Your Pelvic Floor After a Hysterectomy: Recovery, Exercises and Prolapse Risk

A hysterectomy removes the womb, and while it is not a pelvic floor operation, it changes the structures the pelvic floor works with: the NHS lists pelvic surgery such as a hysterectomy among the causes of pelvic organ prolapse.¹ That does not make a prolapse inevitable. It makes the pelvic floor something worth thinking about before the operation, during recovery and in the years after.

I have not had a hysterectomy. A colleague in the staffroom had one last spring, after years of heavy bleeding, and asked me afterwards, knowing what this site is, whether she should “do the exercises”. Nobody at the hospital had said anything to her beyond a leaflet she had lost by the time she got home. The honest answer turned out to be “probably, but ask the people who did the operation when”, which is less satisfying than it sounds and more useful than nothing. This page is the longer version, checked by a specialist pelvic health physiotherapist.

What a hysterectomy changes

A hysterectomy removes the womb and sometimes the cervix, ovaries or fallopian tubes, through the abdomen, through the vagina or by keyhole surgery; the route and what is removed both shape recovery.² The womb sits above the pelvic floor and is held in place by ligaments and connective tissue that also support the top of the vagina. Removing it means the surgeon has to secure the top of the vagina in a new way.

That is the main reason pelvic surgery appears on the NHS list of prolapse causes. The others on the same list are pregnancy and childbirth, being overweight, long-term constipation and straining, and persistent coughing, and prolapse becomes more likely with age, particularly after the menopause.¹ Many people who have a hysterectomy already have one or more of those, which is part of why it is hard to say how much the operation itself adds.

The definition problem from the rest of this site applies here too. Prolapse measured by symptoms affects about 3% to 6% of women; measured by examination, up to 50%.³ Being told that you “have some prolapse” after surgery can mean a finding on examination that causes no symptoms at all, and treatment is aimed at symptoms, not findings. Prolapse symptoms versus prolapse stage explains the gap.

Recovery: the NHS timeline

The NHS says people may leave hospital 1 to 4 days after a vaginal or laparoscopic hysterectomy and up to 5 days after an abdominal one, and that full recovery from an abdominal hysterectomy takes about 6 to 8 weeks, often less after the other routes.²

Question	What the NHS says
Hospital stay, vaginal or laparoscopic	May be able to leave 1 to 4 days later
Hospital stay, abdominal	Usually up to 5 days
Full recovery, abdominal	About 6 to 8 weeks
Full recovery, vaginal or laparoscopic	Often shorter
Lifting	Do not lift heavy objects during recovery; bend knees and keep back straight for light ones
Return to work	May be possible after 6 to 8 weeks if the job does not involve manual work or heavy lifting
Exercise	Walking is always recommended; swimming once wounds have healed
Driving	Not until you can wear a seatbelt comfortably and do an emergency stop

Those are general figures, and your own team will give you instructions for the operation you actually had. The lifting advice matters for the pelvic floor as well as the wound, because heavy lifting raises pressure in the abdomen, and that pressure lands on the pelvic floor and the newly secured top of the vagina.

Where pelvic floor exercises fit

The NHS says hospital staff may show you pelvic floor exercises to help with your recovery, and NICE NG210 encourages women of all ages to do pelvic floor muscle training and to continue it throughout life.²⁴ So exercises are part of the picture. When to start, how gently and how to progress after surgery is a question for your own surgical team, because it depends on the operation.

The thing my colleague found most useful was being told to ask a specific question rather than a general one. Not “should I do pelvic floor exercises?” but “when can I start them, what should they feel like in the first weeks, and when should I build up?” She rang the ward with those three questions and had an answer in one phone call.

The usual caveat applies with extra force after surgery. Strengthening is not right for every pelvic floor. If you have pain, pain with sex, or difficulty emptying, the muscle may be overactive rather than weak, and squeezing harder can make that worse. Hypertonic pelvic floor and downtraining explains what is done instead, and it is why an assessment comes before a programme.

If you already had symptoms before surgery

If you leaked, had a prolapse or had bowel symptoms before the hysterectomy, raise them before the operation, because they affect what is planned and what happens afterwards. Some symptoms may be addressed as part of the same surgery; others will need their own treatment later, and a programme of physiotherapy before surgery is one option to ask about.

Physiotherapy before and after pelvic floor surgery covers the idea of preparing beforehand in more depth. It was written with prolapse and continence surgery in mind rather than hysterectomy, but the principle that it is easier to learn a contraction before an operation than in the sore weeks after it applies here too.

If you were already on a supervised programme, do not simply stop it and hope to pick it up later. Ask when to restart and whether anything should change.

If a prolapse appears afterwards

A prolapse after a hysterectomy is treated according to its symptoms and stage, and for a symptomatic stage 1 or stage 2 prolapse NICE NG123 recommends considering a supervised programme of pelvic floor muscle training for at least 16 weeks.⁵ NG210 frames the same population anatomically, as prolapse that does not extend more than 1 cm beyond the hymen on straining, and recommends considering at least 4 months.⁴ Both durations derive from the same evidence.

The symptoms to watch for are the ones the NHS lists: a feeling of heaviness, discomfort or pressure in the lower tummy or vagina, a bulge or lump inside or coming out of the vagina, pain or numbness during sex, problems emptying the bowel, and bladder problems such as leaking on a cough or sneeze.¹ A prolapse after a hysterectomy is often described as a vault prolapse, meaning the top of the vagina has moved down, but the name matters less than getting it assessed. Pelvic organ prolapse covers the options in full.

When to get help

The NHS says to see a GP after a hysterectomy if you have heavy vaginal bleeding, start passing blood clots or have a strong-smelling discharge.² A wound that opens, signs of infection with a fever, or feeling generally unwell need help the same day, and a prolapse that is painful, will not go back or changes colour is also a same day problem.

The full standing list is on pelvic health red flags. For everything slower, such as a new dragging feeling, new leaking or a bowel that will not empty, a GP or your surgical team can refer you to pelvic health physiotherapy. My colleague is back to her Saturday walks with the dog and does her exercises when the kettle goes on, which is how most of us end up doing them. She says the single most useful thing was having someone tell her the question to ask.