“I Know PT Starts at 6-8 Weeks… But What About Before That?”
I had a patient come in two weeks before her hysterectomy to get advice on what to do immediately after surgery through the six-week mark, and I thought—brilliant! That is exactly where I see most patients unintentionally hurt themselves. Post-operative instructions are often so vague: “Don’t lift more than 10–20 pounds.” That’s a huge range and means something different for every body.
So I decided to write a blog about the first six weeks after surgery, when tissues are actively healing and most vulnerable to excess pressure and strain. Those early weeks matter the most.
Why the First 6 Weeks Matter More Than You Think
After a hysterectomy, your body is doing some serious behind-the-scenes work. Internal tissues are knitting together. Sutures are healing. The pelvic floor and abdominal wall are adapting to a major structural change.
Even if your incision looks fine on the outside, internal healing takes longer. During this phase, the biggest risk isn’t “doing nothing”, it’s doing too much, too soon, especially movements that increase pressure downward into the pelvis.
This is why how you move, breathe, lift, cough, and use the bathroom in the early weeks is just as important as formal PT later.
Think of this phase as protective rehab, not exercise, but smart recovery.
Here’s what we focus on during the healing phase:
- Breathe Before You Move
Anytime you:
- Stand up
- Sit down
- Lift something
- Climb stairs
Exhale as you move. We call this “Exhale with Effort”.
Holding your breath increases pressure inside your abdomen and pelvis. Gentle exhalation helps protect healing tissue and reduces strain.
- Respect the “Gallon of Milk” Rule
For the first 6 weeks:
- Do not lift anything heavier than a gallon of milk (~8 pounds)
- If it feels even slightly heavy, it’s probably too heavy
And when you do carry something:
- Hold it close to your body, not out in front of you
- Squat — Don’t Bend
If you need to pick something up:
- Bend at your hips and knees
- Keep your chest lifted
- Avoid bending forward with a relaxed belly
This reduces downward pressure on healing pelvic tissues.
- Don’t Strain to Poop (Seriously)
Straining is one of the highest pressure activities for the pelvic floor.
Instead:
- Use a footstool to elevate your feet
- Take stool softeners if recommended
- Exhale gently during bowel movements
(Think: fogging a mirror, not pushing)
If it’s not coming out easily, don’t force it.
- Cough With Support — Not Brute Force
If you need to cough, sneeze, or laugh:
- Don’t try to hold it in
- Place a pillow, towel, or your hands against your lower belly
- Gently exhale as you cough
This “splinting” helps absorb pressure and protect healing tissue.
What This Phase Is Not About
The first 6 weeks are not the time for:
- Core workouts
- Kegels
- Bracing or “holding your core tight”
- Testing your limits because you feel better
Feeling better does not mean healing is complete.
Then What Happens at 6–8 Weeks?
That’s when pelvic floor physical therapy typically starts focusing on:
- Restoring strength if appropriate
- Improving coordination and endurance
- Gradually returning to higher-level activity
- Addressing any lingering bladder, bowel, or pelvic symptoms
But how smoothly that goes depends heavily on how well tissues were protected early on. The weeks before PT begins are not “do nothing” weeks. They are healing-critical weeks.
By managing pressure, breathing well, and moving intentionally, you’re setting the foundation for a stronger, safer recovery, and better outcomes once formal physical therapy begins.
In Hope and Healing,
Dr. Tara