Hysterectomy Recovery: Why Pelvic Floor Therapy is the Missing Piece (Pre & Post-Op)

No one gets a hysterectomy “for fun.” Most people arrive at this decision after years of heavy or unpredictable bleeding, chronic pelvic pain, pressure, painful intercourse, or conditions like fibroids or pelvic congestion syndrome. While surgery can be life-changing and necessary, many of the symptoms that lead to hysterectomy are also influenced by how the pelvic floor, core, and nervous system are functioning. Pelvic floor therapy can often help manage pain, pressure, and daily limitations before surgery, while also setting your body up for a smoother recovery afterward.

A hysterectomy removes the uterus, but it also changes your internal landscape. Your body loses an organ that contributed to pressure distribution and support, which means your remaining systems must adapt.

As a pelvic floor therapist here in Moseley, Virginia, I speak with many women who were never told that therapy is an option either before or after their procedure. When an organ is removed, internal pressure shifts and the way your core and pelvic floor muscles coordinate must change. Without guidance, the body often compensates in ways that lead to lingering pain, heaviness, fatigue, or fear of movement.

Check out this quick YouTube video about pelvic therapy before and after a hysterectomy.

Pre-Hab: Muscle Memory is Real

In the video above, I talk about “muscle memory,” which is really about how your brain and body learn to work together. Before surgery, therapy focuses on improving coordination, mobility, and confidence in your movement.

We practice things like getting in and out of bed without straining (log rolling), managing pressure during daily tasks, and mastering exhale on exertion, breathing out when you lift, push, or transition. These patterns matter because your nervous system will rely on them automatically after surgery. Think of this phase as quietly programming your deep core to support healing, protect your incision, and reduce unnecessary strain long-term.

The Post-Op Shift

Once the uterus is removed, the bladder, bowels, and surrounding tissues naturally shift to occupy that space. This is normal. However, this change often brings new sensations like heaviness, pressure, or a dragging feeling that can be unsettling if you were not prepared for it.

In pelvic therapy, we do not focus on strength alone. We focus on internal pressure management, muscle coordination, and functional movement. Think of your core and pelvic floor like an elevator system. As you breathe, the system should move smoothly up and down in coordination. When that rhythm is disrupted, everyday tasks like standing up, lifting laundry, or carrying a child can place unnecessary stress on healing tissues and the pelvic floor.

Retraining Coordination

We help your pelvic floor muscles relearn when to soften and when to gently engage, in sync with your deep abdominal system. When these systems work together, they become more efficient. The goal is not gripping or bracing, but responsive support. This allows your body to conserve energy for healing and movement rather than constantly overworking just to feel stable.

The Power of the Breath

By connecting breath to movement, especially through exhale on exertion, we help regulate pressure inside the abdomen. This reduces the load placed on the pelvic floor and surgical site. Many people notice less heaviness, less pain, and improved endurance simply by learning how to breathe with movement rather than against it.

Functional Movement and the OT Perspective

We do not exercise in a vacuum. We look at how you actually live. How do you get out of bed? Reach for a coffee mug? Pick up your child? Carry groceries?

By integrating breath and pressure management into real-world tasks like getting in and out of the car, lifting the laundry basket, toddler, or car seat, and daily transitions, your recovery happens not just in therapy sessions but throughout your day. The goal is to return you to your meaningful occupations, the things you need and want to do, without feeling like your body is fighting you at every turn.

Natalie, pelvic therapist in Moseley, Woodlake, and Midlothian, Virginia, posing happily with her wide array of pelvic therapy tools that she shares with her clients to help them truly see and understand their own bodies.

Are you preparing for a hysterectomy or navigating recovery in the Moseley, Woodlake, or Midlothian, VA area? At Core + Flow, I specialize in holistic pelvic health for women. I provide one-on-one occupational therapy designed to help you move with confidence, reduce pain, and feel supported through every phase of recovery.

Every recovery is unique. To discuss your specific needs, click here to book a free 15-minute discovery call!

At Core + Flow, we help tweens, teens, and adults stop leaks, pain, and uncertainty from pelvic floor, period, or perimenopause issues so they can trust their bodies and show up for what they love, not just what their symptoms allow.

Disclaimer: The information provided on this website, including videos, text, and graphics, is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or surgical recovery. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this website. Reliance on any information provided by Core and Flow Health is solely at your own risk.