Physiotherapy for Gynaecology

You will shortly be undergoing surgery for hysterectomy or repair.

You may not be seen routinely by a Physiotherapist on the ward however, this leaflet outlines general advice given to you in the preoperative 'GynaeSchool' (hyperlink to page on Gynae school (and in future to video presentations) that you attend before being admitted to hospital.

The modern approach to surgery is to follow an enhanced (early) recovery pathway.  This means a lighter and safer anaesthetic, pain relief based on less sedating medications, the ability to eat before and after surgery and hence a shorter stay in hospital because you will feel well enough to go home sooner.  You can help yourself in this process by complying with guidance outlined below.  However, your recovery and the overall experience of surgery will depend on you general health and fitness before the operation and the reason that you required the surgery in the first place.

Physiotherapy exercises that will aid your recovery

1) Deep Breathing Exercise: Inhale and exhale deeply x 10. Do this hourly and when you wake from sleeping or dosing. This helps to keep your chest clear and expel the anaesthetic. If you need to cough, draw your bent knees up and always support the wound with your hands (you may also hold a towel or pillow over the wound)

2) Ankle and Leg Exercises: Stretch your feet forward and backward as if pedalling for 5 minutes every hour. Slide your legs alternately up and down the bed bending and straightening your knees.  Do not lie or sit with legs crossed. These exercises improve circulation and helps to avoid the risk of blood clots.

3) Mobility Exercise: Once you are out of bed you will be encouraged to walk at least 60 metres on
4 occasions during your stay in hospital to demonstrate you are mobile enough
to be considered for early discharge from hospital.

4) Pelvic Floor Exercises: After any gynaecological surgery it is very important to do pelvic floor exercises.  These muscles control the urethra and anal sphincter and avoid problems with urinary or faecal incontinence.  They are also useful in the prevention or recurrence of pelvic organ prolapse.

How to do Pelvic Floor Exercises:
Locate the muscles around the vagina and anal sphincter, internally squeeze and hold the contraction 5 seconds as if stopping the flow of urine or stopping wind from passing.  Repeat 5 times and do so hourly.  Aim for 50 contractions each day.  Also brace the pelvic floor for support when you cough, sneeze and lift to protect your internal stitches post operatively.

You should keep these exercises up for at least 3 months after surgery. 
If you are struggling to perform pelvic floor exercises ask your nurse to contact the physiotherapist to supply you with a more detailed pelvic floor exercise leaflet.

5) Pelvic Rocking Exercises: This exercise helps mobilise your lower back, tones your abdominal muscles and help to relive the pain of trapped wind which can occur postoperatively.

EXAMPLE:
Lying on your back with knees bent. Gently roll your pelvis forwards and backwards so your lower back flattens against the bed and then arches off a little. Repeat 10 times x 5 times each day.

or you can do this exercise standing, leaning on a work top or chair back flattening your lower back and tilting your belly button and hips towards your head.

What can you do after your hysterectomy / repair surgery?