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How to Identify Unsafe Abdominal Exercises After a Hysterectomy

After a hysterectomy surgery it is essential to understand how to identify inappropriate abdominal or core strength exercises. Many women unknowingly perform abdominal exercises with the potential for serious pelvic injury when returning to their gym workouts and fitness classes after hysterectomy surgery. Unfortunately many well-intentioned fitness instructors are also unaware of this issue leaving women uninformed, vulnerable and confused about appropriate exercise after pelvic surgery. These physical therapist guidelines are designed to help you identify unsafe abdominal exercises after a hysterectomy.

Exercises involving upper abdominal (or “six pack”) muscles pose the most risk to your pelvic floor. Ultrasound studies show that basic abdominal curl exercises force the pelvic floor downwards in women with poorly functioning pelvic floor muscles. The more intense the abdominal or core exercise, the greater the pressure on the pelvic floor and the greater the risk of pelvic floor overload and reduced pelvic support.

Decreased pelvic support can cause an array of serious pelvic floor problems including; vaginal prolapse, incontinence, pelvic pain and anorectal disorders. Hysterectomy surgery involves the upper vagina being stitched up inside a woman’s pelvis in order to support the vagina and prevent vaginal prolapse (i.e. vagina descending down and sometimes out of the woman’s body). Research suggests the risk of vaginal prolapse is increased after hysterectomy surgery.

This means that it is imperative that you understand how to avoid overloading your pelvic floor after a hysterectomy with inappropriate abdominal exercises.The following abdominal exercises all have the potential to overload the floor of the pelvis and should therefore be avoided after hysterectomy surgery;

  1. Abdominal curl exercises involve lifting the head and shoulders from a lying position and are also known as sit up exercises. Variations include; incline sit ups, oblique sit ups (elbow to opposite shoulder) and fit ball sit ups.
  2. Double leg raises involve lifting both legs off the ground simultaneously. Variations include; bicycle legs, double leg raises, Pilates “Table Top” exercise and fit ball between-legs raises.
  3. Intense core abdominal exercises such as “Plank” or “Hover” which are performed routinely in gym workouts, yoga and Pilates classes. Never assume that just because an exercise is a “Pilates” exercise, that it is safe for and will help strengthen your pelvic support. Some Pilates exercises can place intense pressure on the pelvic floor.
  4. Abdominal strength machines that exercise the upper abdominal and/or external oblique muscles against resistance. These machines increase the pressure within your abdomen that is transferred directly to your pelvis. In fact these exercises will actually make your abdominal muscles even more effective at increasing the downward pressure on the floor of your pelvis.

How to identify unsafe abdominal exercises after hysterectomy surgery?

  • Exercises that involve lying and raising the head and shoulders, and/or both legs simultaneously off the ground all increase downward pressure onto the floor of the pelvis. These exercises all have the potential to cause pelvic floor injury, after pelvic surgery and when the pelvic floor muscles are not functioning well.
  • Exercises performed in prone (lying facing the floor) and weight bearing through the hands/forearms and feet (with the body elevated off the ground are intense core abdominal exercises. These can be modified by kneeling rather than weightbearing though the feet. Sometimes these are performed forward over a fit ball. Once again never assume that using a fit ball makes the exercise safe for your pelvic floor.
  • Abdominal exercise machines that exercise the abdominal muscles in upright or in lying have potential to overload the floor of the pelvis. These types of machines are usually used aiming to “flatten the belly”. It is not possible to spot reduce fat from the abdomen with abdominal exercises however this myth still continues to pervade western society. To flatten your abdomen you need to lose fat from all over your body, it is not possible to lose it through exercise from one spot only.

It is desirable for women to return to exercise after hysterectomy surgery and ensure their long-term pelvic health by exercising appropriately. It takes three months for most women to fully heal from hysterectomy surgery. During this recovery time the pelvic floor is at greatest risk of injury. Women should only return to the types of abdominal exercises listed above with their medical specialist’s approval and when their pelvic floor muscles are strong and capable of withstanding the large downward forces associated with these particular exercises. For some women with poorly functioning pelvic muscles this may mean avoiding intense core abdominal exercises altogether and opting instead for more appropriate gentle core abdominal exercises more suitable for their pelvic health and longevity.