Exercise after a hysterectomy: when to walk, lift, swim and run again

Walk from the day after your operation

Getting up and walking early lowers the risk of blood clots. At home, start with short, steady walks close to home a couple of times a day; the RCOG says many women can walk for 30 to 60 minutes after 2 or 3 weeks.

Sources 1, 2, 3, 4

Normal activity isn't harmful

"There is no evidence that normal physical activity levels are in any way harmful", says the RCOG, and building up gradually helps recovery. If you build up step by step, most women are back to their previous activity levels within 4 to 6 weeks.

Sources 2, 3, 4

Pelvic floor and tummy exercises from the first days

Start pelvic floor exercises once your catheter is out and you can pee on your own, building up to 10 long and 10 short squeezes at least 3 times a day, and keep them up for life. Gentle deep tummy exercises, pelvic tilts and knee rolls can start in the first days.

Sources 2, 5

Lifting, swimming and sport: two sets of timings

The RCOG says light loads only for 1 to 2 weeks and nothing heavy until 3 to 4 weeks (4 to 6 after a pelvic floor repair), swimming usually within 2 to 3 weeks, and contact and power sports after at least 6 weeks. POGP's 2017 booklet is more cautious: no heavy lifting for up to 6 weeks, low-impact exercise from 6 to 12 weeks, and high-impact exercise after at least 3 months. Your own surgical team's advice comes first.

Sources 2, 6, 5

Keyhole and vaginal surgery: a quicker return

In a Cochrane review of 63 trials, women went back to normal activities about 11 days sooner after a vaginal hysterectomy, and about 13 days sooner after keyhole surgery, than after an abdominal hysterectomy.

Source 7

Know the warning signs

Get medical advice for vaginal bleeding that becomes heavy or smelly, a fever, increasing tummy pain, red and painful skin around a scar, burning when you pee, or a painful, red, swollen leg. Get help immediately for chest pain, breathlessness or coughing up blood.

Sources 2, 8

What it is

A hysterectomy removes the womb (uterus), so you can no longer get pregnant; it's most common between the ages of 40 and 50. A total hysterectomy removes the womb and cervix, a subtotal one leaves the cervix, and sometimes the tubes and ovaries are removed too. A radical hysterectomy, usually for cancer, also removes nearby tissue.

Sources 9, 10

Keyhole, vaginal or abdominal

Keyhole (laparoscopic) surgery uses small cuts in the tummy, with the womb removed through the vagina. A vaginal hysterectomy is done through a cut at the top of the vagina, with no tummy scar. An abdominal hysterectomy uses a cut of about 10 cm, usually across the bikini line, and may be used for a large womb or when the ovaries need removing. A vaginal hysterectomy is sometimes combined with a pelvic floor (prolapse) repair.

Sources 10, 3, 4, 2

Why it's done

Common reasons include heavy periods, fibroids, long-term pelvic pain from conditions such as endometriosis or adenomyosis, a prolapsed womb and cancer. Because it's a major operation, it's usually offered after less invasive treatments have been tried.

Sources 11, 9

The inside heals more slowly than the scars

POGP's booklet puts it plainly: the outside scar can heal very quickly, but it takes longer to heal on the inside. The RCOG's lifting limits are there to protect how you heal internally. We found no studies of how long internal healing takes, so the timings on this page are expert advice.

Sources 5, 2

Your ovaries and the menopause

If your ovaries are removed, the menopause starts straight away, whatever your age, and you may be offered HRT (hormone replacement therapy). If they're left, the menopause may come a little earlier than it otherwise would. A menopause before 40 raises the risk of thinning bones (osteoporosis).

Sources 9, 12, 2, 13

Complications to know about

Bleeding, infection of the wound or bladder, blood clots and, rarely, damage to the bladder or bowel. The top of the vagina opening up after keyhole or robotic surgery is rare: 0.7% across 26 studies of 10,039 women, more often in smokers.

Sources 13, 2, 14

The pelvic floor later in life

Prolapse needing surgery after a hysterectomy is uncommon: about 1% by 3 years and 5% by 15 years in 17,032 English and Scottish women, more often in women who had a prolapse before. In 165,260 Swedish women, surgery for stress incontinence was more than twice as common after a hysterectomy. These are links, not proof that the operation was the cause, and the NHS (National Health Service) lists pelvic surgery such as a hysterectomy among the causes of prolapse.

Sources 15, 16, 17, 18

The type of operationStrong evidence

In a Cochrane review of 63 trials with 6,811 women, women went back to normal activities about 11 days sooner after a vaginal hysterectomy than after an abdominal one (moderate-certainty evidence; an average of 42 days after abdominal surgery in those trials) and about 13 days sooner after keyhole surgery (low certainty). Keyhole and vaginal surgery didn't clearly differ.

Source 7

Activity limits are expert opinionMixed evidence

We found no trial of lifting or activity limits after a hysterectomy on its own. After prolapse surgery, 108 women told to go back to activity at their own pace, with no limits on lifting or high-impact exercise, were as satisfied at 3 months as women told to avoid heavy lifting and strenuous exercise for 3 months (98% against 94%), with similar results on examination and fewer prolapse and bladder symptoms; a review of 5 trials (434 women) agreed. In 30 women, many everyday lifts raised the pressure inside the tummy no more than getting out of a chair. Longer-term effects are unknown.

Sources 19, 20, 21

Pelvic floor training after surgeryEmerging evidence

Across 6 trials with 776 women, pelvic floor muscle training after a hysterectomy improved sexual function by about 5 points on a 36-point scale (moderate-quality evidence). Its effects on leaking, muscle strength and quality of life were too uncertain to judge, and it didn't change prolapse. In a trial of 374 women having vaginal surgery for prolapse and leaking, adding pelvic floor training before and after surgery didn't improve bladder symptoms at 6 months or prolapse at 2 years. The RCOG and POGP still recommend the exercises after a hysterectomy, and the NHS recommends them as a treatment for prolapse.

Sources 22, 23, 2, 5, 18

Getting back to workEmerging evidence

In two Dutch trials, personalised online recovery advice shortened time off work after gynaecological surgery: a median of 39 against 48 days in 215 women, and 49 against 62 days in 433. In one hospital study of 83 women, the median time to a full return to work after a hysterectomy was 8 weeks.

Sources 24, 25, 26

Weight after a hysterectomyEmerging evidence

In a study of 236 women who had a hysterectomy before the menopause and 392 who didn't, average weight gain in the first year was 1.36 kg against 0.61 kg, a difference that could be due to chance, though more gained over 10 pounds (4.5 kg): 23% against 15%.

Source 27

Abdominal bindersMixed evidence

Two small trials after gynaecological surgery found short-lived benefits in some groups only: less pain for up to 3 days in women over 50 after open cancer surgery (109 women), and more walking in women with up-and-down cuts, over 50 or after complex surgery (75 women), with no change in pain overall.

Sources 28, 29

Getting up early

You'll be helped out of bed and into a chair as soon as it's safe, then encouraged to walk short distances. Getting up and about early lowers the risk of blood clots and chest infections, helps your bowels recover and eases trapped wind.

Sources 2, 1

Deep breathing

Sitting upright, breathe in deeply, feeling your lower ribs move out to the sides. Repeat 4 to 5 times every hour and every time you wake up, and hold a pillow across your tummy if you need to cough.

Source 5

Rest without doing nothing

Rest as much as you can for the first few days at home, but the RCOG says rest doesn't mean doing nothing at all: start light activity around the house within the first few days, break jobs into smaller parts and take regular rests. If something hurts, do a little less for a few more days.

Source 2

Trapped wind and backache

Walking helps, and POGP says pelvic tilts can also ease trapped wind and backache after the operation.

Sources 2, 5

Keyhole or vaginal hysterectomy

• Days 1 to 7: get up and move about, shower, go for short walks and rest in the afternoon if you need to. Not fit for work yet.
• Weeks 1 to 2: longer and more frequent walks. Light loads only, such as a 1-litre bottle of water. Usually not back at work yet.
• Weeks 2 to 4: the trackers say you can start low-impact sport, and many women can walk for 30 to 60 minutes. Swimming can usually start within 2 to 3 weeks, once bleeding and discharge have stopped. Some women go back to work, perhaps on reduced hours or lighter duties.
• Weeks 4 to 6: all daily activities, including lifting, and your usual exercise. Many women are back to normal work.
• From 6 weeks: contact sports and power sports, depending on how fit you were before surgery.

Sources 3, 4

Abdominal hysterectomy

• From the day you get home: short, steady walks close to home a couple of times a day, building up; many women can walk for 30 to 60 minutes after 2 or 3 weeks.
• Weeks 1 to 2: light loads only, such as a 1-litre bottle of water.
• Weeks 2 to 3: swimming can usually start, once bleeding and discharge have stopped.
• Weeks 3 to 4: lifting heavier things, including children, and strenuous activity. Some women are fit for work.
• Weeks 4 to 6: most women are back to their previous activity levels if they've built up gradually.
• Weeks 6 to 8: many women are back to normal work. Contact and power sports wait at least 6 weeks.

Source 2

With a pelvic floor (prolapse) repair

• Days 3 to 7: get up, dress and move around the house, start daily walks and start your pelvic floor exercises.
• Weeks 1 to 4: light loads only, such as a 1-litre bottle of water, for the first month. Many women can walk for 30 to 60 minutes by the second week and are back to their usual walking by the end of the third.
• Weeks 2 to 4: swimming can usually start, once bleeding and discharge have stopped. Some women go back to work, perhaps on reduced hours or lighter duties.
• Weeks 4 to 6: lifting heavier things and strenuous activity. Most women are back to their previous activity levels.
• From 6 weeks: contact sports and power sports, depending on how fit you were before surgery.

Source 6

Walking

• RCOG: short, steady walks close to home a couple of times a day from the day you get home, building up; many women can walk for 30 to 60 minutes after 2 or 3 weeks (by the second week after a pelvic floor repair).
• POGP: daily walking, starting with short distances and building up gradually, and avoid standing still for 30 minutes or more in the early days.
• Where they differ: they don't. Walk every day and build up.

Sources 2, 6, 5

Low-impact exercise: cycling, a cross-trainer, gentle aerobics, beginner Pilates

• RCOG: after keyhole or vaginal surgery, its trackers suggest low-impact sport from 2 to 4 weeks and your usual exercise by 4 to 6 weeks. After any of the operations, most women are back to their previous activity levels within 4 to 6 weeks.
• POGP: low-impact exercise such as swimming, cycling, low-level Pilates, a cross-trainer, brisker walking or gentle aerobics from 6 to 12 weeks, once any bleeding or discharge has stopped. Tell any instructor about your operation.
• Where they differ: by several weeks, with POGP the more cautious.

Sources 3, 4, 2, 5

Swimming

• RCOG: usually within 2 to 3 weeks (2 to 4 after a pelvic floor repair), once vaginal bleeding and discharge have stopped.
• POGP: in its 6 to 12 week stage, once bleeding and discharge have stopped.
• Where they differ: by several weeks. Both say wait until bleeding and discharge have stopped, and the NHS adds after your wounds have healed.

Sources 2, 6, 5, 1

Running, jumping and other high-impact exercise

• RCOG: contact sports and power sports should be avoided for at least 6 weeks, depending on how fit you were before surgery. It doesn't give a separate time for running.
• POGP: wait at least 3 months before more physically active exercise, including high-impact activities and competitive sport. Some exercises that involve heavy straining may need to be avoided for life, especially after prolapse surgery: ask a specialist pelvic health physiotherapist.
• Where they differ: 6 weeks against 3 months.

Sources 2, 3, 4, 5

LiftingMixed evidence

All of this is expert advice: after prolapse surgery, women who went back to activity at their own pace did as well in trials as those told to restrict it.

• RCOG: light loads only, such as a 1-litre bottle of water, for the first 1 to 2 weeks, and nothing heavy, including children, and no strenuous activity until 3 to 4 weeks. After a pelvic floor repair: light loads for the first month, and nothing heavy until 4 to 6 weeks.
• POGP: avoid heavy lifting, such as a vacuum cleaner, a full kettle or a bag of shopping, for up to 6 weeks.
• The NHS: don't lift heavy objects during your recovery.
• Where they differ: 3 to 4 weeks against 6 weeks. When you do lift, the RCOG says keep your feet slightly apart, bend your knees, keep your back straight, tighten your pelvic floor and tummy muscles, hold the load close and lift by straightening your knees.

Sources 2, 6, 5, 1, 19

Whichever timings you follow

Build up gradually. If something hurts, the RCOG says do a little less for another few days, and POGP says stop anything that feels uncomfortable. New or heavier bleeding, a heavy or dragging feeling, or leaking are reasons to drop back and get advice (our suggestion).

Sources 2, 5

The knack, and for life

Tighten your pelvic floor before anything that puts it under pressure, such as coughing, sneezing, laughing, bending or lifting. The RCOG and POGP both say to keep the exercises up for life, and POGP says weak muscles should improve within 3 to 5 months. If you find them difficult, or you're constipated, ask to see a specialist pelvic health (women's health) physiotherapist.

Sources 2, 5

Reminders

The RCOG suggests linking the exercises to something you do every day, such as brushing your teeth, and POGP lists the Squeezy app, the NHS physiotherapy app for pelvic floor exercises.

Sources 2, 5

Signs of a prolapse

See a GP (general practitioner) if you notice a heavy, dragging feeling or a bulge in your vagina, problems peeing or pooing, or leaking. With a diagnosed prolapse, the NHS advises pelvic floor exercises and avoiding heavy lifting, running and trampolining; our pelvic floor guide has more.

Source 18

POGP's sequence

Start with the deepest tummy muscle: lying on your back with your knees bent (or on your side), breathe in, then as you breathe out gently draw your lower tummy in towards your spine and hold for 2 or 3 breaths before relaxing fully. Then add pelvic tilts, knee rolls and a one leg stretch, sliding one heel away and back. When those are easy, move on to knee lifts, single knee fall-outs and bridging.

Source 5

How many

POGP gives no numbers beyond repeating each a few times. Our editorial starting point: 5 to 10 of each, once or twice a day, stopping before your tummy tires or your scar pulls.

Source 5

Leave sit-ups for later

Leave out sit-ups, double leg raises and planks while your tummy heals (our suggestion, as after other abdominal surgery), and build up through the gentler exercises, breathing out on the effort. Ease back if your scar pulls or the middle of your tummy bulges. After keyhole or vaginal surgery, the same exercises apply, and you'll usually move on faster.

Source 5

Bowels and bladder

Avoid straining: eat plenty of fibre and drink 1.5 to 2 litres a day, mainly water, and the RCOG says you may need laxatives at first. On the toilet, sit fully on the seat with your feet raised on a small stool so your knees are above your hips, lean forward with your arms on your thighs, keep your tummy relaxed, and don't hold your breath or push hard. Pee every 3 to 4 hours rather than just in case.

Sources 2, 5

Driving

Not for 24 hours after a general anaesthetic. Before you drive, you need to be free of drowsiness from painkillers, comfortable in the seat and seatbelt, and able to work the controls, do an emergency stop and look over your shoulder. The RCOG's text says this usually takes 3 to 6 weeks after an abdominal hysterectomy and 2 to 4 weeks after keyhole or vaginal surgery (its trackers say 4 to 6), and the NHS says 2 to 6 weeks. Check your insurance policy.

Sources 2, 3, 4, 1, 5

Work

The RCOG says some women are fit to work 3 to 4 weeks after an abdominal hysterectomy, or 2 to 3 weeks after keyhole or vaginal surgery, and many are back to normal work after 6 to 8 weeks or 4 to 6 weeks respectively. A phased return, with shorter hours or lighter duties, helps, and you don't need your GP's permission to go back. The NHS says that if your job doesn't involve manual work or heavy lifting, you may be able to go back after 6 to 8 weeks.

Sources 2, 3, 4, 1

Sex

The RCOG and the NHS suggest waiting 4 to 6 weeks, until your scars have healed and any discharge has stopped; POGP suggests at least 3 to 4 weeks, guided by how ready and comfortable you feel. A lubricant can help with dryness, which is more common if your ovaries were removed.

Sources 2, 1, 5

Surgical menopause

Removing the ovaries starts the menopause straight away, so you may notice hot flushes, sweating, vaginal dryness or poor sleep soon after surgery. Your gynaecologist will talk to you about HRT. A menopause before 40 increases the risk of osteoporosis.

Sources 9, 2, 13

Exercise for your bones

Because an early menopause raises the risk of osteoporosis, our menopause and osteoporosis guides are worth reading once you've recovered: they cover the strength and impact exercise that helps bones, with doses.

Weight

Average weight change after a hysterectomy is small (see the evidence above). The RCOG suggests eating healthily without trying to lose weight for the first couple of weeks, then combining a healthy diet with exercise if you want to lose weight.

Sources 27, 2

Belly swelling and binders

Swelling around the tummy settles with time, and sit-ups won't speed it up (our suggestion). A binder is optional, for comfort: trials found only small, short-lived benefits in some groups.

Sources 28, 29

Scars

Once your wounds have healed, our scar tissue guide covers scar care. Don't massage a wound that's open or infected, and get any new lump near a scar checked.

Tired and tearful is common

Many women feel tired, tearful and emotional at first, and for many it's the last thing to improve. A daily routine helps: get up at your usual time, wash, dress and move about, since the RCOG says sleeping in and staying in bed can make you feel depressed. A hysterectomy can trigger depression, so see a GP if low mood doesn't lift.

Sources 2, 1

If you need help now

If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E (accident and emergency). For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.

Sources 30, 31, 32

Get medical advice from your GP, your hospital, or NHS 111 (NHS 24 in Scotland) if you have

• Burning or stinging when you pee, or peeing often: possibly a urine infection.
• Vaginal bleeding that becomes heavy or smelly, especially if you feel unwell or have a temperature.
• Red and painful skin around your scars: possibly a wound infection.
• Tummy pain that keeps getting worse, especially with a temperature, loss of appetite or vomiting.
• A painful, red, swollen, hot leg, or difficulty bearing weight on your legs: possibly a blood clot (deep vein thrombosis, DVT).

Sources 2, 3, 4

Call 999 (911 in the US)

Shortness of breath, chest pain or coughing up blood can mean a blood clot has travelled to your lungs: get help immediately. Don't drive yourself to A&E.

Sources 2, 8

See a GP

• Low mood that doesn't lift.
• A heavy, dragging feeling or a bulge in your vagina, or problems peeing or pooing.
• Leaking when you cough, sneeze or exercise: our pelvic floor guide can help too.
• You're following all the advice but don't feel you're at the stage you ought to be.

Sources 1, 30, 18, 2

During or after exercise

If something hurts, do a little less for a few days (RCOG), and stop anything that feels uncomfortable (POGP). New or heavier bleeding, a heavy or dragging feeling, or leaking during exercise are reasons to drop back and get advice (our suggestion).

Sources 2, 5, 18

Who to see

Your hospital team or GP for problems with your wound, bleeding or pain; a specialist pelvic health (women's health) physiotherapist for pelvic floor problems, or for advice on lifting and high-impact exercise, especially after prolapse surgery.

Sources 2, 5

"Rest completely for 6 weeks"Strong evidence

The RCOG says rest doesn't mean doing nothing at all, and that there's no evidence normal physical activity is in any way harmful. Walk from the day you get home and build up.

Source 2

"Don't lift more than a kettle for months"Mixed evidence

The RCOG says light loads for 1 to 2 weeks and nothing heavy until 3 to 4 weeks (4 to 6 after a pelvic floor repair); POGP's booklet says avoid heavy lifting, including a full kettle, for up to 6 weeks. No trial supports a fixed limit after a hysterectomy, and after prolapse surgery, women who went back to activity at their own pace did as well at 3 months.

Sources 2, 6, 5, 19, 20

"No womb, no need for pelvic floor exercises"Strong evidence

The RCOG and POGP both say to get these muscles working after the operation and keep the exercises up for life. Surgery for stress incontinence is more common after a hysterectomy.

Sources 2, 5, 17

"A hysterectomy always means the menopause"Strong evidence

Only if your ovaries are removed. If they're left, the menopause may come a little earlier than it otherwise would.

Sources 9, 12

"A hysterectomy makes you put on weight"Emerging evidence

In one study, women gained 1.36 kg on average in the first year after a hysterectomy, against 0.61 kg in women who didn't have one, a difference that could be chance. The RCOG says that as long as you're exercising enough and not eating more than you need, you don't need to worry about gaining weight.

Sources 27, 2

"Sit-ups will flatten a hysterectomy belly"Mixed evidence

Leave sit-ups out while your tummy heals (our suggestion); swelling settles with time. Binders helped comfort only briefly, and only in some groups, in trials.

Sources 28, 29

"Exercise will make your insides fall out"Strong evidence

Prolapse needing surgery after a hysterectomy is uncommon (about 1% by 3 years and 5% by 15 years) and more often affects women who had a prolapse before, and the top of the vagina opening up is rare (0.7%).

Sources 15, 16, 14

"After keyhole surgery I'll be back to everything in a week"Strong evidence

The outside heals faster than the inside. Even after keyhole surgery, the RCOG's tracker puts lifting and your usual exercise at 4 to 6 weeks, and contact and power sports at 6 weeks or more.

Sources 5, 3