Undergoing a hysterectomy is a major surgery and turning point in your life; if you begin to experience pelvic floor pain after your procedure, you may struggle to discern the cause or understand the best way to treat it.

In a nationwide study of 1,299 women, 31.9% experienced chronic pain one year after their surgery. Doctors identified several risk factors of post-hysterectomy pelvic floor pain that can be useful in determining why they experienced these symptoms and the best way to go about treating them.

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Is It Normal to Have Pelvic Pain After a Hysterectomy?

Between 2 and 3% of women experience pain in their pelvic floor after undergoing a hysterectomy. Some of the pain is linked to the development of scar tissue, and it may appear similar to menstrual cramps.

Post-surgical pelvic floor pain can vary; some women experience pain that is similar to what they felt before their operation while others have pain at different times and in varying intervals.

Pain After Urination

It’s not uncommon for women to report changes to their bladder after a hysterectomy. These changes include changes and duration of urination, pain increasing prior to urination and relieving after, feeling a strong urge to urinate and feeling as though you cannot enter your bladder enough.

If you experience pain after urination, this could be the result of bladder spasms, a common symptom women report after surgery. Bladder spasms are often caused by weakened pelvic floor muscle or damage to the nerve areas surrounding the bladder.

These symptoms tend to resolve on their own within three months, but you can help alleviate them by practicing pelvic floor exercises. Some patients also find it helpful to manage their pain with medication as per their doctor’s recommendation.

Pain During Sexual Intercourse

Sexual intercourse can be painful for women following a hysterectomy due to unhealed muscle and tissue. You should wait at least six weeks post-op before engaging in any sexual intercourse; likewise, doctors advise avoiding any other insertions, such as tampons, during this time to allow the body enough time to heal.

Because orgasm includes the contraction of pelvic muscles, attempting to be sexually intimate in other ways may also be uncomfortable or painful. If you underwent a total hysterectomy, you may also experience significant fluctuations in your hormone levels. This can trigger hormonal menopause, which can cause vaginal dryness, weakened vaginal muscles and even vaginal atrophy.

In addition to sharing these symptoms with your doctor, you might also consider incorporating pelvic floor therapy into your treatment. By strengthening the pelvic muscles, you can provide greater strength and support to your internal organs. This can also decrease the pain caused during intercourse and orgasm.

General Pain

Pelvic pain after a hysterectomy can be disruptive and persistent; this is often due to a condition called hypotonia. Hypotonia reduces the muscle tone of your pelvic muscles, though they are still contracted. Reduced blood flow to the area can increase inflammation, which only worsens irritation and painful symptoms.

Pelvic hypotonia can lead to bladder issues as well, including difficulty emptying the bladder, urinary tract infections (UTIs) and incontinence.

What Causes Pelvic Pain After a Hysterectomy?

Many women develop pelvic floor dysfunction after surgery due to muscle trauma; even when a procedure is carried off flawlessly, the lower abdominal wall and pelvic muscles undergo trauma during a hysterectomy.

Generally, symptoms resolve over time as the muscles and connective tissues heal. However, in some cases, women may experience pelvic pain for years after a hysterectomy. Residual ovarian syndrome (ROS) can occur in women whose operation left one or both ovaries intact. After their procedure, they may develop ongoing pelvic floor pain and dysfunction that leads to residual symptoms.

How Long Does Hysterectomy Pelvic Pain Last?

The pain from your surgery is likely to last for several weeks and gradually resolve over time. However, it’s important to recognize the typical post-operative symptoms so you can manage them to the best of your ability.

It’s common to experience some mild pain and discomfort after a hysterectomy, including:

• Bleeding and vaginal discharge.
• Vaginal dryness.
• Menopausal symptoms, such as night sweats, hot flashes and insomnia.
• Redness, burning, itching and pain around the incision site.
• Numbness around your stitches that moves down your leg.

While most patients recover fully on their own within 6 weeks, some problems may persist for longer. Although it is uncommon, some women develop pelvic organ prolapse, a condition in which pelvic organs, like the bowel, slip from their normal position into the vagina.

Pelvic floor exercises can help prevent organ prolapse, especially after surgery when you are more likely to develop the condition.

Risk Factors for Pelvic Floor Dysfunction After Hysterectomy

There are several primary risk factors to be mindful of after your surgery. The most common cases of post-op pelvic floor dysfunction are:

• Limited mobility
• A weak core and pelvic muscles
• History of pelvic hypotonia

In all of these cases, the best way to reduce your risk and moderate pain is to perform pelvic floor exercises. However, you may experience a combination of symptoms that require multiple specialists to develop the most effective pain management plan.

How Pelvic Floor Therapy Can Help Your Recovery

Hysterectomy surgery often limits how much and what types of physical activities you can perform for at least six weeks following your procedure. However, you can safely perform pelvic floor exercises in therapy that not only aid the healing process but help reduce painful symptoms.

Pelvic floor physical therapy is a specialized service that helps address both general pain and specific symptoms unique to your body. If you are in the early stages of recovery, strengthening your pelvic floor muscles can help improve bladder function, reduce incontinence and make transitioning back into sexual intercourse easier.

Strengthening the pelvic floor muscles can also help reduce the risk of pelvic organ prolapse. By stimulating the muscles in a safe and easy way, you learn how to control your pelvic muscles to increase blood flow, ease nerve pain and ease muscle tension.

What to Do if You Experience Pelvic Pain After Surgery

After your hysterectomy, you should reach out to your primary care physician if you experience any pain, discomfort or other problems. They may refer you to a specialist to further help you treat your symptoms.

If you are interested in exploring pelvic floor therapy as one way to manage your pain or post-op symptoms, we are here to help. Please contact the team at Lake City PT to schedule an appointment.