead to pain with penetration, cramping after orgasm or vigorous exercise, or chronic low back or hip pain.

Depending on the way that the surgery is done, some people experience vaginal heaviness or pressure, or may notice something falling out of their vagina. This often occurs due to a situational “perfect storm” that happens with this surgery. Often this procedure is done vaginally, which can put a lot of stretch onto the pelvic floor. If you have difficulty with bowel movements after surgery, you are likely straining on the toilet, leading to more downward pressure on the pelvic floor, which can lead to prolapse type symptoms.

Both of these situations can be improved with pelvic floor therapy. By retraining the musculature (like you would after any surgery), symptoms improve and your tolerance for your favorite movements and activities returns.

The final element is hormonal. Sometimes with this surgery blood flow to the ovaries can be effected, reducing the amount of estrogen our bodies produce. This is especially true in situations where the person has a radical hysterectomy. Sometimes this can lead to pain right at the entrance of the vagina, the vestibule, which is very hormonally sensitive. This can lead to a burning or tearing sensation with penetration.

Because of the reduction in estrogen, the vaginal walls lose their thickness, they stop secreting fluids in the same way, and that can lead to changes in the pH of the vagina. This can then result in more frequent UTIs.

This is improved with vaginal estrogen, which is a wonderful medication that I recommend many of my patients speak with their doctors about.

That in combination with pelvic floor therapy can improve many people’s complaints following a hysterectomy.

Does this sound like you? Send me an email today to learn how pelvic floor PT might be right for you!

-Naomi