Impact of Gynaecological Surgery on the Pelvic Floor

A past history of gynaecological surgery is known to be a risk factor for changes in pelvic floor function. Such surgery can weaken the support structures of the pelvic floor. Researchers have noted that 30% of all urinary incontinence cases are women who have had obstetric or gynaecological surgery.

Women who have had a hysterectomy— surgery to remove the uterus, often for a benign condition— seem to have a higher risk of urinary stress incontinence or pelvic organ descent. This results from damage to pelvic nerves and distortion of the support structures of the pelvic floor. A recently published large population study demonstrated that, compared to women with no prior hysterectomy, women who had undergone a hysterectomy had more than twice the rate of operations to treat stress incontinence and approximately twice the rate of surgery for pelvic organ descent. However, it appears that a hysterectomy is not associated with these disorders in the short term or in younger women, although studies suggest that hysterectomy can be associated with urinary incontinence and pelvic organ descent later in life. The highest overall risk for pelvic floor disorders is seen within the first 5 years after hysterectomy; thereafter the risk gradually declines with time.

The incidence of hysterectomy for non life-threatening diseases in premenopausal and perimenopausal women is generally high. It is important to understand the long term outcomes associated with having this procedure.

• Discuss the possible outcomes with your healthcare practitioner before pelvic surgery.
• Ask for recommendations about which type of treatment is right for you.
• Ask if you should start pelvic floor re-training as part of your comprehensive care plan.

Kegel exercises, combined with use of vaginal cones, are an accepted and well-known approach to restoring the function of pelvic floor muscles. They are often used to help improve the performance of the pelvic floor muscles before "female surgery". It makes sense to train these muscles, to bring them to their best possible condition, in order to prepare for pelvic surgery.

Consult your healthcare practitioner after pelvic surgery to get their recommendations on when you can start gentle pelvic floor retraining. This can be part of your comprehensive care plan to help prevent decreased pelvic floor function later in life.

For more information on pelvic floor reeducation:

• Kegel Exercises
• Pelvic Floor Reeducation with LadySystem® Vaginal Cones
• How to Use LadySystem® - Video Presentation