What to Know Before Hysterectomy: How to Prepare Your Pelvic Floor, Core & Body for Surgery
If you are scheduled for a hysterectomy, you have probably already learned the logistics: when and where to arrive, when to stop eating, how long you may need to be off work, and what you are supposed to avoid during the first few weeks of recovery. But another important part of preparing for hysterectomy is understanding how your body works now, improving habits that can affect your abdomen and pelvic floor, and learning skills that can make recovery easier to navigate.
At Cultivate Your Wellbeing, physical therapy before hysterectomy is not about trying to prevent every possible symptom after surgery or completing a long list of exercises. It is an opportunity to understand how your pelvic floor and core are working, address concerns such as constipation, straining, or bladder habits that may be contributing to symptoms, learn how to better manage pressure with everyday movement, and create a plan for gradually returning to the activities that matter most to you.
Going into surgery more informed can take away some of the uncertainty that often comes with recovery. It also means you already have a trusted resource to turn to if questions or pelvic floor concerns come up afterward.
Why Is a Hysterectomy Performed?
A hysterectomy is a surgery to remove the uterus. There are many reasons you and your medical provider may decide that a hysterectomy is the right treatment for you, including:
Uterine fibroids
Adenomyosis
Endometriosis in some circumstances
Heavy or abnormal uterine bleeding
Uterine prolapse
Chronic pelvic pain in certain situations
Gynecologic cancer or precancerous conditions
The reason for your hysterectomy matters because it helps shape both the surgery and your recovery. For example, someone having surgery after years of pelvic pain from adenomyosis may have very different needs going into surgery than someone having a hysterectomy as part of a prolapse repair.
If you are having surgery because of endometriosis or adenomyosis, you may also find our Endometriosis and Adenomyosis 101: Symptoms, Diagnosis, and How Pelvic Floor Physical Therapy Can Help article helpful as you learn more about how these conditions can affect the pelvis.
Know What Type of Hysterectomy You Are Having
One of the first things to know before hysterectomy is exactly what your surgeon plans to remove. The word hysterectomy refers to removal of the uterus, but there are several different types.
Total hysterectomy-The uterus and cervix are removed.
Supracervical or partial hysterectomy-The upper portion of the uterus is removed, while the cervix remains.
Radical hysterectomy-The uterus, cervix, and additional surrounding tissues are removed. This is typically performed when treating certain gynecologic cancers.
Your fallopian tubes and ovaries are separate from the uterus and are not automatically removed with a hysterectomy.
A salpingectomy means removal of one or both fallopian tubes.
An oophorectomy means removal of an ovary.
A salpingo-oophorectomy includes removal of a fallopian tube and ovary.
This distinction is especially important when discussing your ovaries. If your ovaries remain, they can continue producing hormones even though you will no longer have periods after removal of the uterus. Removing both ovaries before natural menopause has different hormonal implications and is worth discussing specifically with your surgeon.
If you are having surgery for prolapse, ask about the entire procedure
A hysterectomy performed for uterine prolapse may be only one part of the surgery. Your surgeon may also be planning a procedure to support the top of the vagina, repair the front or back vaginal wall, or address another pelvic floor concern.
Before surgery, it can be helpful to ask:
Exactly what structures are being removed?
Will my ovaries remain?
Will my fallopian tubes be removed?
How will the hysterectomy be performed?
Am I having any additional prolapse repairs or support procedures?
What restrictions will I have after my specific surgery?
How will I know when I am ready to gradually increase activity?
Knowing what is happening to your body can make the recovery recommendations you receive afterward much easier to understand.
Why Think About Your Pelvic Floor Before Hysterectomy?
Your pelvic floor plays an important role in spinal and core stability, organ support, bladder and bowel control, and sexual function. Understanding how your pelvic floor is working before surgery, and knowing how to support it during early recovery, can help you feel more confident as you heal.
Some women benefit from strengthening. Others already have muscles that are holding too much tension, particularly after years of pelvic pain, painful periods, endometriosis, pain with intimacy, constipation, or bladder symptoms. The goal is to understand your starting point.
Can your pelvic floor contract when you need support?
Can it fully relax when you need to empty your bladder or bowels?
Can you breathe while using your abdominal and pelvic floor muscles, or do you automatically hold your breath and bear down?
Do you know how to lift and bend in a way that manages pressure well?
Learning these things before surgery gives you useful information and practical skills to carry into recovery.
6 Things to Work on Before Hysterectomy
1. Learn How to Contract and Relax Your Pelvic Floor
A healthy pelvic floor needs more than strength. It needs coordination. Ideally, your pelvic floor should be able to gently contract when support is needed and then fully relax again. Both are important. This is especially helpful to understand before hysterectomy because different people come into surgery with very different pelvic floor awareness, strength, and coordination.
If you are having a hysterectomy as part of prolapse treatment, building strength and learning pressure-management strategies may be helpful. You may also have developed a habit of tightening or gripping your pelvic floor in response to pressure or heaviness. Understanding whether your muscles need more strength, more relaxation, or better coordination can help guide what you work on before surgery. To learn more about the different reasons you may feel pelvic pressure, read Pelvic Heaviness Postpartum: Prolapse or Tight Pelvic Floor?.
If you have spent years experiencing pelvic pain, painful intimacy, endometriosis, adenomyosis, constipation, or urinary urgency, your pelvic floor muscles may already be tense or protective. In that situation, simply adding more pelvic floor contractions may not be what your body needs and can sometimes increase symptoms. Learning how to recognize tension and use strategies to help your pelvic floor relax can be an important part of reducing symptoms and improving coordination.
A skilled pelvic floor physical therapist can help determine what your muscles are doing and whether they need more strength, more relaxation, or better coordination. At Cultivate Your Wellbeing, we look at how your pelvic floor works with your breathing, abdominal muscles, movement, and everyday habits so your plan is specific to your body.
2. Get Constipation and Straining Under Control
If constipation is already part of your life, addressing it before surgery is one of the most practical things you can do.
Anesthesia, changes in activity, and some postoperative pain medications can all make bowel movements more difficult temporarily. It is much easier to learn good bowel habits before surgery than when your abdomen is sore and you are trying to recover.
Before your hysterectomy, consider whether you:
Regularly strain to have a bowel movement
Hold your breath while trying to empty
Have hard or difficult-to-pass stools
Spend a long time sitting on the toilet
Feel like you cannot completely empty
Frequently experience constipation
Learning good toilet positioning, breathing, and pelvic floor relaxation can reduce how much you need to strain and make bowel movements easier to manage before and after surgery.
Our article ontoilet positioning and breathing for constipation is a good place to start. From there, you can explore our other constipation resources if you need more support with things like fiber, hydration, movement, or pelvic floor and abdominal contributors.
It is also helpful to ask your surgical team what they recommend for preventing constipation after surgery so you have a plan before you need it.
3. Pay Attention to Your Bladder Habits
Bladder urgency and frequency are symptoms we commonly see in pelvic floor physical therapy after hysterectomy, especially when the pelvic floor is tense, the bladder has become more sensitive, or someone has developed habits such as going “just in case” very frequently.
Before surgery, it can be helpful to notice your current bladder patterns:
How often are you urinating during the day?
Are you regularly going “just in case” even when your bladder is not very full?
Do you rush to the bathroom as soon as you feel an urge?
Are you limiting fluids because you are worried about needing to urinate?
Do you have urgency, frequency, leakage, or pain with a full bladder already?
Understanding your baseline makes it easier to recognize what changes after surgery and when something may benefit from additional support.
A skilled pelvic floor physical therapist can help with bladder retraining, urge-management strategies, pelvic floor relaxation, and identifying habits that may be contributing to urgency or frequency. At Cultivate Your Wellbeing, we also look at how your bladder symptoms relate to pelvic floor tension, breathing, bowel habits, movement, and your overall recovery so treatment is specific to what your body is doing.
4. Practice Breathing and Pressure Management With Lifting
It’s impossible to move perfectly at every moment throughout the day, but it can be helpful to optimize posture and understand what is happening in your body when you are challenged by lifting something heavy or performing a difficult movement.
Many people automatically hold their breath and bear down when they lift, stand up, carry something heavy, or perform a challenging exercise. Learning how to coordinate your breath, abdominal muscles, and pelvic floor, while also building strength through your hips and legs when needed, can help you manage these tasks more efficiently.
Before surgery, you can practice:
Exhaling through the effort of a movement
Using your legs and hips when lifting
Avoiding unnecessary breath-holding
Coordinating abdominal support without bearing down
Adjusting the weight, position, or movement when something feels too challenging
These skills can be particularly useful when you eventually return to groceries, laundry baskets, exercise, yard work, work responsibilities, or picking up children.
If you would like to understand this concept more, read our article on pressure management and the pelvic floor.
5. Go Into Surgery With as Much Strength and Activity as Is Appropriate for You
You do not need to suddenly start an intense exercise program before your hysterectomy. Instead, think about maintaining or gradually building the capacity you already have.
Walking, leg and hip strength, trunk strength, balance, and general activity all contribute to how easily you move through everyday life. Your starting point after surgery may feel different for a while, so having some strength and endurance beforehand can be useful.
Core exercise before hysterectomy does not need to mean crunches or strenuous abdominal workouts either. We often use exercises that combine trunk and hip strength with good breathing and pressure management. A bird dog, for example, can be a great way to practice maintaining trunk support while moving an arm or leg without holding your breath or creating unnecessary downward pressure.
The best exercise will depend on your current symptoms, health, activity level, and the reason you are having surgery. The goal is not to “train for surgery.” It is to go into it feeling as capable and connected to your body as you reasonably can.
6. Understand That Returning to Activity Is a Process
This is one of the biggest things we wish more women knew before hysterectomy. After surgery, you will receive restrictions from your surgeon based on the type of procedure you had and how you are healing. Those recommendations are important and should guide your early recovery.
The confusing part often comes afterward. You may be told not to lift more than a certain amount of weight for several weeks. Then you reach the end of those precautions and are told you are cleared for activity. But what does that actually mean?
If you have been lifting no more than 10 pounds, your first day off restrictions probably is not the day to pick up a 40-pound child repeatedly, carry every grocery bag inside at once, or immediately return to your previous weight-training program.
Healing and rebuilding capacity are related, but they are not exactly the same thing.
A graded return may mean gradually increasing:
Walking distance or pace
Time spent on your feet
Household activities
Lifting weight
Core strengthening
Pilates or yoga
Gym exercise
Running or impact activities
Work demands
Knowing before surgery that you will eventually build back up can help you approach recovery with much more confidence.
Your surgeon determines when your surgical tissues are ready for different activities. A skilled pelvic floor physical therapist can help bridge the gap between being medically cleared and actually feeling strong, confident, and capable returning to the activities that matter to you. At Cultivate Your Wellbeing, we help you gradually rebuild strength, endurance, and movement capacity based on your body, your surgery, and your goals.
What If Pelvic Pain Is One Reason You Are Having a Hysterectomy?
If pain is part of your reason for surgery, we hope treating the underlying condition brings significant relief. It can also be useful to understand whether anything else may be contributing to your symptoms before surgery.
Pelvic pain can come from more than one structure. The pelvic floor, abdominal wall, hips, back, bladder, bowels, nerves, scars, and the way the nervous system has responded to persistent pain can all contribute.
Someone who has spent years tightening her pelvic floor in response to painful periods, for example, may still need help teaching those muscles to relax even after the source of the painful periods has been treated. This does not mean surgery will not help. It simply gives us a fuller picture of your body. Establishing that picture before surgery can be valuable because you know what was present beforehand and what may still deserve attention once you have healed.
If you have endometriosis, our article Why Do I Still Have Pain Months After Endometriosis Surgery? goes deeper into why pelvic pain sometimes has multiple contributors even after successful treatment of endometriosis.
What Does Physical Therapy Before Hysterectomy Look Like?
At Cultivate Your Wellbeing, a pre-hysterectomy physical therapy visit is individualized to your symptoms, surgery, activity level, and goals. Depending on your needs, we may look at:
Your current pelvic floor symptoms
Bladder and bowel habits
Constipation or straining
Your ability to contract and relax your pelvic floor
Breathing and pressure management
Abdominal and core coordination
Hip, leg, and general strength
Current exercise and activity
Existing pelvic or abdominal pain
Lifting and movement strategies
What to expect as you begin moving again after surgery
An internal pelvic floor assessment can provide helpful information for some people, but it is always optional and performed only with your consent.
You also do not necessarily need months of physical therapy before surgery. For someone without significant pelvic floor symptoms, even 1 to 2 visits may be enough to understand your baseline, learn key strategies, and develop a plan.
Someone already experiencing pelvic pain, constipation, prolapse symptoms, bladder concerns, or difficulty coordinating the pelvic floor may benefit from addressing those concerns more fully before surgery.
A Simple Pre-Hysterectomy Check-In
As your surgery approaches, consider these questions:
Can I contract and fully relax my pelvic floor?
Am I having regular bowel movements without significant straining?
Do I know how to breathe and manage pressure when I lift or exercise?
Am I maintaining the strength and activity that feels appropriate for my body right now?
Do I understand exactly what procedures my surgeon is performing?
Do I know my initial postoperative precautions and who to ask when I am unsure about progressing activity?
You do not need to have everything perfect before surgery. The goal is simply to have useful tools, a better understanding of your body, and a starting point for recovery.
Preparing for Recovery Before Surgery
There is a lot to think about when you are getting ready for a hysterectomy, but preparing your body does not have to be complicated.
Learn how your pelvic floor works. Take care of constipation. Practice good pressure management. Keep moving and building strength in ways that feel good for your body. Understand what surgery you are having. And remember that returning to activity afterward will be a progression.
Recovery is not about protecting your body forever. It is about allowing tissues to heal and then gradually helping your body regain the strength, mobility, and confidence you need for everyday life.
Stay tuned, in our next article, we will talk specifically about hysterectomy recovery and pelvic floor physical therapy after hysterectomy, including returning to exercise and lifting, rebuilding core strength, scar mobility, pelvic floor symptoms, intimacy, and what to do when your precautions end but you are not quite sure how to get back to everything you want to do.
Looking for Support Before or After Hysterectomy in Mequon or Brookfield, WI?
At Cultivate Your Wellbeing, we provide individualized pelvic floor physical therapy before and after hysterectomy.
Whether you want to understand your pelvic floor before surgery, address constipation or pelvic pain, learn how to exercise and lift with better pressure management, or have a plan for returning to activity afterward, we can meet you where you are and help you understand what your body needs.
Our Mequon clinic is conveniently located just off I-43, making it accessible from Mequon, Thiensville, Cedarburg, Grafton, and surrounding communities.
Our Brookfield location is centrally located in Brookfield, providing another convenient option for women throughout the greater Milwaukee area and western suburbs.
You do not have to wait until you are struggling after surgery to learn how your body works. A little preparation beforehand can give you useful tools to carry with you throughout recovery.
Ready to prepare for your hysterectomy or looking for support afterward?