Friday Q A After A Partial Hysterectomy

Q: I have a student who's had a partial hysterectomy. As she described it, to prevent the organs from pressing on her perineum the surgeon used a mesh "ligament" to attach the top of the cervix to a ligament in her back. She says that it feels "weird" and sometimes uncomfortable when we work on deep inner bodywork, such as Agni Sara (or various preparations) or ways to access Uddiyana Bandha. She feels it most when we do breath retention on the out breath and create an inner vacuum as you elongate the torso. Have you come across this before? Is there any risk for her to work on this? Any modifications you'd suggest?

A: In fact, I have not come across this particular complaint from any yoga students who have had hysterectomies of any kind. However, I have personal experience with the presence of mesh used in abdominal surgery and its effect on yoga practice. Over 10 years ago, I developed a hernia in the groin area on my left side. Upon further evaluation by a surgeon, it was discovered I had an even bigger potential opening on my right groin area, and surgery was recommended to repair and seal off these openings. This was accomplished using the kind of mesh I suspect your student had placed during her surgery. I was told that I might expect some unusual sensations in the area of the groin creases after my surgery, but that it usually would disappear after an uncertain amount of time. And, indeed, following my hernia repair, I initially felt soreness, and eventually after that disappeared, I was left with a kind of tightness, especially on my right side, that I had not had prior to surgery. As I returned to my normal practice routine I noticed it in certain yoga poses, most notably in High Lunge when the right leg was back. This persisted for some time, certainly for months, but then gradually began to fade. And at this time, I no longer notice any unusual tugging or weird sensations in the area where the mesh is still certainly located. 

But back to the student in question. So, what is a “partial hysterectomy”? Hysterectomies, in general, are the second most common surgery performed in the US each year. A partial hysterectomy refers to a procedure where only the uterus is removed, not the cervix or the ovaries. This type of operation involves a shorter recovery time, and is commonly used in the treatment of fibroids and severe and uncontrollable vaginal bleeding. Mesh is often used to hold the cervix in place, since the structures that would normally do that are gone with the uterus, and the vagina could prolapse, or fall, toward the pelvic floor. Unfortunately, there can be complications with the use of mesh, such as mesh shrinkage, which can cause such serious complications as intense pain, scarring, vaginal shortening, and sexual dysfunction. Although this does not sound like the case here, it is worth being aware of these potential complications.

In the case presented here, I would be less concerned about a student who was only having “weird” sensations at certain times in the practice. However, if there is outright discomfort, it might be important for her to check back in with her surgeon and make sure there is nothing more worrisome going on. For instance, it is not uncommon for patients to develop scar tissue around the sites of abdominal surgeries. If that scar tissue, or “adhesions” as they are also sometimes referred to, is causing enough problems, pain or otherwise, it is sometimes recommended to do a follow-up look via endoscopy and possibly release the scarred areas, which in many cases will result in reduced or resolved pain and improved overall abdominal function. The first step is simply to have a follow-up with her doc.

If the student is mildly uncomfortable only when doing certain things, there might be some ways to approach her yoga practice to her benefit. Since we are not diagnosticians as yoga teachers, we would focus on trying to modify the practice so as to avoid stimulating pain. The most obvious thing to try is to do less Uddiyana Banda and Agni Sara, both reducing the depth of contraction of the abdominal muscles and the amount of time spent in either state. The student can then participate to the appropriate degree for her unique situation without going to the point of triggering the discomfort. This could hold true for other poses or practices that she discovers also create the undesired discomfort. Periodically, she could try the full poses or practices to see if her body has adjusted to the mesh, and take things from there. While it is entirely possible that with time, these sensations will subside, keep in mind that pain is the body’s way of telling us to look a little further. Please let us know how things proceed.

—Baxter

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