In this fourth edition of our “What to Expect” series, we’re focusing on hysterectomy recovery from a pelvic floor perspective. If you or a loved one is preparing for this surgery—or recovering from one—it’s completely normal to feel unsure about what comes next. We’re here to walk you through the recovery process and share how pelvic floor physical therapy can help support your healing, confidence, and quality of life.
Recovery After a Hysterectomy:
A Step-by-Step Guide
A hysterectomy is a surgery to remove the uterus and, in some cases, the cervix, fallopian tubes, and/or ovaries. It may be performed abdominally, vaginally, or laparoscopically depending on your condition and your surgeon’s recommendation.
Hysterectomy is a common treatment for chronic pelvic pain, fibroids, endometriosis, abnormal bleeding, cancer, or pelvic organ prolapse. While the surgery can provide relief from symptoms, it also changes how the pelvic floor and core work together—making rehabilitation essential for full recovery.
Before Surgery: Preparing for Success
Proper preparation can help set you up for a smoother surgery and recovery.
Here’s what to expect:
- Pre-surgical Physical Therapy: Strengthening your core and pelvic floor muscles, improving posture, and increasing thoracic and hip mobility can help optimize your surgery outcomes and recovery. Physical therapy before surgery may also teach you techniques for managing pain and improving movement.
- Clearance and Testing: Your surgeon may order various tests (e.g., blood work, ultrasounds, etc.) and perform a physical exam to assess your condition and ensure you’re a good candidate for surgery. You’ll also be asked about your medical history and any medications you take.
- Pre-operative Instructions: You’ll receive specific instructions about when to stop eating and drinking before surgery, which medications to stop taking, and any other necessary preparations.
During Surgery: What Happens on the Day
On the day of surgery, you’ll be admitted to the hospital or surgical center.
Here’s a general overview:
- Anesthesia: You’ll be given general anesthesia so you won’t feel pain during the procedure. In some cases, regional anesthesia (epidural or spinal block) may be used instead.
- Surgical Procedure: The surgery itself typically lasts between 1 to 4 hours, depending on the type of procedure performed. Your surgeon will make small incisions either via the abdomen or vagina to access the pelvic cavity. Depending on the type of hysterectomy, the surgeon will then remove your uterus, and in some cases, the cervix, fallopian tubes and/or ovaries.
- Post-operative Care: You’ll be monitored in a recovery area after surgery to ensure you wake up safely from anesthesia. Pain control, antibiotics, and fluids will be managed as needed.
The First 24–48 Hours After Surgery
Immediately after surgery, the goal is rest and pain control.
You can expect:
- Hospital Stay: Most patients stay in the hospital for 1-2 days depending on the procedure and how you are recovering. Some may be discharged the same day for minimally invasive procedures.
- Pain Management: Medications, positioning, and rest will help manage discomfort in the abdomen and pelvis.
- Mobility Support: Nurses and physical therapists may help you begin gentle walking and deep breathing to reduce complications like blood clots or pneumonia.
- Bladder Care: A catheter may be in place for a short time post-surgery. Some women experience temporary changes in bladder habits.
Starting Your Recovery: Weeks 1–6
In the first 6 weeks, healing takes priority—but that doesn’t mean you can’t support your body. Most patients are not yet in formal pelvic floor therapy but can start gentle foundational practices with guidance from their surgeon and from their pelvic provider if seen prior to the procedure.
What to Expect:
- Activity Restrictions: Avoid lifting anything heavier than a gallon of milk (~10 lbs), straining during bowel movements, or high-impact movement. If needed, supplementation for bowel movements can be helpful to soften stool, under guidance from your doctor.
- Postural Support: Work on supporting your abdomen as needed with transitional movements, such as holding a pillow as you roll to sit up, to avoid excessive straining of your incisions. Make sure you feel supported in your back and abdomen with sitting and lying down and remove supports as tolerated.
- Gentle Core Engagement and Movement: In this early stage, you may begin light diaphragmatic breathing, gentle pelvic floor awareness, and light walking as tolerated to reduce the risk of blood clots. If you have symptoms such as heaviness, incontinence, or pain, these can be signs to decrease activity and will be addressed with physical therapy.
Rebuilding Strength and Function: Weeks 6–12
This is when many patients are cleared for pelvic floor physical therapy and are ready to rebuild function.
What to Expect:
- Pelvic Floor Evaluation: We assess how well your muscles are activating, coordinating, and supporting pelvic organs. We’ll also examine scar mobility and core engagement. Assessments can be performed externally or may be performed internally with one gloved finger and lubrication, gently assessing the muscles of your pelvic floor. This will be explained in detail and consent will be taken before any internal work is performed.
- Rehabilitation Begins: Guided, individualized therapy focuses on gentle strength, posture, bladder and bowel control, and returning to pain-free movement.
- Scar & Soft Tissue Work: Gentle hands-on work may help with tightness or pain around surgical scars.
Long-Term Recovery: 3 Months and Beyond
While most people feel significantly better within 3 months, full pelvic floor recovery may take longer—especially if you had pre-existing issues like prolapse, incontinence, or chronic pelvic pain.
What to Expect:
- Full Function Goals: Return to exercise, intimacy, travel, and other meaningful activities. We tailor your rehab to your lifestyle and goals—whether that’s lifting your kids, going on hikes, or running a marathon!
- Ongoing Strength & Support: We continue building endurance and strength while keeping an eye out for symptoms like heaviness, leaking, or discomfort that can arise as activity increases.
- Education for Prevention: You’ll learn strategies to prevent issues like future prolapse or strain, including lifting techniques and core coordination strategies.
WHAT ABOUT MY SCARS?
Scar tissue is a natural part of healing after a hysterectomy, but without proper mobility, it can cause discomfort or restrict muscle movement. Scars may be present at the abdomen or within the vagina, depending on the approach utilized.
Healing Timeline:
- 0–2 weeks: Focus on rest, hydration, and incision care. No deep massage or topical treatments.
- 3–6 weeks: Begin gentle scar desensitization (like light fingertip tapping or feather brushing around the site).
- 6+ weeks: After the wound has closed, more hands-on soft tissue release and mobilization can be performed, either on yourself or from your pelvic floor physical therapist. Abdominal and internal scar tissue mobilization are included, as needed and with your consent. This is beneficial to improve mobility and sensation in the scar tissue and decrease pain, if present.
Based on your presentation, we may use tools such as manual therapy, cupping, or scar massage techniques to help soften tissue and restore normal movement patterns.
Tips for a Smooth Recovery
- Honor the healing timeline: This is major surgery—even if it was done laparoscopically. Give yourself grace.
- Be proactive with therapy: Waiting too long to address symptoms like leaking, pain, or heaviness may delay recovery.
- Communicate with your team: Your PT, surgeon, and pelvic health providers want you to thrive—we’re here to help.
