If You Are Having a Hysterectomy with Excision Surgery

Questions to Ask Your Surgeon

• Will my cervix be removed?
• Will my ovaries be removed or retained?
• Why are you recommending removal or retention of my ovaries?
• How long should I expect recovery to take?
• What activity restrictions will I have after surgery?
• When can I return to work, exercise, swimming, and sexual activity?
• What symptoms would concern you during recovery?

What to Expect

• Spotting or light bleeding may occur for several weeks.
• Fatigue is common and can last longer than expected.
• Internal healing continues long after your incisions appear healed.
• Pelvic pressure, pulling sensations, and occasional discomfort can be part of the normal healing process.

Vaginal Cuff Recovery (If Your Cervix Is Removed)

Important Precautions

• Nothing should be placed in the vagina until cleared by your surgeon.
• Avoid intercourse, tampons, vaginal dilators, and internal pelvic floor therapy until approved.
• Avoid constipation and straining during bowel movements.
• Follow all lifting restrictions provided by your surgeon.

Contact Your Surgeon Immediately If You Experience:

• Heavy bright-red bleeding
• A sudden gush of fluid
• Severe pelvic pain or pressure
• Fever
• Foul-smelling discharge
• New or worsening symptoms that concern you

If You Retain Your Ovaries

Even after hysterectomy, your ovaries continue producing hormones.

What to Expect

• Ovulation may continue.
• Ovulation pain can still occur.
• Hormonal fluctuations may continue.
• Breast tenderness may still occur.
• Acne and other hormone-related symptoms may persist.
• Some patients experience temporary ovarian discomfort during recovery.
• Retaining the ovaries may help support long-term bone, cardiovascular, cognitive, and sexual health.

Pelvic Floor Recovery

Many patients experience pelvic floor dysfunction before and after surgery.

Common Symptoms

• Pelvic tightness
• Deep aching or pressure
• Bladder urgency or frequency
• Burning sensations
• Pain with sitting
• Pain with intercourse after surgical healing

Helpful Strategies

• Walking
• Diaphragmatic breathing
• Pelvic floor relaxation exercises
• Heat therapy
• Pelvic floor physical therapy when cleared by your surgeon

Bladder Symptoms After Surgery

Temporary bladder symptoms can occur after excision surgery, particularly if disease involved the bladder, ureters, or surrounding tissues.

Common Symptoms

• Urinary frequency
• Urinary urgency
• Bladder spasms
• Burning without infection
• Sensation of incomplete emptying

Contact Your Provider If:

• You cannot urinate
• You develop a fever
• Symptoms suddenly worsen
• You notice significant blood in your urine

Healing Is Not Linear

Excision Is Not an Instant Cure

While many patients experience significant improvement after excision surgery, healing looks different for everyone.

Some patients feel better immediately, while others experience temporary symptom flares as the body heals. It is common to have periods of improvement followed by days where symptoms seem to return or worsen. This does not necessarily mean the surgery was unsuccessful.

During recovery, patients may experience:

• Pelvic floor tightness or spasms
• Nerve healing pain, burning, tingling, or pulling sensations
• Bladder urgency, frequency, or discomfort
• Temporary bowel changes
• Fatigue
• Bloating and abdominal swelling
• Hormonal fluctuations, particularly when ovaries are retained
• Increased soreness after activity

Recovery is often measured in months rather than days or weeks. Internal healing continues long after the incisions have healed, and many patients continue to notice improvements for 6–12 months after surgery.

Healing is not always a straight line. Good days and bad days are both a normal part of recovery. Be patient with your body, give yourself grace throughout the healing process, and remember that recovery looks different for every patient.

Recovery Timeline: What’s Normal?

Week 1

• Fatigue
• Gas pain and bloating
• Incisional soreness
• Pelvic discomfort

Weeks 2–4

• Improved mobility
• Continued fatigue
• Intermittent pelvic discomfort
• Increased activity may temporarily increase symptoms

Weeks 4–8

• Continued internal healing
• Gradual improvement in pain and energy levels
• Occasional pulling, pressure, or soreness with activity

Months 3–6

• Ongoing nerve healing
• Continued pelvic floor recovery
• Gradual improvement in overall symptoms
• Many patients continue noticing improvements well beyond the initial recovery period

Months 6–12

• Continued healing and remodeling of scar tissue
• Ongoing improvements in pelvic floor function
• Gradual stabilization of symptoms and hormonal patterns
• Many patients report continued improvements in pain, energy, bowel, bladder, and quality of life during this time

Additional Post-Operative Recovery Supplies

Recovery Must-Haves

• Squatty Potty
• Heating pad
• Ice packs
• Electrolyte drinks
• Protein shakes
• Small pillow for car rides
• Reacher/grabber tool
• Abdominal support pillow
• Period panties a size up for bloating and sensitive abdomen

Updated Incision Care

Follow your surgeon’s incision-care instructions. In most cases, gently washing the area with soap and water and patting dry is sufficient. Avoid applying ointments, creams, hydrogen peroxide, or other products unless specifically instructed by your surgeon.

When to Contact Your Surgeon vs. When to Go to the Emergency Room

Recovering from surgery can feel overwhelming, and it is normal to have questions about what is expected and what may require medical attention.

Contact Your Surgeon If You Experience:

• Increasing pain that is not improving with prescribed medications
• New or worsening pelvic pain
• Persistent nausea or vomiting
• Increasing redness, swelling, or drainage around incisions
• Fever greater than 100.4°F (38°C)
• Burning with urination or symptoms concerning for a urinary tract infection
• New bladder urgency, frequency, or discomfort that is worsening
• Constipation that does not improve with recommended treatments
• Concerns about vaginal bleeding, spotting, or discharge
• Questions about medications, activity restrictions, or recovery expectations

Seek Emergency Medical Care Immediately If You Experience:

• Chest pain
• Shortness of breath
• Difficulty breathing
• Loss of consciousness or fainting
• Signs of a blood clot, including significant swelling, redness, warmth, or pain in one leg
• Severe allergic reaction
• Heavy vaginal bleeding (soaking through a pad every hour)
• Inability to urinate
• Severe abdominal pain that is sudden or rapidly worsening
• Persistent vomiting preventing you from keeping down fluids
• Signs of vaginal cuff complications, including:
  • Sudden severe pelvic pain
  • A sudden gush of fluid
  • Heavy bleeding
  • Tissue protruding from the vagina

When in Doubt

If you are unsure whether your symptoms are normal, contact your surgeon’s office. It is always appropriate to ask questions during recovery. Early communication can help address concerns before they become more serious.

Remember: Every recovery is unique. Your surgeon and care team are your best resource for questions related to your individual procedure and healing process.