Hysterectomy and pelvic floor recovery: how to regain strength and support
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One of the main jobs of your pelvic floor muscles is to support your uterus, bladder, and other pelvic organs. But what happens when the uterus is removed, and how does that affect everything else?
It’s completely normal to have questions (and even some concerns) about your pelvic floor after a hysterectomy, a surgery that removes the uterus and sometimes also the ovaries. It’s a big surgery — when the uterus is removed, the structures in your pelvis shift. Neighboring organs, such as your bladder and intestines, naturally adjust to fill the space. Your muscles, connective tissues, and nerves adapt along with them.
All of these new changes can temporarily lead to pelvic floor dysfunction. You might notice symptoms like pelvic discomfort, urinary leakage, or a feeling of heaviness or pressure. While this can feel concerning, these responses are often part of your body’s normal healing process.
You can rebuild strength in your pelvic floor muscles and improve coordination with simple treatments, such as exercise therapy and practicing relaxation techniques.
Learn how to support your pelvic floor after a hysterectomy, especially with targeted exercises recommended by Hinge Health physical therapists.
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What happens to your pelvic floor after a hysterectomy?
Your pelvic floor is a group of muscles and connective tissues that stretch like a hammock from your pubic bone to your tailbone. These muscles support your pelvic organs and play an important role in bladder and bowel control as well as sexual function.
Following a hysterectomy — the removal of the uterus — surrounding tissues and muscles shift to support the other nearby organs. “The pelvic floor can react in many ways following this major surgery,” says Caitlin Warner, PT, DPT, a physical therapist at Hinge Health. “Hysterectomy can temporarily disrupt your pelvic floor muscles as your body recovers, which can lead to muscle weakness and fatigue. We can also see more muscle tension if the pelvic floor is working harder to create support or reacting to pain.”
Nerves may also be irritated during surgery, which can temporarily affect sensation as they heal. And like any surgery, scar tissue can form, sometimes limiting mobility or contributing to discomfort.
If your ovaries are also removed, estrogen levels drop more quickly, which can make pelvic tissues more sensitive and may contribute to symptoms like vaginal dryness, discomfort, or prolapse.
But even after all of these changes to your pelvic floor, you can regain strength and comfort with time, movement, and pelvic floor physical therapy.
Symptoms of pelvic floor changes after hysterectomy
Not everyone experiences pelvic floor dysfunction after a hysterectomy, but research shows some symptoms — including changes to pelvic floor and sexual function — are common during recovery and often improve over time. These include:
Urinary leakage or urgency
Pelvic pressure or heaviness (possible pelvic organ prolapse)
Difficulty emptying your bladder or bowels
Discomfort or pain during sex
How movement can help your pelvic floor recover
It’s understandable to feel reluctant about moving around after surgery. But even gentle movement early on can support your recovery.
Once your provider clears you, gentle movement and pelvic floor physical therapy can support your healing. Movement helps improve blood flow, reduce muscle guarding (a natural protective response from your muscles), and retrain your muscles to work together harmoniously again.
“In general, most people can begin targeted pelvic floor exercises around six weeks after hysterectomy, with clearance from their doctor,” says Dr. Warner.
After surgery, some muscles in your core and pelvic region may become less active or “protective.” Others may become overactive. The goal of rehab isn’t just strengthening — it’s more so about restoring balance, coordination, and confidence in movement, bodily functions, and even intercourse.
“When the uterus is removed, the ligaments will be reattached for support, but the pelvic organs lose their central anchor point,” explains Dr. Warner. “Exercises that build strength, improve coordination, and reduce tension can help your body adapt and function more comfortably.”
Consider starting with gentle activity like walking or light stretching, then gradually build into more targeted strengthening exercises as you feel ready.
How soon after a hysterectomy can you do pelvic floor exercises?
Everyone heals differently after a hysterectomy, says Dr. Warner. The type of hysterectomy and surgical method (abdominal or laparoscopic) can also factor into your recovery time. In general, most people can begin gentle pelvic floor exercises around six weeks post-hysterectomy, once cleared by their doctor.
Most people have a post-operative appointment after their surgery — this is a great time to ask your provider when it's safe to start gentle exercise and what types of movement are right for you. Your provider can also take into account any other health conditions that may affect your healing timeline.
Exercises for pelvic floor recovery after hysterectomy
Want expert care? Check if you're covered for our free program →- Diaphragmatic breathing
- Pelvic tilt
- Abdominal bracing with heel slides
- Standing march
- Hip flexor stretch
Together, these exercises support your core and pelvic floor as a unit. “The pelvic floor doesn’t work alone,” says Dr. Warner. “Your hips, back, and abdominal muscles all play a role in support and stability.” Diaphragmatic breathing is essential for promoting relaxation and reconnecting your core and pelvic floor muscles. Pelvic tilts gently stretch and strengthen the back and abdominals, abdominal bracing and the standing march activate core muscles, and the hip flexor stretch targets muscles in the hips.
Practicing all of these movements regularly, once you're cleared to do so, can improve circulation, reduce tension, build strength, and help you move more comfortably as you recover.
A quick note on Kegels:
Kegels can help strengthen pelvic floor muscles, but they’re not always the first step after surgery. “Exercises such as Kegels shouldn’t be started until your doctor gives you clearance,” says Dr. Warner. “Every surgery and recovery is different.”
Early on, focusing on breathing, gentle movement, and coordination can be more helpful than jumping straight into strengthening.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Pelvic floor physical therapy is more than just kegel exercises. Various exercises tailored to your symptoms and needs are key to getting relief. Pelvic floor PT can relieve many different pelvic issues, such as pelvic pain, painful sex, and urinary incontinence.
Members of the Hinge Health pelvic health program experience an average 67% reduction in pelvic pain and 54% reduction in urinary incontinence within the first 12 weeks. Learn more*.
Treatments and strategies for pelvic floor recovery
Treatments and strategies to help ease or prevent pelvic floor problems after hysterectomy and promote pelvic floor recovery after surgery will depend on the nature and severity of your symptoms. Your healthcare provider may recommend a combination of physical therapy and targeted exercise, scar massage, relaxation techniques, and supportive lifestyle strategies.
Here’s more about these treatment options:
Try pelvic floor physical therapy and targeted exercises. Targeted exercises, such as the ones above, can help you build strength, ease tension, and improve range of motion to help ease pelvic floor symptoms after hysterectomy. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit. (Check with your healthcare provider before starting any new exercise routine or resuming activities after a hysterectomy.)
Stay active. You’ll likely have some movement restrictions as you heal, and most people are advised to avoid strenuous exercise or heavy lifting for several weeks. But gentle movement is still important. Walking, in particular, can help boost circulation, improve mobility, and support healing. As your provider clears you, gradually ease back into more activity, including core strengthening.
Engage your core when you lift. While you should avoid heavy lifting during your recovery, if you need to lift something that’s light, gently engage your core, bend your knees, keep the object you’re lifting close to your body, and keep your back neutral to reduce strain. One tip to make movement feel easier? Make sure you exhale as you lift the object up, instead of holding your breath.
Manage constipation. Constipation is common after surgery and can strain your pelvic floor muscles. Aim for at least 25-35 grams of fiber daily (from fruits, vegetables, beans, and whole grains) and stay well hydrated to keep things moving.
Consider scar massage. Scar tissue can become tight and uncomfortable as it heals. Gentle massage (once cleared to do so) can help keep tissues flexible, reduce discomfort, and support healthy circulation.
Practice healthy toilet habits. Sit (don’t hover) to fully relax your pelvic floor, and don’t delay bowel movements. If needed, use a small stool under your feet so your knees are higher than your hips — this can make it easier to go without straining.
Try relaxation techniques. Breathing exercises, progressive muscle relaxation (which involves tensing and then relaxing muscle groups one at a time), and meditation can help reduce muscle tension and calm your nervous system, which may ease pain all across your body.
How to prevent pelvic organ prolapse after hysterectomy
Pelvic organ prolapse happens when the muscles and tissues that support your pelvic organs become weakened or stretched, which can cause organs like the bladder or rectum to move lower than usual. A long-term study found that while prolapse can occur after hysterectomy, targeted prevention strategies can help reduce your risk.
One key factor in prevention is managing intra-abdominal pressure, or the pressure inside your abdomen during activities like lifting, straining, or holding your breath. Too much pressure can put extra demand on your pelvic floor, which may increase your risk of prolapse over time.
To help reduce that strain, focus on:
Strengthening your pelvic floor via physical therapy and targeted exercises
Avoiding breath-holding or straining during everyday tasks
Managing constipation and chronic coughing
Using proper lifting techniques
When to see a doctor
Pelvic floor changes after hysterectomy often improve with simple treatments, such as targeted pelvic floor exercises and time. But if your symptoms are severe, getting worse, or significantly affecting your daily activities, see a healthcare provider. It's also a good idea to get care if you have:
Heavy vaginal bleeding
Severe or worsening pelvic pain
Signs of infection (fever, redness, swelling, discharge)
A visible bulge in the vaginal area
Difficulty urinating or controlling bowel movements
PT tip: Exhale with effort
How you breathe can directly affect your pelvic floor. Slow, steady breathing helps these muscles relax and move naturally, while shallow breathing or breath-holding can increase tension and pressure.
Holding your breath — especially while doing something strenuous — increases pressure in your abdomen, which can strain your pelvic floor during recovery. “A helpful cue is to think ‘exhale with effort,’” says Dr. Warner.
Try this when:
Standing up from a chair
Getting out of bed
Lifting something
Having a bowel movement
How Hinge Health can help you
If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
References
Chang, O. H., Saldanha, I. J., Encalada-Soto, D., Jalloul, R. J., Rozycki, S., Orlando, M., White, A., Yang, L. C., Thompson, J. C., Nihira, M., Bretschneider, C. E., Jeppson, P. C., Balk, E. M., & Gupta, A. (2025). Associations between hysterectomy and pelvic floor disorders: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. doi:10.1016/j.ajog.2025.03.018
Chen, V., Shackelford, L., & Spain, M. (2021). Pelvic Floor Dysfunction After Hysterectomy: Moving the Investigation Forward. Cureus, 13(6), e15661. doi:10.7759/cureus.15661
Forsgren, C., Amato, M., & Johannesson, U. (2022). Effects of hysterectomy on pelvic floor function and sexual function—A prospective cohort study. Acta Obstetricia et Gynecologica Scandinavica, 101(10), 1048–1056. doi:10.1111/aogs.14437
NHS website. (2018, May). Recovery. Nhs.uk. https://www.nhs.uk/tests-and-treatments/hysterectomy/recovery/
T. Kuittinen, Tulokas, S., Päivi Rahkola-Soisalo, Brummer, T., Jyrki Jalkanen, Eija Tomás, Juha Mäkinen, Jari Sjöberg, Päivi Härkki, & Maarit Mentula. (2023). Pelvic organ prolapse after hysterectomy: A 10‐year national follow‐up study. Acta Obstetricia et Gynecologica Scandinavica, 102(5), 556–566. doi:10.1111/aogs.14542