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.

Pelvic Organ Prolapse, or POP, is a symptom that affects many people but is not always openly discussed. It occurs when one or more pelvic organs—such as the bladder, bowel, or uterus—shift from their normal position and descend, often resting against the vaginal wall. While some degree of movement is considered normal, a prolapse is diagnosed when symptoms are present. What Does POP Feel Like? People with POP often describe a sense of heaviness or dragging in the pelvis. Others may notice a bulge in or outside the vagina, discomfort during daily activities, or a feeling that something is “coming down.” POP can also affect bladder and bowel function, leading to symptoms like incomplete emptying or frequent urgency. What Increases the Risk of POP? The most significant risk factor for developing POP is vaginal childbirth. However, it's not just childbirth itself, but certain factors around the delivery that play a role: Birth weight over 4kg Pushing for less than 20 minutes or more than 2 hours Obstructed labour or instrumental delivery (forceps, vacuum) Other contributing lifestyle factors include: Chronic constipation or long-term straining Persistent coughing (e.g., due to asthma or smoking) Heavy lifting over extended periods Family history of prolapse Menopause, due to hormonal changes affecting tissue support Conservative Treatment Options For many people, POP can be managed conservatively without surgery. Treatment may include: Pelvic Floor Muscle Training : Strengthening these muscles improves the support they provide to pelvic organs. Horizontal Rest : Lying down throughout the day can help reduce the sensation of heaviness and give your body time to recover. Hormonal Therapies : Your doctor may prescribe topical oestrogen to help strengthen vaginal tissues, particularly after menopause. Pessary Use : A pessary is a small silicone device inserted into the vagina to provide internal support for the organs. Lifestyle Modifications : Addressing chronic constipation or cough and avoiding unsafe repetitive heavy lifting can reduce strain on the pelvic floor. For personalised guidance, it’s important to consult a qualified pelvic health physiotherapist who can tailor your treatment to your specific needs and goals. When Is Surgery Considered? In more severe cases of prolapse, or when conservative measures do not relieve symptoms, surgery may be recommended. If this is the case, your healthcare provider will refer you to a specialist for a comprehensive assessment and to discuss your surgical options. Conclusion Pelvic Organ Prolapse is common, but with the right support and management strategies, it doesn’t have to limit your quality of life. Early intervention through physiotherapy and lifestyle changes can significantly improve symptoms and help you feel confident in your body again. If you're experiencing symptoms or want to know more, reach out to a pelvic health physiotherapist to explore your options.