Pelvic surgeries are procedures that affect any part of the pelvis, including the organs, muscles, ligaments, tissues, and so on.

These surgeries significantly affect the pelvis and pelvic floor—which can result in dysfunction or even prolapse if not cared for properly.

Regardless of the type of pelvic surgery you need, pelvic floor physical therapy plays an important role in preparing you for surgery and recovering your pelvic function, mobility, and sensation.

There are many types of pelvic surgeries, as the pelvis contains and interconnects with many different organs, structures, tissues, and ligaments. Here are some examples of different types of surgeries that affect the pelvis and pelvic floor:

Gynecological

Gynecological surgeries are procedures that alter the reproductive organs and structures for those born with a vagina.

This includes surgeries such as hysterectomies, endometriosis surgery, prolapse surgery, or other surgeries affecting the uterus, ovaries, fallopian tubes, cervix, or vagina.

These types of surgeries can be preventative, such as to prevent future pregnancy, or they may be used to solve pain and other symptoms.

Urological 

This refers to surgeries involving the bladder or urinary tract. These surgeries are often reparative, aiming to restore function to the urinary system when there is damage or dysfunction.

It may also require partial or total removal of some structures that may be causing pain and other symptoms.

Colorectal 

Colorectal surgeries are surgeries affecting the lower digestive tract. These surgeries are used to correct problems with the rectum or anus, such as damaged anal sphincter muscles, hemorrhoids, and more.

Reconstructive 

Reconstructive surgeries can vary widely!

They can include cosmetic surgeries for individuals wanting to change the appearance of their genitals, genital reconstruction for gender-affirming purposes, or even reparative surgeries—such as restoring the perineum after a difficult delivery.

Reproductive (For Those With a Penis)

There are many surgeries that can affect the penis, testicles, or prostate. This can include vasectomies, penile prosthesis implantation, testicle removal, prostate gland removal, and more.

Trauma and Emergency 

Some situations, such as trauma, accidents, or other emergencies may make immediate pelvic surgery necessary. This can include damage to the inner structures or organs, bone fractures, blood accumulation, and more.

Oncology-Related 

Unfortunately, cancer can affect areas of the pelvis. These surgeries often look to remove problematic tissues, and sometimes may remove organs in more severe cases. Oncology-related surgeries can also refer to the removal of pelvic lymph nodes.

Start Healing with Hive

There are many different conditions or complications that may pose a need for pelvic surgery. Individuals may undergo pelvic surgery for reasons such as:

• Restoring function or reducing symptoms from a condition
• Preventing future complications or pregnancy
• Altering the appearance of their body (cosmetic surgery)
• Changing their body for gender-affirming health

When it comes to alleviating an individual’s symptoms from a condition, pelvic surgery is typically only suggested when the individual has significant pain, recurrent symptoms, or has lessened mobility.

Additionally, surgery may be used to find lasting relief for more severe conditions that conventional treatments are unable to manage.

Some examples of conditions that could require pelvic surgery include the following:

• Pelvic organ prolapse
• Urinary incontinence
• Fecal incontinence
• Nerve entrapment
• Chronic pain
• Recovery from birth trauma
• Endometriosis
• Adhesions
• Fistulas 
• Structural sexual dysfunction
• Pelvic infections
• And more

Many of these conditions—such as endometriosis, pelvic organ prolapse, adhesions, or urinary incontinence—can usually be managed or treated with pelvic floor physical therapy.

However, when these become too severe, such as late-stage prolapse or deep infiltrating endometriosis, surgery may become the only option. Pelvic floor therapy is still here to provide a supporting role!

Let’s look at the benefits of physical therapy for pelvic surgery next.

Pelvic floor therapy usually aims to prevent surgery by improving function, flexibility, and mobility of your pelvis and internal structures.

As mentioned before,  there are some cases where individuals may have a more extreme condition or situation that makes surgery necessary.

Even then, pelvic floor physical therapy plays a very important role.

Physical therapy not only prepares you for surgery, but also improves your surgical outcomes and healing experience. It restores your function and comfort after surgery, and reduces the risk of complications.

Let’s explore the ways that physical therapy provides benefits in both preparation and recovery of pelvic surgery:

Preparation

There are many ways a pelvic floor therapist can help prepare you for surgery. Not only can they provide a wealth of information about the pelvic structures and how they are affected by surgery, but they can also familiarize you with the recovery experience.

Preparation for the recovery period can include:

• Educating you on the pelvic floor and how it is affected by any pelvic surgery.
• Educating you on pain management.
• Preparing you for movements that will be difficult after surgery.
• Educating you on the timeline of recovery and when you can return to activities.

Your physical therapist doesn’t just prepare you mentally—they’ll work on physical aspects, too.

In order to best prepare your body for the impact of surgery, reduce the risk of complications, and allow for a better recovery experience, your physical therapist will improve the condition of your pelvic floor and other structures pre-surgery.

This includes the following tasks:

• Relieving pelvic floor dysfunction.
• Improving pelvic floor function, coordination, and flexibility.
• Improving the muscle balance of the hips, abdominals, low back, and pelvis.
• Improving posture and reducing tension on the pelvis or pelvic floor.
• Teaching relaxation methods that will be beneficial during the recovery period.
• Improving efficiency in certain movements that may put pressure on the pelvic floor.
• Teaching modified movements that will help manage pain during early recovery.

Recovery

During recovery from a pelvic surgery, pelvic floor physical therapy addresses post-surgery dysfunction, pain, scar tissue, pelvic floor function, postural imbalances, and core stability.

Allowing a pelvic floor therapist to support you through these important aspects can help improve your healing, maintain better function and comfort, and support a higher quality of life long-term.

Here are some examples of treatment methods used during the recovery period:

Pain and Scar Management

After a pelvic surgery, you will likely experience pain and swelling. Your physical therapist can use treatments such as heat therapy, cold therapy, or other appropriate modalities to ease your pain and reduce swelling.

As you progress through your healing stages, your physical therapist can help you manage your scar tissue through mobilization and education. Caring for your new scar tissue will help prevent pain, discomfort, and sensitivity; as well as reduce the likelihood of adhesions.

Postural and Movement Mechanics

After a pelvic surgery, it may prove difficult to walk, bend, sit, or move. Your physical therapist will help you gradually move back into these activities with proper core and pelvic floor coordination.

They’ll help ensure your posture doesn’t put tension on the pelvic floor, and will provide movement training that allows for efficient transitions (sitting to standing, standing to sitting).

Pelvic Floor Training

After any pelvic surgery, your pelvic floor will be weak. It will need extra care in order to return to normal function and comfort—therefore, your physical therapist will guide you through pelvic floor training to regain control and strength in those muscles.

This can include neuromuscular re-education and biofeedback, which will help guide you back into understanding and controlling pelvic floor contractions and relaxations. Regaining control of these functions will allow you to further engage in exercises to build strength and reduce tension.

Depending on the type of surgery you receive or the symptoms you may be experiencing, it may be appropriate to incorporate dilator therapy into your treatment.

Dilator therapy is a safe and effective practice that uses insertable tools to gently stretch vaginal or rectal tissues. These tools come in many sizes, and allow a patient to practice at their own pace.

Dilators are very useful for tissue desensitization and improving sexual comfort!

Addressing Post-Surgery Dysfunction

Pelvic surgeries unfortunately can make other complications arise, such as low back pain, hip pain, urinary urgency, incontinence, constipation, and sexual dysfunction. These problems can be monitored and addressed by your pelvic floor therapist during your recovery stage.

These dysfunctions are not only caused by the effects and trauma of surgery, but also how you move during recovery. It is easy to overcompensate while trying to prevent pain in the pelvis—and unintentionally create tension and pain in other areas.

Therefore, your pelvic floor therapist will teach you how to avoid pain guarding to ensure your posture doesn’t worsen tension or pain on other parts of the body during your recovery.

Along with the pelvic floor training mentioned earlier, your provider will teach you bathroom strategies (for urination and bowel movements) to help reduce straining that may be contributing to dysfunctions like constipation or incontinence.

Exercise Prescription

Many individuals may benefit from an exercise and stretching routine after surgery. This helps balance the muscles in all areas that affect the pelvis, such as the hips, core, and back.

Balancing these muscles helps ensure proper muscle coordination, and helps prevent pelvic tension. Additionally, stretching these areas will allow for better overall flexibility and mobility!

Although this article has covered many common treatment methods for pelvic surgery, pelvic floor physical therapy can vary depending on the specific type of pelvic surgery. Be sure to check out the pelvic floor conditions page to find more treatment information on specific pelvic surgeries! 

No matter your type of pelvic surgery, Hive’s physical therapists are dedicated to creating a holistic treatment plan just for you. They may utilize any of the following treatments in order to provide you with a comprehensive treatment experience:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback