Introduction
A few days ago I sat with a client who’d recently had a hysterectomy. She’s normally an active woman but she had become frightened of her own body, because she’d been told not to lift anything heavier than a kettle, not to “use her core,” and definitely no crunches. Can we please stop telling women this!!
Then she told me she was scared she’d cause a prolapse just by getting up wrong. She meant standing up out of a chair, which she will do dozens of times a day for the rest of her life.
I hear this constantly, from capable, sensible women who have been left believing their bodies are fragile because nobody explained the advice they were given. They get a list of don’ts with no context and no reasoning, and no clear sense of what any of it is supposed to be protecting them from, and then they go home and try to work it out on their own.
The things nobody warns women about
When researchers measure pressure inside the abdomen, the biggest spikes don’t come from crunches, or dumbbells, or picking up a toddler. They come from:
- straining with constipation
- coughing, particularly chronic coughing
- sneezing
- standing up from a chair
- getting out of bed
These are the things we can’t avoid doing. If we’re going to talk seriously about risk after pelvic surgery then constipation and coughing deserve far more attention than a set of controlled abdominal exercises, and yet women are warned about lifting while hearing almost nothing about their bowels in the context of pressure management.
Exercise has not been shown to cause prolapse
Despite decades of advice telling women to avoid lifting and avoid anything strenuous, there is no good evidence that exercise causes prolapse, and none that it causes a prolapse repair to fail.
The 2024 review of postoperative activity restrictions is clear on all three of the assumptions we’ve been working from:
- there’s no evidence that avoiding movement improves healing
- there’s no evidence that lifting causes recurrence
- there’s no evidence behind the standard “nothing heavier than a kettle for six weeks” rule
That rule isn’t a research finding. It’s a tradition that got passed down and repeated without ever being properly tested, and it’s a strange thing to say to a woman who has children to carry, shopping to bring in and a life she’d quite like to get back to.
What the trials actually found
Two good quality trials compared women after prolapse surgery who were told to take it easy with women who were told to return to normal life. The women who moved more did not do worse, they did not have more prolapse, they did not undo their surgery, and at one year both groups looked the same. Some of them reported fewer symptoms than the women who had rested.
The 7th International Consultation on Incontinence, a well respected global body, now recommends liberal activity after surgery instead of restriction. Restriction has costs of its own. Movement supports mood, sleep, confidence and independence, early mobilisation stops women deconditioning, and feeling like yourself again does a lot for recovery.
Fear is not a rehabilitation plan
When a woman is told not to lift anything heavy, she doesn’t hear a nuanced clinical instruction. She hears something much bigger and much more frightening:
Don’t lift anything. Don’t bend. Don’t use your core. Don’t trust your body.
That stays with women for months, sometimes years, and what follows is avoidance, loss of strength, shrinking confidence and often worse pelvic floor symptoms than they started with. That’s a lot to carry for advice with no evidence behind it.
What we should actually be focusing on
Constipation
Straining generates substantial pressure and we don’t take it seriously enough. Support looks like fibre, fluid, good toilet positioning with the feet supported, the knees above the hips and a forward lean, plus pelvic floor strategies and a referral to a dietitian or GP if things aren’t improving.
Chronic coughing
Repeated coughing loads the pelvic floor far more than carrying shopping ever will, so this might mean a respiratory review, reflux management, smoking cessation support, and teaching the knack so the cough isn’t landing on an unsupported pelvic floor.
Individual guidance instead of blanket bans.
The questions that actually help are:
- what surgery did you have?
- what feels uncomfortable when you move?
- what were you doing before?
- what do you want to get back to?
- how anxious do you feel about movement?
That’s rehabilitation. Restriction should be used sparingly and if it is used, then there needs to be a timeline and a plan to mitigate the side effects of restriction.
My client didn’t need a longer list of forbidden movements. She needed context, reassurance and a plan that fitted her actual life, so this is what I told her and it’s what I’d tell you too.
Your body is not fragile, you are not going to undo your surgery by moving, and the things you’ve been taught to fear are not the things creating the highest pressures inside your abdomen. Constipation and chronic coughing matter far more than crunches ever will.
Liberal activity after gynaecological and prolapse surgery is safe, exercise is not a proven risk factor for recurrence, over restriction causes real harm, and a paced, confident return to movement is part of the treatment.
Women deserve guidance that empowers them, not a kettle rule that nobody can explain, and quite frankly insulting.
