3 Things Your Surgeon Won't Tell You After Your Hysterectomy

I'm not gonna lie.

People who are all like "these are the 3 things that :insert expert here: would never tell you" annoy me go no end; these statements are positioned to create fear and uncertainty in a profession that this person is (probably) trying to grift from. So I take these statements with a grain of salt, and I encourage you to do the same.

That being said, I've been a pelvic floor physical therapist long enough to know that there are, in fact, things that your surgeon (probably) will not tell you after getting a hysterectomy.

Not because they're bad surgeons or don't know their stuff.

But because they are not pelvic floor PTs.

They don't know what we know because they don't do what we do. There are a bazillion reasons for why that is, for which I might write another blog post, but for now let's leave it at that: surgeons are not pelvic PTs just like pelvic PTs are not surgeons. We have different educational backgrounds and different areas of expertise.

So, without further ado, let's check out the 3 things your surgeon might not tell you after getting a hysterectomy...

1) If you've had your ovaries removed, you might benefit from topical estrogen. This is usually prescribed by your doctor, and it helps decrease that irritated, skin "ripping" feeling around your vulva and your vaginal opening. Your vulva has estrogen receptors, and your ovaries produce estrogen: when they're removed, these tissues don't get the best hormone nutrition so to speak. If you're not a candidate for topical estrogen, a hyaluronic acid made specifically for vulvas and vaginas, might be your next best bet! And even if you still have your ovaries but are going through peri/menopause, these might be good tools to have in your pelvic floor tool box.

2) You are going to have scar tissue build up in your abdomen, especially if you've had a laparoscopic surgery. A buildup of scar tissue with any surgery prevents those muscles from actually getting strong; instead, they rely on that tension from the scar to do a lot of the work for them instead of performing optimally. And while you're never going to be able to totally prevent scar tissue from forming, as this is part of the normal healing process, there are things you can do to prevent the complications from scar tissue from forming:

• Always exhale when you're doing something...exhale when you're sitting down, exhale when you're standing up, exhale when you're lifting, exhale when you're pulling, exhale when you're pushing.

• Don't hold your breath (especially when you're doing hard things).

• Practice diaphragmatic breathing where on the inhale, you're allowing your ribs and belly to expand outward, but you're not pushing the air down. This sets up an environment for your abs to perform optimally.

3) Your pelvic floor muscles are probably going to be on the tighter side, and this is due to a couple of factors: one being that you've just had an organ removed that your pelvic floor helps support. The other point being that your deep abs probably are not the strongest to help work with the pelvic floor, partly because of swelling and the nature of the surgery itself (refer back to the scar tissue blurb in #2). So, the pelvic floor feels like it needs to overcompensate and do the most, leaving it in an environment where it can't relax fully. And remember: where we get our strength is from both a muscle's ability to be flexible and relax and also contract well. Here are some pelvic floor calming tips:

• Just like it helps with relaxing your abs, diaphragmatic breathing will also help relax the pelvic floor, where on the inhale, you're thinking about your vaginal opening slightly softening and opening (sometimes visualizing a flower blooming helps with this) without pushing the air down.

• Working on deep ab strength to help combat the pelvic floor wanting to take over, and working on the coordination of both muscle groups so they perform together vs one taking over for the other.

• Not clenching anything on your body: so not squeezing your butt cheeks together, not standing with a backward lean where your shoulders come back and behind you, and not standing with your hips resting against the counter as you wash the dishes or brush your teeth. You're making sure everything is relaxed, so that your pelvic floor has the ability to gain flexibility instead of being jacked up in protection mode all the time.

So remember: surgeons are great at what they do. They are amazing at surgical interventions and knowing whether those interventions "took" or need some additional assistance. They're also really great at assessing how your healing is going and if there are any red flags to be aware of.

What they're not the best at are understanding the musculoskeletal components when it comes to surgical aftercare and how to rehab those areas.

Because they're not rehab professionals.

And that is okay.

It's why pelvic PTs exist.

It seriously takes a village to build pelvic floors that are strong and resilient AF.

And I deeply believe that.