How to identify unsafe abdominal exercises after a hysterectomy

After 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 injuries when they return to their gym workouts and fitness classes after hysterectomy surgery. Unfortunately, many well-meaning fitness instructors are also unaware of this issue, leaving women uninformed, vulnerable, and confused about proper exercise after pelvic surgery. These physical therapist guidelines are designed to help you identify dangerous abdominal exercises after a hysterectomy.

Exercises that involve the upper abdominal muscles (or “six pack”) pose the greatest risk to the pelvic floor. Ultrasound studies show that basic abdominal flexion exercises force the pelvic floor down 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 less pelvic support.

Decreased pelvic support can cause a number of serious pelvic floor problems including; vaginal prolapse, incontinence, pelvic pain, and anorectal disorders. Hysterectomy surgery involves suturing the upper part of the vagina inside the woman’s pelvis to support the vagina and prevent vaginal prolapse (that is, the vagina descends downward and sometimes out of the woman’s body). Research suggests that the risk of vaginal prolapse increases after hysterectomy surgery.

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

1. Abdominal curl exercises They involve lifting the head and shoulders from a lying position and are also known as sitting exercises. Variations include; Slant crunches, oblique crunches (from elbow to opposite shoulder) and ball crunches.
2. Double leg raises It involves lifting both legs off the ground simultaneously. Variations include; bike legs, double leg raises, Pilates “Table Top” exercise and fit ball raises between the legs.
3. Intense abdominal exercises such as “Plank” or “Hover” that are routinely performed in gym workouts, yoga and Pilates classes. Never assume that just because an exercise is a “Pilates” exercise, it is safe and will help strengthen your pelvic support. Some Pilates exercises can put 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 pressure within your abdomen that is transferred directly to your pelvis. In fact, these exercises will make your abdominal muscles even more effective in increasing downward pressure on the pelvic floor.

How to identify unsafe abdominal exercises after hysterectomy surgery?

• Exercises that involve lying down and lifting the head and shoulders, and / or both legs simultaneously off the floor, increase downward pressure on the pelvic floor. All of these exercises have the potential to cause pelvic floor injuries, after pelvic surgery and when the pelvic floor muscles are not working well.
• Exercises that are performed in the prone position (lying down facing the floor) and with weight bearing through the hands / forearms and feet (with the body raised off the floor are intense core abdominal exercises. These can be modified by kneeling instead of bearing weight with The feet are sometimes performed forward on a fitness ball Again, never assume that using a fitness ball makes the exercise safe for your pelvic floor.
• Abdominal exercise machines that exercise the abdominal muscles in an upright or lying position have the potential to overload the pelvic floor. These types of machines are often used with the aim of “flattening the belly”. It is not possible to reduce belly fat with abdominal exercises; however, this myth still continues to pervade Western society. To flatten your abdomen you need to lose fat from your entire body, it is not possible to lose it by exercising in one place.

It is desirable for women to return to exercise after hysterectomy surgery and ensure their long-term pelvic health by exercising properly. It takes most women three months to fully recover from hysterectomy surgery. During this recovery time, the pelvic floor is at increased risk of injury. Women should only return to the types of abdominal exercises listed above with the approval of their specialist physician and when the pelvic floor muscles are strong and able to withstand 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 for more appropriate gentle core abdominal exercises better suited to your pelvic health and longevity.