We Treat Hysterectomy Pain Without Drugs
The most common surgical technique for hysterectomy is abdominal surgery. To access the uterus, the surgeon must first cut through several structures, including the skin and the peritoneum (tissue enclosing the abdominal and pelvic organs). After surgery, all of the cut tissues must heal.
Doctors generally expect complete recovery within four to eight weeks. For vaginal surgery, recovery usually occurs within one to two weeks. Sexual activity can generally be resumed after six weeks, regardless of the surgery type.1
Hysterectomy has become a fairly common surgery. In fact, so many women struggle with issues related to the pelvis that one in three women in the U.S. over age 60 has had a hysterectomy.1Of the 600,000 women who undergo hysterectomies in U.S. every year, most recover within the given time frame and return to pain-free lives.1 However, a study in 2007 found that 32% of women who underwent hysterectomies experienced chronic pelvic pain one year after their hysterectomy. The study also found that a vaginal surgery (rather than an abdominal surgery) did not significantly lower the risk of chronic pain.2
The Journal of Minimally Invasive Gynecology examined women who had diagnostic laparoscopy for pain after hysterectomy. The most common findings were adhesions, adnexal remnants (appendages of an organ left behind after surgery), and endometriosis (the lining of the uterus found outside the uterus.)3
Adhesions are thick strands of collagen that form to help the body heal and repair after infection, trauma, surgery or various other injuries. Although the body needs these strands to help tissue repair, adhesions can have a side-effect of binding and restricting structures that were previously mobile.
The tissues of the pelvis are extremely delicate and are meant to glide easily over each other. During a hysterectomy, the surgeon cuts or burns through pelvic tissues to remove the uterus and sometimes other structures. Collagen cross-links rush in to repair the tissues at the surgical sites. Thus, adhesions may form after surgery. These adhesions act like a powerful glue, binding neighboring structures – such as the intestines, bowels, vagina or bladder.
When adhesions form after hysterectomy, women can experience a variety of side-effects, including:
- Pelvic or intercourse pain
- Low back pain (due to adhesive pulls into that area)
- Uncomfortable tightness or pulling
- Decreased desire, lubrication and orgasm
- Pain with or after urination
- Constipation or painful bowel movements
- Small bowel (intestinal) obstruction (SBO)
Symptoms can range from moderate discomfort to severe, recurring pain or tightness. In the case of SBO, they can become life-threatening as adhesions block the intestines, preventing food from passing thorough the digestive tract.
Intercourse pain and sexual dysfunction after hysterectomyFollowing a hysterectomy, a woman can expect intercourse to be uncomfortable the first couple of times. If a woman has had one or both ovaries removed, she may also experience a decrease in lubrication and desire as her body goes through menopause.
If a woman feels pain with intercourse after six weeks despite several tries, she may have a ‘mechanical’ problem such as vaginal adhesions or adhered pelvic ligaments. Many women feel that if they continue to try and push past the pain, the pain will eventually go away. If it doesn’t resolve after three or four attempts, we generally find that adhesions have formed in this area, pulling or restricting the vagina or attaching its delicate tissues to nearby structures, causing pain with intercourse.
The Journal of Sex & Marital Therapy classified female sexual function into six measurable domains: desire, arousal, lubrication, orgasm, satisfaction and pain4. Although a woman who has undergone a hysterectomy may initially experience decreased function in these areas, function should return within a few weeks. If they do not, it is a sign that adhesions may be restricting the area, preventing normal sensation and function. In our published studies on this phenomenon, we found that treating the adhesions can return function in these areas.
With her husband, massage therapist Larry Wurn, Belinda took a much deeper look at the etiology and biomechanics of adhesion formation. They found that the molecular bonds that attached each of the tiny collagen fibers to its neighbor appeared to dissipate or dissolve with certain site-specific manual techniques. With this knowledge, they developed the Wurn Technique® to free adhesive bonds and return structures to a more functional, pain-free state.
The Wurn Technique® is designed to reduce or eliminate adhesions crosslink by crosslink. It has been shown in peer-reviewed medical journals to decrease pain and improve function without surgery or drugs.
- It carries risks associated with anesthesia or infection.
- Surgeons can mistakenly cut of burn nearby or underlying structures.
- Despite the best skills of the finest surgeon, the body tends to create more adhesions as it heals from the very surgery designed to remove them.
A study in Digestive Surgery showed that 55 to 100 percent of women develop adhesions following pelvic surgery3. Another study reported that 35 perfect of all open abdominal or pelvic surgery patients were readmitted to the hospital more than twice to treat post-surgical adhesions during the 10 years after their original surgery4. Thus, pelvic surgery itself has been implicated as a major cause of adhesion formation and many patients become trapped in a cycle of surgery-adhesions-surgery – with no end in sight.
2. Rosen R, Brown C, Heiman J, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J. Sex Marital Ther. 2000;26:191-208. PMID 10782451.
3. Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal Adhesions: Etiology, Pathophysiology, and Clinical Significance.Dig Surg. 2001; 18: 260-273. PMID 11528133.
4. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O’Brien F, Buchan S, Crowe AM. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet Br J Med. 1999; 353: 1476-80. PMID 10232313.
By Belinda Wurn, PT, National Director of Services, Physical Therapist at Clear Passage Physical Therapy - Gainesville, Florida Area