Hi, I'm Michelle. Today I'm going to be helping you with starting your pelvic floor exercises
after hysterectomy. So this is a real beginner's lesson. So, what we're going to be doing,
is doing some exercises on the ground and then you can progress those exercises to sitting
up. And these are exercises that you start to strengthen your pelvic floor muscles when
you have approval to start your exercises from your doctor or from your surgeon.
So if you think about where the pelvic floor muscles are�if you think of the pelvis,
and that's the front of the pelvis and underneath is a space (underneath here) you've got
your two sit bones and you've got the tailbone. So the pelvic floor muscles run underneath
this area of your pelvis, in and around where you sit. From the pubic bone to the tailbone so
from front to back and also too from side to side. So you can see that they fill up
that area there, and that's what's holding everything up. So after your hysterectomy
surgery it's really important that you have those muscles strong and supportive to support
your surgery and the stitches that have been put in and the repair long-term.
So, let's get started lying down. Just before we do start, make sure that these exercises
feel really comfortable, so, we're really focusing at strengthening gradually and just
doing what you can do little bit by little bit. Let's start down on the ground now. So
you've got somewhere at home or if you're watching this video if you can lie yourself
down with a comfortable cushion and a mat or a towel on the ground. Let's get going.
Okay, so we're in our lying down position, and the idea with lying down for your exercises
is that your pelvis is like this, so really your muscles aren't under the load of gravity
and body-weight, so your insides aren't pushing down. So in that lying down position, it can
make the muscles a little bit easier to activate and it can just decrease the load on your
pelvic floor a little bit more. And you {2:01 wern/would/worried?} if you're doing these
exercises lying down.
So, I've got two pillows here. I've got one for underneath my head and I've got one to
support my legs. Now a lovely position to lie in after your surgery is on your back
with a pillow underneath your knees particularly if you have a tummy; you'll find that's much
more comfortable. So you can be positioning yourself lying down, in this position just
coming down gently, lying on your back with your legs on the pillow like that. Or, alternatively
you could lie on your side (and I'll face you this way) with a pillow between your legs
like that, so that you're nice and comfortable. And now we're going to just start with a couple
of repetitions of these exercises. So, before we start, let's visualize the area that we're
working. We're visualizing the muscles in and around the back passage around the anus in
and around the vagina and in and around the urethra (or the urine tube.) Those muscles
are going to be just gently lifting and squeezing inside, and then releasing down and relaxing.
And to start with, we're only just going to start with a couple of repetitions being mindful
that this is really gentle to start with. You shouldn't be feeling any discomfort at
all with this exercise. And just do what you can do.
So let's start. So I'm imagining my drawing up action is this way. So I'm going to start
and I want you to start at home by just drawing in and around gently, in and around the back
passage, the vagina and the urethra, lifting up and squeezing inside. Lifting and squeezing,
lifting and squeezing and relax, and let go completely. And take a deep breath in
and out. So I'm not squeezing my bottom muscles, and I'm not pulling my tummy in. Those areas
are staying relaxed. I'm drawing up in and around the area where I sit in and around
those pelvic openings. Let's try again. Here we go: Just gently, lift and squeeze, and
lift and squeeze, and then completely relax and let the muscles go. And have a deep breath
in and out.
Let's try one more time at home. So just once more, just to see how we're going. Here we
go. Back, middle and front, lift inside drawing up and in lift and squeeze, keep lifting,
keep breathing relax the muscles right back down to resting. Big breath in into
your belly. Let the muscles relax breathing out and rest. So that's how you'd start,
with just those few repetitions, and that might be just enough to do today. See how
you feel, and if you feel okay then you might repeat that same little routine tomorrow.
I also want to show you how to do some seated exercises. So we're going to move on now to
some upright seating exercises that you can progress to at home. Okay, so we've moved
now into sitting; I'm just sitting on a low stool, you can be sitting on a chair or a
fit-ball if you choose to at home. And remembering that now we're doing the pelvic floor muscles
and lifting them against gravity. So ideally we all want our pelvic floor muscles to work
upright (against gravity) so that we can exercise them sitting, upright or standing upright,
so that they'll work in those positions. If we do all our exercises lying down where
those muscles don't have to work against gravity they're not going to strengthen nearly as effectively.
So let's get started with our seated exercises for after your hysterectomy surgery.
I'll just put my pelvis down over here. So, I'll sit side-on to you, or just sit on an
angle so that you can see my positioning. So, what I want you to do at home, is with
your feet flat, a small inward curve in the lower back, lengthen your spine so lift
up your spine roll your shoulders back and down always feels good to do that anyway.
So that's your posture to start your pelvic floor exercises. And, I hope that you can
feel between your sit-bones and your pubic bone, you can feel that diamond area that
triangular area in there and imagining back towards the tailbone. That's the area we're
lifting in and lowering down. So again really gently at home, I'd like you to draw in and
lift up around your three pelvic openings, so lift up inside and keep breathing. Lift
and squeeze, and keep breathing, lift and squeeze, and lower down slowly, slowly slowly.
And have a big breath in and let it go.
So if your muscles are weak, you might only feel a little bit of a flicker; you might
not actually feel the pelvic floor muscles lowering down. Just do what you can do and
work with it gradually over time. It will take time to re-strengthen. Just give it the
time and persevere with your exercises. Let's go again. So, at home, lifting up inside,
just gently lift and squeeze, lift and squeeze inside keep lifting pelvic floor muscles
inside and relax down slowly. Take a deep breath in, into your belly, let your pelvic
floor right down, back to relaxation position. And let's go one more time, lifting up just
gently, lifting and squeezing, squeeze and lift inside, squeeze and lift and lowering
back down, right back down to rest. Deep breath in and out, and let your pelvic floor completely
relax.
And again, that might be the little routine that you do just for the first week, just
doing a couple of lifts and lowers. As you as your recovery takes place you can start to
do more repetitions in a row, but you won't start to increase the strength of the holds
until you can get up to a good ten repetitions in a row. That's when you start to be doing
stronger holds. Initially you're starting to increase the duration or the length of
your holds.
So let's review what we've just done. We've talked about our exercises lying on the ground so
our pelvic floor exercises lying down you could do those on your bed, for when your
pelvic floor muscles are weak and when you're just starting back into your exercises. And
then we've talked about progressing your exercises into sitting, so that you get a little bit
more strength and a little bit more functional strengthening real world strengthening to
get your muscles strong for every day, walking around and moving and doing the things you
need to do. We've really emphasized starting off gradually the exercises being pain-free,
starting off with a gentle contraction and relaxation really being very important. Gradually
increasing how long you're doing your holds for, and then finally increasing the strength
of your holds.
So, I really hope those exercises help you with your hysterectomy recovery, and taking
the time to really develop strong pelvic floor muscles to support long-term after your surgery.
Well, that's all for me today. For more information on your pelvic floor exercises, visit me at
PelvicExercises.com.au I'll look forward to exercising with you again soon. Bye for now.