Pelvic Floor & Core Rehabilitation

Pelvic Floor & Core Rehabilitation

Your foundation for confidence, control, and recovery

After a hysterectomy, it’s natural to wonder what’s happening “down there.”
Your pelvic floor and deep core are part of a finely tuned system, one that supports your bladder and bowel, stabilises your spine, and responds automatically every time you breathe, move, or lift.

Surgery, hormones, and healing can all influence how this system behaves.
The good news? It can recover beautifully with calm, consistent attention.

What the Pelvic Floor Does

Your pelvic floor is a hammock-like group of muscles and connective tissue that supports your pelvic organs.

When it’s working well, it contracts and relaxes in rhythm with your breath and movement, lifting gently on the exhale and releasing on the inhale.

After hysterectomy, these muscles may feel weaker, heavier, or simply “different.” That’s normal. The key is reconnection, not restriction.

When and How to Begin

Most women can safely start reconnecting with their pelvic floor within the first week after surgery, sooner if you’re comfortable and there’s no pain or bleeding.

Step 1: Breathe

  • Inhale through your nose, letting your ribs and belly expand.

  • Exhale slowly and imagine a tiny lift inside (like you’re stopping wind).

  • Relax completely before the next breath.

This is gentle awareness, not a workout. Do this lying down or seated once or twice daily.

Step 2: Begin Targeted Training (~Day 7 onward)

Once cleared by your consultant, start structured Pelvic Floor Muscle Training (PFMT) - both slow holds and quick squeezes.

  • Lift and hold for up to 5 seconds, rest for 5.

  • Add 5–10 quick squeezes.

  • Gradually build hold time to 10 seconds, practising in lying, sitting, then standing.

  • Use the NHS Squeezy App for reminders and correct pacing.

These exercises are safe, evidence-based and, according to Cochrane reviews, the first-line treatment for regaining bladder control and pelvic support.

Understanding Pelvic Floor Tone

Not every woman needs “Kegels.”
Research shows that roughly:

  • 50–60 % have low tone or underactivity

  • 30–40 % have normal tone

  • 5–15 % have high tone (overactivity)

A high-tone pelvic floor can feel tight, sore, or cause urgency and pain with sex or emptying the bladder. More squeezes can make this worse.
The only way to know your type is through an internal assessment by a pelvic health physiotherapist.

Pelvic floor assessment and internal checks are outside the scope of fitness instructors and personal trainers. Always seek a pelvic health physio for an accurate diagnosis.

Find one here:

What to avoid

Don’t hold your breath while tightening your pelvic floor.

  • Don’t clench your buttocks, thighs, or jaw - these muscles love to “help” but only get in the way.

  • Don’t do hundreds of fast squeezes or “challenge” routines from social media.

  • Don’t panic if you feel nothing at first. Connection returns gradually.

Remember, you’re healing from major surgery. Your pelvic floor needs the same respect as your incisions.

When to Seek Extra Help

If you experience:

  • Ongoing leakage or urgency

  • Vaginal heaviness or bulging

  • Pelvic or lower-back pain

  • Pain with sex or tampon use

…pause your exercises and contact your GP or pelvic health physio. Early assessment can make recovery quicker and prevent prolapse progression.

The Bigger Picture

Reconnecting with your pelvic floor is about trust, not tension. These muscles are part of how you move, laugh, lift, and live, they’re your foundation, not your limitation.

Start small, be patient, and celebrate progress. Strength and confidence will come back, one mindful breath at a time.

When you feel ready, we’ll build on this foundation in Return to Exercise & Loading where you’ll learn how to add strength, impact, and freedom back into movement safely.

Evidence Summary

Our pelvic floor guidance follows the latest evidence from Cochrane Reviews (2023) and Chartered Society of Physiotherapy (CSP) recommendations.

Evidence confirms that:

  • Gentle pelvic floor activation can begin within the first 7–10 days (when cleared by your team)

  • Regular, mindful practice improves continence, support, and confidence

  • Breathing techniques help relaxation but don’t replace muscle training

Early, guided training builds strength safely, it’s not about squeezing harder, but reconnecting with control and confidence.