Pelvic Pain After Hysterectomy

Recent studies have indicated that a significant number of women experience chronic pelvic pain, leading to a considerable number of hysterectomies being performed each year as a treatment option. Surprisingly, research suggests that even after undergoing a hysterectomy, up to 25% of these women continue to experience pelvic pain. The factors contributing to the failure of surgery in alleviating pelvic pain still remain unidentified.

What Is Hysterectomy?

A hysterectomy is a surgical operation in which the uterus is removed. It is often recommended as a treatment option for conditions such as uterine fibroids, endometriosis, or gynecologic cancer. Hysterectomy can be of three primary types:

• Total Hysterectomy – This involves the removal of both the uterus and cervix, and it is the most commonly performed type of hysterectomy.
• Partial Hysterectomy – Also known as a supracervical hysterectomy, this procedure removes the upper part of the uterus while leaving the cervix intact.
• Radical Hysterectomy – This is typically performed when gynecologic cancer is diagnosed. The uterus, cervix, and surrounding tissues are removed during the procedure.

Hysterectomies can be performed through different approaches, such as vaginal or abdominal surgery. They can be done using a traditional incision or laparoscopically, or a combination of both methods. Regardless of the approach used, it is crucial to avoid overexertion and take proper care of yourself after the procedure.

In the following sections, we will discuss the signs that indicate you may have overdone it after a hysterectomy, activities that should be avoided, and when it is necessary to seek medical attention.

Signs of Overexerting After Hysterectomy

As a major operation, hysterectomy will be followed by pain. Pelvic pain specialists should be consulted when signs of pain and dysfunction within the pelvic floor start. Below are indications that you have exerted excessive effort following your procedure

• Persistent pain – It’s normal to experience some pain or discomfort after a hysterectomy. Pain medications are typically prescribed for the first 1 or 2 weeks after surgery. However, if you feel increased pain during activities, it may be a sign of overexertion. Take a break and cautiously resume after a few days. As time passes, normal activities should cause less pain. If the pain persists or worsens despite medication, contact your doctor.
• Bleeding or discharge from the vagina – After a hysterectomy, it’s normal to have vaginal bleeding and discharge for a few weeks. This will gradually decrease and eventually stop. If you notice increased bleeding or discharge after certain activities, take a rest and monitor the situation. During recovery, you may need to use a pad. However, if the bleeding or discharge becomes heavy, saturates the pad quickly, or contains blood clots, contact your doctor.
• Leakage from the incision – Leaking a small amount of clear or light red fluid from abdominal incisions in the days following a hysterectomy is normal and will diminish soon. Activities that strain or stretch the incision area can cause more fluid or blood drainage. Stop those activities causing irritation and let the area rest and heal. Wearing loose, breathable clothing may help prevent irritation. However, if you experience a significant amount of fluid or blood that saturates dressings, seek immediate medical attention. Pus draining from the incision indicates an infection and requires prompt medical care.

What Should Be Avoided After the Procedure, and For What Duration?

Your doctor will provide you with detailed information regarding activities to avoid during your recovery. The specific timeframes may differ based on factors such as the type of hysterectomy you underwent, the method used for the procedure, and your overall health. When in doubt, it is important to adhere to your doctor’s instructions. Let’s explore some of these activities and when you can resume them.

• Bathing and showering – After leaving the hospital, you will be given instructions on how to care for your wounds. Generally, you can shower the day after your procedure, but avoid direct contact with the incisions. Gently pat them dry with a clean tissue or paper towel afterward. The specific bathing instructions may vary, and it could take up to 4 weeks before fully submerging in a bath.
• Exercising -After surgery, it is important to engage in physical activity for a speedy recovery. The healthcare staff will provide you with exercise information upon discharge, including pelvic floor exercises. Start with low-impact exercises like walking and consider swimming once wounds have healed and bleeding has stopped. Gradually increase the intensity of your exercise routine, but avoid strenuous activity and heavy lifting until cleared by your doctor. Heavy lifting generally refers to objects over 20 pounds, so remember to bend your knees and maintain good posture when lifting lighter objects.
• Household activities – Ask a family member or friend for help with household activities during your recovery. They can assist with tasks like cleaning, laundry, and meals initially. Gradually, you can resume these activities on your own as you feel better. Break tasks into smaller parts to make them more manageable, taking breaks in between. Modify tasks to reduce strain, like sitting while folding clothes. However, avoid strenuous activities and heavy lifting, including vacuuming, carrying heavy items, and driving during your recovery.
• Driving – Before you resume driving after surgery, ensure you meet specific criteria. This includes being able to operate car controls, feel comfortable wearing a seat belt, and effectively perform an emergency stop. Also, make sure you are no longer taking sedative medications. Assess your comfort level by sitting in your car and practicing driving motions while it’s off. Once you feel ready, have a friend or family member accompany you on your first trip for support and assistance if needed.
• Working – The timing of your return to work after a hysterectomy depends on your job requirements. Remote work may allow for an earlier return compared to physically demanding jobs. For non-physically demanding jobs, you can usually go back to work within 4 to 6 weeks after a laparoscopic or vaginal hysterectomy. With an abdominal procedure, it may take longer, around 6 to 8 weeks.
• Sexual activity – Wait until your surgical wounds have fully healed and vaginal discharge has stopped before resuming sexual activity, typically around 8 weeks after a hysterectomy. Once you’ve reached this point, you can engage in intercourse as long as it feels comfortable. It’s normal to experience a decrease in libido initially, but it usually improves with time. If you experience vaginal dryness, using a lubricant can help alleviate discomfort during sex.
• Traveling – When planning a trip after a hysterectomy, consider factors like duration, comfort during travel, and suitability of activities for your recovery. If you have any doubts, consult your doctor for guidance on potential risks and ensuring a safe journey.

When To Seek Medical Attention After a Hysterectomy?

It is recommended to schedule a follow-up appointment with your doctor approximately 2 weeks after your hysterectomy to evaluate your recovery progress. However, there are certain indications that require immediate medical attention. If you experience any of the following, it is important to contact your doctor:

• Vaginal bleeding or discharge with a foul odor.
• Symptoms of a urinary tract infection, such as frequent urination, painful or burning sensation during urination, cloudy urine, or foul-smelling urine.
• Signs of an infection around the incision site, including fever or chills, tenderness, redness, or swelling around the incision, or pus draining from the incision.
• Persistent constipation or diarrhea.

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Conclusion

Rest and engaging in light physical activity are both crucial aspects of the recovery process after a hysterectomy. Nevertheless, it is important to be mindful of the possibility of overexertion. Indications of overexertion may include heightened pain, vaginal discharge or bleeding, or drainage from the incision site. If the symptoms worsen, it is recommended to contact your doctor. You will receive specific instructions regarding the timing and manner in which you should gradually resume activities during your recovery. Throughout the recovery period, it is essential to exercise patience and listen to your body’s cues.