Overcome Your Hysterectomy Pain

Hysterectomy

A hysterectomy is the surgical removal (abdominally or vaginally) of the uterus. The cervix, upper vagina, ovaries, fallopian tubes, and supporting tissues may also be removed. This procedure is performed for various reasons, including fibroids, endometriosis, uterine prolapse, chronic pelvic pain, and cancer, among others.

Hysterectomy has become a fairly common surgery. In fact, so many women struggle with issues related to the pelvis that one in three women in the U.S. over age 60 has had a hysterectomy.¹

Recovery after Hysterectomy

The most common surgical technique for hysterectomy is abdominal surgery. Doctors generally expect complete recovery within four to eight weeks. For vaginal surgery, recovery usually occurs within one to two weeks. Sexual activity can generally be resumed after six weeks, regardless of the surgery type.¹

Pain and Dysfunction after Hysterectomy

Of the 600,000 women who undergo hysterectomies in U.S. every year, most recover within the given time frame and return to pain-free lives.¹ However, a study in 2007 found that 32% of women who underwent hysterectomies experienced chronic pelvic pain one year after their hysterectomy. This is a large, and (we feel) unacceptable number. The study also found that a vaginal surgery versus an abdominal surgery did not significantly lower the risk of chronic pain.²

The Journal of Minimally Invasive Gynecology examined women who had diagnostic laparoscopy for pain after hysterectomy. The most common findings were adhesions, adnexal remnants (appendages of an organ left behind after surgery), and endometriosis (the lining of the uterus found outside the uterus.)³

Adhesions are thick strands of collagen that form to help the body heal and repair after infection, trauma, surgery, or various other injuries. Although the body needs these strands to help tissue repair, adhesions can have a side-effect of binding and restricting structures that were previously mobile.

The tissues of the pelvis are extremely delicate and are meant to glide over each other. During a hysterectomy, the surgeon cuts or burns through these tissues to remove the uterus and sometimes other structures. Collagen cross-links then rush in to repair the tissues at the surgical sites. Thus, adhesions may form after surgery. These adhesions act like a powerful glue, binding neighboring structures – such as the intestines, bowels, vagina, or bladder.

When adhesions form after hysterectomy, women can experience a variety of side-effects, including:

Pelvic or Intercourse Pain

Low back pain (due to adhesive pulls into that area)

Uncomfortable tightness or pulling

Decreased desire, lubrication, orgasm

Pain with or after urination

Constipation, painful bowel movements

Small bowel (intestinal) obstruction (SBO)

Symptoms can range from moderate discomfort to severe or recurring pain or tightness. In the case of SBO, they can be life-threatening as adhesions block the intestines, preventing food from passing thorough the digestive tract.

Sexual Dysfunction and Intercourse Pain after Hysterectomy

Following a hysterectomy, a woman can expect intercourse to be uncomfortable the first couple of times. If a woman has had one or both ovaries removed, she may also experience a decrease in lubrication and desire as her body goes through menopause. 

If a woman feels pain with intercourse after six weeks despite several tries, she may have a ‘mechanical’ problem (e.g. vaginal adhesions, adhered pelvic ligaments.) Many women feel that if they continue to try and push past the pain, the pain will eventually go away. If it doesn’t resolve after three or four attempts, we generally find that adhesions have formed in this area, pulling or restricting the vagina, or attaching its delicate tissues to nearby structures, causing pain during sex. 

The Journal of Sex & Marital Therapy classified female sexual dysfunction into six measurable domains: desire, arousal, lubrication, orgasm, satisfaction, and pain⁴.  Although a woman who has undergone a hysterectomy may initially experience decreased sexual function, these categories should return to a satisfactory level. If they do not, it is a sign that adhesions may be restricting the area, preventing normal sensation and function. In our published studies on this phenomenon, we feel that these adhesions decrease desire or lubrication, can prevent full (or any) orgasm, and generally decrease satisfaction from the pre-surgery state.

Surgery for Pain and Dysfunction after Hysterectomy

Until recently, lysis (burning of adhesions during laparoscopy or laparotomy) was the only option to remove adhesions in the pelvis. While lysis of pelvic adhesions can be effective, surgery has two major drawbacks:

• It carries risks from anesthesia and infection
• Despite the best skills of the finest surgeon, the body creates more abdominal adhesions as it heals from the surgery designed to remove them.

A study in Digestive Surgery showed 55% to 100% of women develop adhesions following pelvic surgery⁵. Another study reported that 35% of all open abdominal or pelvic surgery patients were readmitted to the hospital more than twice to treat post-surgical adhesions during the 10 years after their original surgery⁵. Thus, pelvic surgery itself has been implicated as a major cause of adhesion formation and many patients become trapped in a cycle of surgery-adhesions-surgery – with no end in sight.

Treating Pain, Dysfunction, and Adhesions at Clear Passage Physical Therapy®

We know pelvic adhesions well. We faced this situation 20 years ago when the physical therapist director of Clear Passage Physical Therapy, Belinda Wurn, developed severe adhesions after pelvic surgery and radiation therapy. Unable to work due to chronic pelvic pain, and having seen the devastating and debilitating effects of pelvic adhesions in her own patients, she was determined to find a non-surgical way to address chronic pelvic pain and adhesions.

With her husband, massage therapist Larry Wurn, Belinda took a much deeper look at the etiology and biomechanics of adhesion formation. They found that the molecular bonds that attached each of the tiny collagen fibers to its neighbor appeared to dissipate or dissolve with certain site-specific manual techniques. With this knowledge, they developed the Wurn Technique® to free adhesive bonds, and return structures to a more functional, pain-free state.

The Wurn Technique® is designed to reduce or eliminate adhesions crosslink by crosslink. It has been shown in peer-reviewed medical journals to decrease pain, and improve function without the risks of surgery or drugs. The technique has also been shown to greatly reduce endometriosis pain – one of the most common findings when surgeons did a second-look surgery in women who had previously had a hysterectomy.

Visit our “what treatment is like” web page for more information, or click the link at the top of this page now, to complete a medical history questionnaire and apply for a free, in-depth consultation.

1.  http://www.womenshealth.gov/faq/hysterectomy.cfm
2. http://www.ncbi.nlm.nih.gov/pubmed/18307483?ordinalpos=37&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
3. Rosen R, Brown C, Heiman J, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J. Sex Marital Ther. 2000;26:191-208. PMID 10782451.
4. Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal Adhesions: Etiology, Pathophysiology, and Clinical Significance.Dig Surg. 2001; 18: 260-273. PMID 11528133.
5. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O’Brien F, Buchan S, Crowe AM. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet Br J Med. 1999; 353: 1476-80. PMID 10232313.