March 15, 2011

Hysterectomy Recovery! A Cranky Fitness Guide

(Image credit: Resurge International)

I realize that hysterectomy recovery is a rather specialized topic. Very few Cranky Fitness readers are waking up fuzzy-headed in a hospital bed at this moment, wondering what will happen next now that the nice surgeon has yanked out a bunch of your body parts. You'd rather hear about a new super-easy exercise to firm up your flabby thighs, right? Or maybe clever hints on how to make cauliflower taste like cotton candy? Tips on how to tell if you have vaginal cuff cellulitis: probably not high on your list.

But hey, don't go away yet: hysterectomies are pretty darn popular! Even if you don't plan on having one yourself, you may well have a mother, sister, friend, or coworker who just can't wait to join this super-cool surgical sorority. Wouldn't it be handy to have a bit more info, so you can be all supportive and knowledgeable and not get your head bitten off by your loved one for making some dumbass remark?

Or, maybe you've googled here because you are facing surgery yourself. You may be worried about side effects, and curious as to how this operation will affect your physical fitness and psychological well-being. So, as a public service, I didn't just scour the web for resources to answer your urgent questions about hysterectomies and how to recover from them. I went the extra mile and had one myself! (The fact that I was four months "pregnant" with a big ol' fibroid-filled uterus had practically nothing to do with it).

So here is exactly what you can expect from your hysterectomy:

Any f*cking thing in the world.

Yep, from what I can tell there does not seem to be a "typical" hysterectomy experience. You could acquire super-human strength and x-ray vision, or you could end up with constipation, mood swings, and purple wombats crawling out of your navel. People mostly seem to have good experiences, but seriously, it's a crapshoot.

But I won't let the fact that each hysterectomy is unique stop me from sharing some information and tips. Here are a few things I learned about the whole hysterectomy deal, either from personal experience or from Dr. Google.

1. Where to go on the web: The best single resource for hysterectomy information is a site called hystersisters. They have a few general articles, some of which are helpful, and some... not so much. The real value is in the reader forums. Vast numbers of women have written about their experiences and shared helpful tips. Any obscure question or weird symptom you might be curious about? Someone has had that same question or symptom and can quell your panic until you can talk to your doctor. Which leads to the next tip:

2. Choose a kick-ass surgeon and a top-notch hospital. Yeah, so this might not always possible, given your location and insurance coverage, but to the extent you can ask around, it's worth doing some research. I had an awesome surgeon in Boston who cheerfully took on the huge mess I had in my lower abdomen and removed it all laparoscopically, and she kept on top of my follow-up despite my moving across country where even the longest speculum ever made could not reach me. And then I saw another great urogynecologist in San Diego. Do I think it was a coincidence that both these amazing, skilled, warm, professional and communicative doctors were women? I do not! Women doctors rock.

3. The recovery process may be something of a roller coaster ride. Expect a faster recovery if you get laparoscopic surgery, but don't expect miracles. There is at least one website advertising robotic laparoscopic surgeries that features a woman enthusiastically returning to the golf course a few days after surgery. For most women it feels pretty darn heroic to get out of bed, get dressed, and walk around. Yep, walking is good and helps with healing--but the expectation that one should be playing 18 holes before breakfast may lead to suicidal or homicidal thoughts.

4. You will need help. Preferable, an angelic spouse or best friend, and a generous and sympathetic social support network. I was lucky to have those, and it made a huge difference. (Not as helpful: small children, high maintenance pets, or surly teenagers. They should all be packed off to other quarters or supervised by someone other than yourself). And it's not a matter of strength, willpower, or determination: there are a bunch of things you're simply not allowed to do right after a hysterectomy. These include things like laundry, sweeping, shopping, driving, or subjecting yourself to any TV shows, movies, or radio programs that you do not personally approve of. (Okay, perhaps your doctor may forget to include that last one on the list, but don't tell your partner that. And speaking of partners, high on the list of forbidden activities is: sex. For a really, really, really long time. It kinda sucks).

But what if you feel great? Then it gets frustrating, because you still have to lay off normal activities for as long as your doctor tells you to. I felt energetic and ready to get back to "real life" within a couple days of my surgery, but had to restrain myself from overdoing it. (Not chores, of course. I hate chores. But I wanted to go back to working out.) The reason for these restrictions? Sadly, it's not just about fatigue or fragility. If you're too active or do the wrong stuff at the wrong times you can seriously mess things up inside without even realizing it. One word that strikes fear in the heart of any woman recovering from hysterectomy: Adhesions. From what I understand, adhesions are nasty bits of scar tissue that form inside you where they shouldn't, and if they're feeling particularly malevolent they can glue your internal organs together out of spite. Are those dust bunnies under the bed worth going back for more surgery to unstick things? Think carefully before you let your inner Superwoman try to put on her cape. A bathrobe and fuzzy slippers may be the better choice.

5. Common post-operative complaints/concerns: See the post-op forum at hystersisters for tons of these. But highlights include fatigue, "swelly belly," bleeding, constipation, trouble urinating, mood swings, numbness, lumps, bladder spasms, joint pain, insomnia, headaches, itchiness, and comically insensitive husbands. If you're getting your ovaries removed as part of the process, and are not going on hormone replacement, you'll also get to hop on the express train to menopause and enjoy all those fun symptoms too!

Note: and yeah, there are even worse things that can happen, like you could become incontinent or your stitches could come lose and your guts could burst out through the hole in the back of your vagina. But the scary stuff is pretty darn rare, and being a bit of a hypochondriac, I decided it was in my best interest not to spend much time researching it.

6. Exercise: So once you've been cleared to ease back into an exercise routine, how best to approach it? Good question! And I still don't have a damn answer! Helpful post-hysterectomy resources for working out are practically nonexistent--especially if you are the least bit hardcore in how you define "exercise." Most advice seems geared to women who have never exercised before in their lives. Or you get some combination of "listen to your body," "listen to your doctor," "don't lift heavy," "don't do abdominal exercises for a long time," and "be really really careful!!!"

[Nov 2012 Update: Help is Here! A panel of personal trainers stopped by to offer advice, including videos, on how to safely exercise your core and abs post-hysterectomy, check it out!]

My own experience has been a bit frustrating, especially since I've also got a stubborn case of plantar fasciitis and a broken elbow. Five months out, and I'm still not back to my old strength training routine, though I'm figuring out aerobic stuff to do. For some reason, my beloved elliptical remains problematic and generates pelvic pain, but I can do a stair stepper. (I like the wimpy kind, where you can choose your own step height and speed, not the hardcore escalator kind where you have to trudge up real stairs and can't keep up with fast-paced music. Have you ever seen someone look happy on one of those machines?) Bike riding figured heavily into the post hysterectomy rotation--until I fell off and broke my arm. Yay me!

7. What the hell is pelvic physical therapy? Well, I'm finding out first hand. Turns out the reason I've been having trouble trying to get back to my exercise routine is because my pelvic floor and core muscles spaced out and forgot how to function properly. My transverse abdominal and multifidus muscles got a bad case of attitude and went on strike, and my pelvic floor muscles said, "oh, hey, no problem! We're uptight and neurotic anyway, we'll just do all the work and go into a semi-permanent state of spasm. Aw, don't thank us, we're happy to do it!"

So I'm now trying to learning how to find all these elusive muscles, relax or strengthen them as indicated, and breathe from my belly. Oh, and get used to having a very nice physical therapist lube me up and test my clenching/relaxing ability where I'm not used to having a whole lot of company.

(BTW, pelvic physical therapy is also an excellent idea for those suffering from urinary incontinence--a huge issue for tons of women that is rarely talked about except in Depends commercials. And really, do you want diapers to be your go-to resource when there are better options? If you are in the San Diego area, check out these folks for pelvic physical therapy. Not only are they staffed with excellent and personable PT's, they have free granola bars in the waiting room.)

So will I ever get back to doing burpees and pull-ups and bulgarian split squats again? I sure as hell hope so! In the meantime, I've got plenty to do on my exercise list, even if the results aren't visible to casual acquaintances.

8. So why have a hysterectomy in the first place? Benefits are unique to each person, but for many of us, all the hassles are totally worth it. There are lots of reasons to get a hysterectomy (cancer, insane menstrual bleeding, pelvic pain, etc,) and plenty of alternatives to consider. So when you decide to opt to have a big chunk of your insides yanked out, it's usually because you are sick to death of coping with gynecological issues. Even with side-effects to deal with, my sense from both online communities and real life friends: very few women regret the surgery once they've fully recovered. And many wish they'd done it years ago.

So, anyone else out there have any gyno complaints, medical gripes, hysterectomy experiences or insights to share? Or just wanna say hi? It's all good!