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The Role of Pelvic Floor Physiotherapy After a Hysterectomy A hysterectomy is a significant surgical procedure, and while it can be necessary for a range of medical conditions, recovery requires careful consideration. The pelvic floor and core do not automatically restore their previous function following surgery. Regardless of whether the procedure was performed via an abdominal, vaginal, or laparoscopic approach, targeted rehabilitation is often essential. Pelvic floor physiotherapy provides evidence-based strategies to optimise healing, restore function, and support long-term pelvic health. Below is an outline of how a physiotherapist may assist across the different stages of recovery. Early Recovery (0–6 Weeks) Focus: Education, Protection, Gentle Awareness During the initial post-operative phase, the priority is to protect healing tissues and establish safe movement patterns. A physiotherapist may provide: Pelvic floor education — guidance on how surgery has altered pelvic support, biomechanics, and bladder/bowel function. Breathing and core coordination — gentle diaphragmatic breathing techniques to reduce tension, support circulation, and minimise swelling. Safe movement and postural strategies — instruction on bed mobility, transfers, and walking to avoid unnecessary strain. Scar and tissue healing advice — information to optimise scar recovery, reduce the risk of adhesions, and monitor for signs of complications. Mid Recovery (6–12 Weeks) Focus: Activation, Strengthening, Confidence Once surgical healing is established, rehabilitation progresses to restoring muscle activation and movement control. This may include: Pelvic floor muscle retraining — graded internal or external exercises focusing on coordination, endurance, and strength. Core muscle activation — re-education of deep abdominal muscles, particularly the transversus abdominis, in synchrony with the pelvic floor. Postural alignment and movement retraining — addressing compensatory patterns or protective guarding to optimise pelvic loading. Scar mobilisation — manual therapy to improve tissue mobility, circulation, and sensitivity. Later Recovery (3+ Months) Focus: Return to Function, Fitness, and Lifestyle The longer-term phase of rehabilitation supports a safe return to higher levels of activity and addresses ongoing pelvic health needs. This may involve: Exercise progression and return-to-sport planning — individualised advice for safely resuming walking, lifting, gym training, Pilates, or sport while minimising risk of prolapse or core dysfunction. Bladder and bowel retraining — management of urgency, leakage, or constipation, which may present post-surgery. Support for intimacy and pelvic pain — rehabilitation for dyspareunia, vaginal tightness, or scar-related discomfort. Prolapse prevention and long-term pelvic health — strategies to manage intra-abdominal pressure and maintain pelvic organ support. Why Consult a Pelvic Floor Physiotherapist? Pelvic floor physiotherapists are trained to assess not only the muscles, but the integration of breath, core, scars, posture, and daily movement patterns following surgery. This holistic assessment allows for a tailored rehabilitation plan to support both short- and long-term recovery. Importantly, it is never too late to commence pelvic floor physiotherapy. Whether a patient is six weeks or six years post-hysterectomy, physiotherapy can assist in improving function, comfort, and quality of life.
Understanding the Risk Factors for Pelvic Organ Prolapse (POP) Pelvic organ prolapse (POP) is a condition where one or more of the pelvic organs (such as the bladder, uterus, or rectum) shift downward and push into the vaginal wall due to weakened support from the pelvic floor. It’s more common than many realise, and while it can feel overwhelming, knowing the risk factors can help you take steps to protect your pelvic health. Key Risk Factors 1. Vaginal Birth Childbirth is one of the most significant contributors to POP. Vaginal deliveries, particularly when forceps are used, when the baby is large, or after multiple births, can place considerable strain on the pelvic floor muscles and connective tissues. 2. Age As we age, our muscles and tissues naturally weaken. This includes the pelvic floor, which means the likelihood of prolapse increases over time. 3. Obesity Carrying extra body weight increases pressure on the pelvic floor. Over time, this added strain can contribute to the development of POP. 4. Genetics Sometimes, pelvic health challenges run in families. If you have a close relative with POP or connective tissue disorders, you may be more predisposed to experiencing prolapse yourself. 5. Menopause Hormonal changes associated with menopause—particularly lower oestrogen levels—can lead to thinning and weakening of pelvic tissues, making them less supportive. 6. Prior Pelvic Surgery Procedures like a hysterectomy can affect pelvic support structures and increase the risk of prolapse later on. 7. Chronic Strain Repetitive straining from chronic constipation, persistent coughing (such as from smoking or lung disease), or frequent heavy lifting can all place continuous pressure on the pelvic floor, increasing the risk of POP. 8. Connective Tissue Disorders Some people have naturally weaker connective tissues due to genetic factors. Conditions like hypermobility can make the pelvic floor less resilient and more prone to prolapse. What Can You Do? While not all risk factors can be avoided, there are proactive steps you can take to support your pelvic health: Maintain a healthy weight to reduce pressure on the pelvic floor. Address chronic straining by managing constipation, cough, or lifestyle factors that increase abdominal pressure. Strengthen your pelvic floor muscles through targeted exercises. A pelvic health physiotherapist can guide you in learning the right techniques. Final Thoughts POP is influenced by many factors—some you can’t control, like age and genetics, and others you can actively address. By understanding your risk profile and making supportive lifestyle changes, you can strengthen your pelvic health and reduce the likelihood or severity of prolapse. If you’re concerned about your pelvic floor or would like personalised guidance, our team at Pelvic Health Melbourne is here to help.
The Perimenopausal Changes No One Warns You About Perimenopause — the transition period leading up to menopause — is a natural phase in every woman’s life. While symptoms like hot flushes and mood swings are widely discussed, there are other, less talked-about changes that can have just as much of an impact on daily life. Let’s explore some of the more surprising changes to your bladder, bowel, and periods — and what you can do to manage them. Bladder: “Why Do I Always Feel Like I Need to Go?” If you've noticed you're heading to the toilet more often — or feeling an intense need to go, only to pass a small amount — you're not alone. As oestrogen levels decline, the tissues supporting the bladder and urethra can become thinner and less elastic, leading to: Increased bladder urgency More frequent urination A lingering sensation of not quite emptying What You Can Do Try not to respond to every urge straight away. Bladder retraining can help your body adjust and reduce the frequency of urgency over time. Avoid common bladder irritants that can make urgency worse. These may include: Coffee Alcohol Artificial sweeteners Fizzy drinks Spicy or acidic foods (depending on your individual sensitivity) Bowel: Slower, Smellier, and More Sensitive Digestive changes are also common during perimenopause. Hormonal fluctuations can slow gut motility, which may result in: Increased constipation New food sensitivities More noticeable (and often smellier) wind These changes are often unexpected but entirely normal. Supporting your gut health with fibre-rich foods, hydration, and regular physical activity can make a significant difference. Periods: Heavier, Irregular, and Less Predictable For many women, perimenopause brings changes to menstrual cycles well before periods stop altogether. You may experience: Heavier bleeding than usual Irregular cycles — sometimes longer, sometimes shorter Spotting or bleeding between periods Important: Any new spotting or unusual bleeding should be checked by your GP. While often harmless, it’s important to rule out any underlying issues. You Don’t Have to Just “Put Up With It” These changes are common, but that doesn’t mean you have to live with discomfort or uncertainty. At Pelvic Health Melbourne, we specialise in supporting women through perimenopause and beyond. We provide expert care to help you: Manage bladder urgency Reduce or eliminate after-dribble Improve bowel function Strengthen pelvic floor health What We Offer Personalised pelvic health assessments Evidence-based treatment plans tailored to your needs Compassionate, confidential care at every stage of menopause Book your pelvic health consultation today and take the first step toward feeling more in control of your body — and your life.
