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Hysterectomy and the Whole Woman® Posture

When we come into the world as newborn baby girls, our spine is completely straight. Our three pelvic organs and their channels: urethra-bladder, vagina-uterus, rectum-sigmoid colon, form long, straight lines through a funnel-shaped torso.

Only when we begin to stand, walk and run under the forces of gravity do pronounced arches appear in our lower back and bottoms of our feet. By early childhood, the lumbar curve is a fully developed, large-radius arc.

As the lumbar spine is pulled forward with every breath we take, so the pelvic organs are pulled down and forward against the lower abdominal wall. The pelvic outlet is at the back of the body and the pubic bones are positioned front to back underneath like straps of a saddle.

It is the muscular uterus, and the equally muscular and contractile “round ligaments” of the uterus, that work to keep the uterus pulled forward. Because the bladder is connected to the uterus at the level of the cervix, when the uterus pulls forward, it takes the bladder with it. It is important to understand that prolapsed organs have not fallen down, they have fallen back from the lower belly to the outlet at the back of the body. When the uterus is positioned fully forward, or anteverted, the vaginal walls are pulled up taut, providing support to the bladder and rectum.

It is important that every woman understand that the uterus is the hub of a pelvic ring, and connected 360º around the body. Natural dynamics of breathing under the forces gravity either pin the organs into position at the front of the body, or push them backward toward the pelvic outlet, depending upon body alignment, or posture.

The uterus not only helps to hold itself and surrounding organs in place, but it also holds the bony pelvis together from the inside. The pelvis is made up of three bones and six moveable joints. Although unstudied by gynecology or orthopedics, there is much anecdotal evidence that great musculoskeletal change occurs after hysterectomy, especially if the surgery was performed during the reproductive years. The pelvis widens and the rib cage settles very close to the hips. The lumbar curve flattens, while a hump develops at the base of the neck. By age 60, one-third of American women no longer have the “hub of the wheel” and these musculoskeletal changes are very easy to identify in our population.

With these changes comes significant back pain as the lower spine is no longer connected to the muscular, forward pulling uterus. Prolapsed bladder and rectum are inevitable, and the possibility exists for the small intestines to eviscerate through either a closed and everted vagina (vault prolapse), or a vagina that has re-opened at the top due to dehiscence of sutures.

The surgical response to post-hysterectomy cystocele and rectocele is “A&P” repair, with or without mesh. In traditional anterior and posterior repair, front and back vaginal walls are dissected at the midline, and a strip of vagina is removed with the goal of “narrowing” the vaginal opening. The conventional framework is that a narrow “hole” at the bottom of a soft-tissue “floor” is less likely to allow organs to fall through. In reality, the opening is at the back and the organs are positioned at the front of the body.

When the uterus is removed and the vaginal walls “narrowed”, the long, normally flattened vagina becomes like a shallow cave. No longer can it protect itself by flattening down against intraabdominal pressure. Sitting atop the cave are the entire intestines, soft tissue against soft tissue. Just standing and breathing creates a tremendous amount of intraabdominal pressure and it is those pressures that result in epidemic proportions of post-hysterectomy vaginal vault prolapse.

Since its formation in the early part of the 20th century, gynecology has envisioned the orientation and dynamics of the female pelvis incorrectly. In truth, we have a strong, bony pelvic floor that, along with the multi-layered abdominal wall, supports all our pelvic and abdominal organs. This concept is very important for the post-hysterectomy woman to understand. You may not have your uterus, but the top of your back vaginal wall is still connected to your intestines through fascial layers. You can use the weight of your intestines to pull your vaginal walls forward enough so they can flatten against intraabdominal pressure. In this position, they are protected from the pelvic outlet, which is at the back of the body. This is a head-to-toe posture that pulls the abdominal wall up, never in.

Post-hysterectomy women need to understand the true dynamics of pelvic organ support as much as wombed women. The key is whether enough vaginal length has been left to flatten against internal pressures. All vaginal surgery for prolapse further ruins the dynamics of pelvic organ support.

Support the natural shape of your pelvis, as well as the health of your hip joints, with external belts worn lower in front and higher in back. Understand that the lower spine has lost its major internal support structure and begin the Whole Woman postural work slowly and carefully.

{ 9 comments… add one }
  • carolyn July 28, 2014, 9:50 pm

    yes i have prolapse put i can not aford to but this im on a set income and can just make it from one month to next is there a woman out there that might give me one of there ? would realy think them if so.

  • Ann April 15, 2014, 5:50 am

    I was fortunate to find your website and and insight after being diagnosed with both rectal prolapse and cystocele. I have found the exercises helpful, but the rectal prolapse is my biggest problem. The intestine prolapses out of the rectal cavity after each BM. Is there anything additional that I can do to solve this problem?

  • Dahlia April 11, 2014, 4:38 am

    My questions are all that have been asked by Meredith.
    Hysterectomy has been suggested by my Dr because of large fibroids, heavy bleeding and anemia.
    I have never been so afraid in my life. I am so concerned about The many changes that no one ralks about.

  • Annette Lufflum November 1, 2012, 5:27 am

    I had back pain before my recent hysterectomy however the pain is a lot worse and standing longer than 5-10 mins is impossible.
    I have had all organs removed due to womb cancer.
    Should I be asking for physio and is ther excersises that I can do?
    Many thanks,
    Annette.

  • Jenn October 22, 2012, 10:41 am

    So very little research (like, none!) on paralyzed women. I’ve been paralyzed from T11 for 27yrs and had a partial hysterectomy 1yr ago. Reading this article worries me.

    The only way I can convey paralysis to people is like being attached to a cadaver that still circulates blood. No muscles nor tendons have worked in almost 3 decades … not even sure how developed they were at age 12.

    I had a fall while going from my chair to car (lifting myself) two weeks before the prolapse and had used crede/valsalva for all those years previous on a neurogenic bladder.

    Should I expect more organs to want to respond to gravity? This vaginal vault thing was never explained to me though my physician did mention this could happen again in another 20yrs.

  • Louise October 1, 2012, 6:03 pm

    Hi Christine

    Thanks for this article. Yes, you are right women who have had hysterectomy will still have some ability to allow the top part of the vaginal walls to come forward, pulled forward by the intestines. Meredith, to understand this I suggest that you go to the Forums and use the Search box to look for these subjects, There are about twelve years of posts on the Forums. Christine’s books and DVD’s are where you will find the reasoning behind Christine’s statements. You can also find information in the FAQ’s and the Resources Tabs on the main website, http://www.wholewoman.com .

  • Betsy September 26, 2012, 10:28 am

    Hi Meredith – this blog is connected to the Whole Woman website. Go to the Home page, go to the Hysterectomy page, go to the Frequently Asked Questions tab where you will see a complete explanation of WW posture, with diagrams and photographs. Be aware that this postural work is most effective on women who have not had hysterectomy – because the uterus is the hub of pelvic organ support. That being said, WW posture can still help you keep your organs forward. Do check it out!

  • Lindy Roy September 26, 2012, 6:31 am

    Thank you Christine for this really excellent and important article. It clearly explains normal and healthy pelvic organ positions, how women can either maintain or optimise their chances of re-attaining healthy pelvic organ positions and thereby avoid or reduce pelvic organ prolapse problems.

    This article includes information relevant to all women, not just women who’ve had hysterectomies.

    Pass this on to the women in your life. It’s one of the best gifts you can give them!

  • Meredith September 25, 2012, 6:13 pm

    Definitely noticed the organization of my internal organs has changed since my uterus was removed 5 years ago (ovaries and cervix remain). So I try to pull myself up into straighter posture whenever I think of it. Otherwise, the natural tendency is to slump and hump. Yes, I have a hump forming on my spine below my neck.
    This article seemed promising, but after reading it, I don’t think I leave with anything more than my previous notion that I should stand up as straight as I can when I notice I am not.
    I do not understand from this article what “the Whole Woman postural work” that is to be performed slowly and carefully is! I would love to understand what that work is, and do it. The part about the belts is too vague to be able to adopt. And HOW are we supposed to
    “use the weight of your intestines to pull your vaginal walls forward enough so they can flatten against intraabdominal pressure”? More information please!
    The sentence “This is a head-to-toe posture that pulls the abdominal wall up, never in.” is also unclear. Aren’t all postures head-to-toe postures? What does it mean to pull the abdominal wall up, never in?
    Any elaboration on the things mentioned in this article would be extremely useful to many of us! Thanks for putting it out there, but more please!

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