Why do I have a pooch after hysterectomy?

Quick Answers

There are a few common reasons why you may develop a belly pooch or pouch after having a hysterectomy:

– Loss of estrogen can lead to fat depositing around the abdomen. Estrogen helps keep fat distributed evenly, so low estrogen post-hysterectomy can create a pooch.

– Damage or weakening of the abdominal muscles during surgery. Incisions through the abs can cause muscle separation or weakness.

– Scarring and adhesions under the incision. Internal scarring can make the abdomen stick out.

– Weight gain is common after hysterectomy. Added pounds often deposit around the midsection.

– Fluid retention and bloating are common after surgery. This causes temporary abdominal distension.

– A hysterectomy disrupts the pelvic organs. This impacts posture, core strength, and abdominal tone.

– Healing takes time. Swelling and numbness post-surgery can make the tummy look puffy temporarily.

What Causes a Pooch or Belly Bulge After Hysterectomy?

There are several reasons you may develop a pooch, pouch, or belly bulge after having your uterus and possibly your cervix or ovaries removed via hysterectomy. Here are some of the most common causes:

Loss of Estrogen Effects on Fat Storage

One of the major impacts a hysterectomy has on the body is a marked decrease in estrogen levels. This is especially true if the ovaries are removed during the hysterectomy, as the ovaries are the main producers of estrogen in the body.

Estrogen helps promote more even distribution of fat all over the body. Estrogen causes fat storage in the buttocks, hips, thighs, and breasts. With lower estrogen after a hysterectomy, fat that would normally deposit in these areas instead tends to accumulate around the abdomen and midsection. This leads to increased belly fat.

Some women notice a very distinct pooch or bulge develop in the lower abdomen right after a hysterectomy. Others find that while they had a flat or toned tummy before surgery, the abdominal area becomes soft and distended post-hysterectomy even if their weight stays the same. This is due to the effects of reduced estrogen on where fat is deposited.

Weakened or Separated Abdominal Muscles

During an abdominal hysterectomy, an incision is made either horizontally across the bikini line or vertically from the pubic bone to the navel. This allows the surgeon access to the uterus and other reproductive organs to remove them.

However, cutting through the abdominal muscles can damage and weaken the rectus abdominis muscles. These long, flat muscles run vertically between the rib cage and pubic bone, one on either side of the belly button. They are commonly referred to as the “six-pack” or “abs”.

If the abdominal muscles get separated during surgery, it disrupts their ability to support the abdomen. Additionally, the muscles may scar and heal in such a way after surgery that they do not regain normal function and strength. This can cause a protruding pooch or bulge along the incision site that was not present prior to hysterectomy.

Scarring and Adhesions Under the Incision

While the surgeon does their best to minimize scarring and adhesions during a hysterectomy procedure, some internal scarring in the abdomen is inevitable. Scars can form along the incision line on the outside of the abdomen. But they also develop under the skin along the abdominal wall and between organs.

This internal scarring is known as adhesions. Adhesions act like tough fibrous bands of tissue that can bind organs and tissues together that are not normally connected. This pulls organs and skin inward, sometimes creating a visible pooch along the hysterectomy scar.

Adhesions under the incision site or around the remaining reproductive organs can prevent the abdomen from returning to a smooth, flat appearance after hysterectomy. The scarring essentially causes the abdominal wall to stick out. gently massaging the adhesions over time can help break them apart and reduce pooching.

Weight Gain

Many women find that they gain a modest amount of weight, usually 5 to 15 pounds, during the first year after a hysterectomy. This is common for several reasons:

– Reduced activity during recovery
– Emotional eating due to depression or grief over hysterectomy
– Hormonal shifts that increase appetite
– Slower metabolism after loss of the uterus

This weight gain does not always distribute itself evenly. The extra pounds often preferentially deposit around the abdominal area. This contributes to developing a belly pooch or bulge that was not present prior to surgery. Sometimes the weight gain is very focused right around the hysterectomy scar.

Making dietary changes and increasing exercise, once healed from surgery, can help minimize and even reverse a post-hysterectomy pooch caused by weight gain. But it is important not to start dieting too soon after surgery, as adequate nutrition supports healing.

Swelling and Numbness

It is completely normal for the abdomen to be swollen and look distended for several weeks or even months after a hysterectomy. The swelling is worst in the first 2 to 6 weeks but may persist for 6 months or more.

This is caused initially by trauma from the surgery itself. The abdominal tissues become inflamed during the procedure. Fluid accumulations and edema contribute to swelling as well.

Scar tissue developing under the incision can also make the area look swollen and puffy. Over time, the swelling resolves and the abdomen should return to a normal appearance.

Numbness along the incision is also normal during recovery. This reduced sensation can make the tummy appear puffy or pooched when in reality the swelling is still going down. As nerve endings regenerate and numbness subsides, the abdomen firms up.

Disruption of the Pelvic Floor

The uterus, cervix, and ovaries play an important role in supporting the other pelvic organs. When the uterus is removed and the pelvic anatomy disrupted, it significantly impacts posture, core strength, pelvic alignment, and tone of the pelvic floor muscles.

After hysterectomy, the remaining organs kind of “fall” into the empty space left by the removed uterus. This creates a bulging appearance in the lower abdomen. Problems with pelvic organ prolapse after hysterectomy can also cause a pooch.

Doing pelvic floor physical therapy can help strengthen the pelvic floor muscles again after they are disrupted from a hysterectomy. This provides better support under the abdominal contents and reduces pooching.

Cause of Post-Hysterectomy Pooch Explanation
Loss of estrogen Fat deposits more around abdomen instead of hips/thighs
Weakened abdominal muscles Incisions can damage the abdominal muscles and cause weakness or separation
Internal scarring and adhesions Scar tissue under incision pulls abdomen outward
Weight gain Added fat often deposits around midsection
Swelling and numbness Makes abdomen look puffy until it resolves after surgery
Disruption of pelvic floor Pelvic organs fall forward after uterus removal

How Long Does Post-Hysterectomy Belly Pooch Last?

For some women, a post-hysterectomy pooch resolves on its own within a few months after surgery. Once swelling goes down, strength returns, and any surgical adhesions stretch out, the abdomen often firms up and returns to a flatter appearance.

But for other women, that pooch never fully goes away without taking steps to actively address the causes. A belly bulge that persists for more than 6 to 12 months after a hysterectomy is unlikely to resolve on its own.

Factors that influence how long a post-hysterectomy pooch lasts include:

– How much weight was gained after surgery
– If the abdominal muscles were severely weakened
– How dense and extensive internal scarring is
– The number of pregnancies before hysterectomy
– Age at time of hysterectomy
– Genetics and body type
– Pre-existing diastasis recti

Younger women who were fairly fit before surgery and did not have multiple pregnancies typically see their post-hysterectomy pooch resolve more quickly. Older women and those with pregnancies are more likely to have a permanent pooch unless they take action to correct it.

For some women, the pooch lasts forever if they do not do strength training to build up the abdominal muscles, physical therapy to improve core strength, scar massage to break up adhesions, and exercise to lose weight gained after the hysterectomy.

How to Get Rid of Pooch After Hysterectomy

It takes time and patience, but there are some effective ways to get rid of a belly pooch or bulge that developed after hysterectomy:

Allow Time for Healing

It is completely normal for the abdomen to look distended and puffy after surgery. Allow several months for swelling to resolve, numbness to subside, and incisions to fully heal. While urgent medical issues should not be ignored, some pooching shortly after surgery will improve on its own. Avoid doing strenuous exercise too soon after surgery. Follow all post-op guidelines from your surgeon.

Do Core Strengthening Exercises

Physical therapy or a guided postpartum and abdominal recovery exercise program helps re-strengthen the abdominal muscles after they are cut and damaged during hysterectomy. Proper core strengthening helps resolve rectus diastasis from pregnancy as well. Avoid just doing endless crunches, sit-ups, or vigorous twists which can make pooching worse.

Try Out Pelvic Floor Therapy

Seeing a pelvic floor physical therapist can teach techniques to support the pelvic organs again after hysterectomy through releasing tight muscles and connective tissue while strengthening weak muscles. This improves control, reducing pooching. Pelvic floor therapy also helps relieve pelvic pain which aids comfort and ability to be active.

Improve Posture and Movement Patterns

How you hold your body on a daily basis impacts abdominal tone and alignment. Regular stretching, foam rolling, yoga, Pilates, and lessons from a posture coach helps re-train your movement patterns. This takes pressure off the abdomen and engages the core properly to minimize pooching long-term. Supportive posture helps reverse swayback and slouching.

Try Non-Surgical Scar Treatment

Using topical gels with herbs like gotu kola and gently massaging scars helps break up adhesions under the skin that contribute to pooching along the hysterectomy incision. Silicone scar sheets can also help flatten and smooth external scarring. Getting internal scar tissue mobilized by a physical therapist feels painful but helps release the pooch.

Consider Elective Abdominoplasty

For some women, pooching and bulging after hysterectomy is so severe that nonsurgical options do not resolve it. In these cases, a tummy tuck or abdominoplasty may be performed to tighten and flatten the abdomen by repairing separated muscles and removing loose skin and fat. Though a major surgery, it can produce dramatic improvements in abdominal contouring.

Lose any Excess Weight

If you gained fat after hysterectomy that deposited around your middle, creating a pooch, getting back to your pre-surgery weight can help. Make dietary changes to eat fewer processed foods and sugar. Incorporate vegetables, lean proteins and whole grains. Gradually increase exercise intensity and duration. Aim for 30 to 60 minutes of activity most days to start burning fat.

When to See Your Doctor

In most cases, having a post-hysterectomy pooch or tummy bulge is normal and not dangerous. But it is important to discuss any unusual or severe symptoms after surgery with your gynecologist. Seek medical advice if you experience:

– Fever, nausea, vomiting or intense pain – may indicate infection

– Bowel obstruction from internal scarring

– Hematoma or bleeding under the incision

– Seroma – fluid accumulation under the skin

– Worsening swelling over weeks or months

– Bulge seems to be enlarging – could indicate a hernia

Monitoring for complications is especially important in the first few weeks after the hysterectomy procedure. Report any issues to your surgeon. But for most women, a hysterectomy pooch or belly bulge is merely a cosmetic nuisance rather than a medical emergency. Still, bringing it to your doctor’s attention is a good idea.

Can a Pooch Be Prevented After Hysterectomy?

Some pooching or bulging after hysterectomy is inevitable due to the unavoidable trauma to the abdominal tissues and muscles during surgery. But certain steps can be taken to minimize pooching:

– Stay active before surgery to build abdominal muscle strength

– Reach and maintain your ideal weight prior to surgery

– Quit smoking which impairs healing

– Choose an experienced, highly skilled surgeon

– Opt for a vaginal or laparoscopic hysterectomy when possible

– Consider prophylactic anti-adhesion products like Seprafilm

– Follow all post-op instructions diligently

– Start pelvic floor therapy soon after surgery

– Wear compression garments in the weeks following surgery

– Avoid constipation and straining after surgery

– Introduce abdominal and core strengthening exercise starting 6 weeks post-op

Even with these preventative measures, some pooching is likely to occur and patience will be required as it resolves. But taking steps to optimize health pre-op and care during recovery can reduce a post-hysterectomy belly bulge. Staying active and allowing time for full healing are key.

Conclusion

A pooch or bulge in the abdomen is a common occurrence after having a hysterectomy. Several factors cause this protruding pooch including loss of estrogen, weakened abdominal muscles, internal scarring, weight gain, swelling, and disruption of the pelvic floor after organ removal.

For some women the pooch resolves within months, but for many it persists unless they take action to strengthen muscles, reduce scarring, improve posture, lose weight, and support the pelvic floor. Gentle exercise, physical therapy, scar massage, and a healthy diet can help. If bulging remains severe, surgery like a tummy tuck could be considered.

Don’t panic if a pooch develops after hysterectomy. But do see your doctor about any unusual pain, fever, vomiting or worsening swelling which could indicate complications. With patience and time, the abdomen usually returns to a flatter, firmer profile. Supporting your body through good self-care optimizes healing.

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