A hysterectomy, or the surgical removal of the uterus, is one of the most common procedures in the U.S. Around 600,000 women in the U.S. undergo a hysterectomy every year.
According to the American College of Obstetricians and Gynecologists, the most common reasons for a hysterectomy include:
- Uterine fibroids
- Endometriosis
- Uterine prolapse
- Cancer of the uterus, cervix, or ovaries
- Abnormal uterine bleeding
- Chronic pelvic pain
With medical advances, it may be safer and easier to recover from major surgery now than ever before. Recovery starts with rest and a gradual return to exercise and other daily activities. But recovery is different for everyone.
We tapped experts to learn how to return to exercise after a hysterectomy. Here’s what you need to know, including when to start and which exercises to avoid.
How do you exercise safely after a hysterectomy?
There are several surgical options for a hysterectomy, said Kecia Gaither, MD, MPH, a board-certified OB/GYN at NYC Health + Hospitals/Lincoln in the Bronx, New York. These include:
- Total vaginal hysterectomy
- Total laparoscopic-assisted vaginal hysterectomy
- Robotic-assisted vaginal hysterectomy
- Total abdominal hysterectomy
Your recovery time depends on the type of surgery you had.
“Six weeks is typically the time frame given for recovery, after which activities like sex, [light] lifting, swimming, and exercise can resume,” Gaither said.
Consider these tips to help you resume exercise after a hysterectomy. These are general guidelines, so check with your healthcare provider first.
In the hospital: Start light physical activity
Recovery time in the hospital ranges from 24-72 hours, Gaither said. While there, you may see a physical therapist or nurse who will help you start light activity. Examples include:
- Short walks a few times per day
- Pelvic tilts
- Breathing exercises
- Range-of-motion exercises for your arms
You might not feel like doing much in the first days after a hysterectomy. Listen to your body and try to follow your provider’s guidance during this time. Light activity may promote healing and help with a faster recovery.
A very small study tested a physical therapy program in women who had a hysterectomy. The program included short walks and range-of-motion and isometric exercises. After four weeks, the women who did the physical therapy program reported better recovery and quality of life than those who did not.
Weeks 1-2: Practice circulation and breathing exercises
Experts say you should avoid heavy lifting (anything over 10 lbs) for the first three weeks after a hysterectomy. Instead, focus on low-intensity movement.
“In the first two weeks, short walks as needed and gentle movements will help with any post-operative swelling and can improve overall stiffness in the muscles,” said Judith Meer, PT, DPT, physical therapist and certified pelvic rehabilitation practitioner (PRPC).
If you have limited mobility in the first weeks after a hysterectomy, doing circulation exercises during the day can reduce the risk ofblood clots, Meer said. Examples include ankle pumps and heel slides.
“Deep belly breathing exercises done while laying on your back will help mobilize your core muscles, coordinate your pelvic muscles, and gently stretch scar tissue from the inside,” she said.
You can also begin gentle pelvic floor exercises (more on that below) during this time frame.
Weeks 3-6: Gradually increase activity
At this point, experts recommend gradually increasing your walking time. But keep it under 30 minutes at a time. Start on flat surfaces and progress to hills as tolerated. You should also continue pelvic floor- and abdominal-strengthening exercises.
Gaither said to be aware of the following signs that you are overdoing it. Stop any exercise or movement and call your doctor if you have the following symptoms:
- Fever or chills
- Severe pain
- Issues with urinating or defecating
- Nausea or vomiting
- Heavy vaginal bleeding or unusual discharge
- Shortness of breath or chest pain
Weeks 6-12: Slowly progress to higher-intensity exercise
“Low-impact exercises like longer walks can start at 6 weeks,” Meer said. “Stationary cycling is appropriate if it doesn’t feel uncomfortable on the perineum (the area between the vagina and anus).”
You can start gentle exercises such as Pilates and yoga. The goal is to be as active as you can while you gradually resume your daily activities and fitness routine. Continue to avoid heavy lifting for at least 12 weeks, or until your healthcare provider has cleared you.
After 12 weeks: Return to your fitness routine
At this point, you might be able to resume your pre-surgery exercise routine — or something close to it.
“By 3 to 4 months, you can progress to more intense strength training, with a focus on core strength and stability, and cardio activities, like high-intensity workouts or jogging,” Meer said.
Remember to listen to your body. Be aware of any long-term issues after a hysterectomy, Meer advised, especially if you had your ovaries removed during the procedure, as well. And check with your healthcare provider.
The following symptoms may occur after a hysterectomy with ovary removal, which can lead to surgical menopause:
- Changes in pelvic muscle strength
- Decreased libido
- Vaginal dryness
- Painful intercourse
- Urinary leakage
- Hot flashes
- Night sweats
- Sleep problems
- Mood changes
“Don’t think you’re resigned to this ‘new normal’ after your surgery, because it’s never too late to make improvements,” Meer said.
What are the best exercises after a hysterectomy?
Exercise after a hysterectomy is designed to strengthen your muscles — including the pelvic floor and abdominals — as you resume your usual activities.
Talk to your healthcare provider before trying the following exercises. And remember, a gradual progression is best.
1. Kegels
The following kegel exercise may help strengthen your pelvic floor. Pelvic floor exercises after a hysterectomy are essential to restore bladder and bowel function. They can also help restore normal sensation during sexual activity.
Meer suggested talking to a pelvic floor physical therapist (PT) if you have difficulty doing a kegel. A pelvic floor PT can also help you address issues such as back or scar pain when you perform certain movements.
- Step 1: Lie on your back with your knees bent and your feet flat on the floor. Over time, you can progress to sitting and standing while doing kegels.
- Step 2: Squeeze your pelvic floor muscles. To do this, think about squeezing the muscles to stop yourself from peeing (at your vagina) and passing gas (at your anus). Try not to squeeze your buttocks or leg muscles. Focus on the pelvic floor only.
- Step 3: Squeeze and hold for 3 seconds.
- Step 4: Repeat 10 times (or until you feel fatigued).
- Step 5: Do this 3-5 times a day.
2. Pelvic tilts
Pelvic tilts target deep abdominal muscles to help strengthen your core. These muscles help support your back, so there is less stress on your pelvic floor during lifting and other activities. Meer said pelvic tilts may also help relieve any gas if you feel bloated after surgery.
- Step 1: Lie on your back with your knees bent and your feet flat on the floor.
- Step 2: Squeeze your pelvic floor, then focus on contracting your abdominal muscles as you press the small of your back into the floor. You will feel your pelvis tilt back.
- Step 3: Hold for 3-5 seconds and then relax.
- Step 4: Do 2-3 sets of 10-15 reps.
- Step 5: Repeat 3-5 times a day.
3. Bent leg fall-out
This bent leg fall-out exercise can help you build core strength as you regain control of your pelvic floor.
- Step 1: Lie on your back with your knees bent and your feet flat on the floor.
- Step 2: Tighten your pelvic floor and abdominal muscles.
- Step 3: Let one knee fall out to the side. Keep your pelvis and back stationary as your knee slowly falls to the side.
- Step 4: Slowly bring your leg back to the starting position.
- Step 5: Repeat with the other leg.
- Step 6: Continue switching legs, completing 5-10 reps on each side. That’s one set.
- Step 7: Do 2-3 sets.
- Step 8: Repeat 3-5 times a day.
What exercises should you avoid after a hysterectomy?
You’ll need to avoid certain activities and exercises after a hysterectomy. However, restricted activities may differ depending on what type of hysterectomy you had.
Be mindful when doing activities that involve straining.
“It’s very important not to strain with bowel movements or urination post-operatively,” Meer said. “Tightening your pelvic floor muscles [performing a kegel] before you lift, cough, or sneeze is important to decrease the amount of downward pressure you’re applying on this area.”
Here are some general guidelines for activity restriction after surgery. But check with your healthcare provider for specific recommendations.
- No bicycling for at least 3 weeks
- No vacuuming for 6 weeks
- No heavy lifting — 10 lbs or more — for 12 weeks
- No driving for at least 2 weeks
- No sex for 6-12 weeks, depending on the type of surgery
- No standing for more than 30 minutes for the first 6 weeks
- No high-impact activities or competitive sports for at least 12 weeks
The bottom line
A hysterectomy, or the surgical removal of the uterus, is a common procedure. It may be part of a treatment to resolve uterine fibroids, endometriosis, or cancer.
Gentle exercise after a hysterectomy — including short walks, abdominal exercises, and pelvic floor strengthening — plays an important role in the healing and recovery process. But the road to recovery is different for everyone. Talk to your healthcare provider before you try any physical activity after a hysterectomy. Avoid heavy lifting or high-intensity exercise until your provider gives you the OK.
