Q: Why do I have cramps after a hysterectomy?

You describe cramps, not unlike menstrual cramps, after masturbation. Orgasm includes contraction of pelvic floor muscles, and it sounds like you're experiencing some spasms of those muscles. Radical hysterectomies often require tissue removal or dissection surrounding the uterus and ovaries. It's likely your spasms are caused within nerves and muscles that are still healing.

I suspect this will improve with continued healing, but using an anti-inflammatory medication like ibuprofen may help relieve the pain. If, three months or so after surgery, when most healing has taken place, the spasms and pain persist, a consultation with a pelvic floor physical therapist may be helpful. They can assess the muscles and nerves of the pelvic floor and often remedy persistent pain.

Continue that healing work! I'm hopeful the pain will resolve itself.


Dr. Barb DePree MD
Dr. Barb DePree MD

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34 Responses

Dr Barb
Dr Barb

July 20, 2020

Casey, I think that it is still early enough that I wouldn’t be too concerned about the persistent spotting and cramping. If there is any residual endometriosis there may be some occasional pain/cramping. The bleeding comes from the top of the vagina where there is an incision that takes weeks to heal so some light bleeding is not a surprise and that may continue for a few more weeks.

Casey
Casey

July 20, 2020

On March 15, 2020, I had a cyst rupture and rip open my left fallopian tube causing massive internal bleeding (ironically, I was already scheduled for a hysterectomy 3 weeks later). They did an emergency right salpingectomy and stopped the internal bleeding, I had over 2 liters of blood in my belly so the healing was slow going. On June 11th, 2020, I was able to have my total hysterectomy (left the ovaries since I am mid 30s) and a left salpingectomy. The pathology showed fibroids and adenomyosis in my uterus. They also removed another large cyst from my left ovary and several places of endometriosis (over the years, I have had 3 other endometriosis removal surgeries). So I know that there is scar tissue and nerve damage and don’t expect the hysterectomy to be a magic procedure that takes away all of my pain, especially while keeping my ovaries. However, I am now 5 weeks post op and am cramping as if I am going to begin my cycle. I also am still bleeding from the surgery, not heavily, but at a slow constant rate. I know going through both of these traumas in a 3 month span will take time for me to get back to normal, but at what point do I need to be concerned about the pain and the spotting?

Dr Barb
Dr Barb

July 06, 2020

Denise, I’m not sure what is going on but you need further attention, an exam and maybe additional imaging to try to determine the cause of pain. This doesn’t sound normal for 5 weeks post operatively.

Denise
Denise

July 06, 2020

I had a partial hysterectomy about 5 weeks ago caused by endometriosis/ huge fibroids that prolapsed out my vaginal canal. Because the fibroid wasn’t getting blood it went necrotic causing an abscess on my uterine wall. Fast forward to today. The immense pain that I’ve been living with that the hysterectomy was suppose to rectify/alleviate is still here. I’m cramping as if i still have my uterus. I got here because a lot of drs didn’t listen or down played my very severe issues. I can’t get my gynecologist oncologist to hear me. I understand she hasn’t been through what I’ve been through. Because of this pandemic I couldn’t go see a different specialist and we only have one in town any advice. Still experiencing pain on top of their lack of care is literally insult to injury.

Dr Barb
Dr Barb

May 29, 2020

Natasha, Cramping is usually considered uterine in its source but there are other structures in the area that can cause cramping, mostly bowel or the GI tract. Sometimes adhesions from surgery can cause cramping like pain, especially if ovaries are left behind and are involved in adhesions. The pelvic floor muscles can cause cramping pain and surgery can be a trigger for pelvic floor dysfunction. A careful pelvic exam may be able to determine if the source is pelvic floor or not, and often pelvic floor PT is helpful for this.

Natasha
Natasha

May 28, 2020

2 years ago I had to have a full hysterectomy because I had cancer in my uterus. To this day I continue to have bad cramps, Why?

Dr Barb
Dr Barb

May 19, 2020

Antoine, Some hysterectomies are ‘supracervical’ – the cervix is left behind (and maybe a bit of the lower uterine cavity or endometrium), most hysterectomies are removal of the cervix and uterus completely. If it was supracervical you may have a bit of remaining endometrium that responds to the cyclic hormone production from the ovaries and you will shed that endometrium and have a light period, this isn’t too unusual or worrisome. If you are still bleeding after complete removal of uterus and cervix, I can’t explain that bleeding and you need to ask a few more questions about what might be the cause. That would not be expected of explained by still having your ovaries. I hope this makes sense and is helpful.

Antoine
Antoine

May 19, 2020

Hi, im 46 years old i had my partial hystectomy last august 2018. Im not married. What i have noticed is that i have menstrual cramping and spotting that lasted 4 or 5 days similar to monthly perior but just spotting i have this sometimes after 2 months sometimes after 3 months this time after one month…its k8nd of weird. I went to see my OB and had check up she said its normal because i still have both ovaries one in the left is started to shrink and the one in the right have a small cyst and no need for me to worry because i am in my pre-menopausal period…but still im not satisfied and im a bet worried. Please help. Thank you

Dr Barb
Dr Barb

March 12, 2020

Rhonda-Usually with pelvic cramping we think of the uterus as the most likely source but now without that other options might be bowel, or pelvic floor muscles. Pelvic floor muscles are a bit more likely because of more recent surgery. Ovaries, with ovulation may be described as cramping pain, but that would likely be cyclic.

Rhonda
Rhonda

March 12, 2020

Hello Dr. Barb. I’m 45 and I had a hysterectomy back in Sept 2019. I still have both my ovaries but what I’ve noticed is that I have cramps all the time not just a week leading up to what would have been my cycle.
What would that be?

Dr Barb
Dr Barb

January 16, 2020

Shawna: Without a uterus the other most likely organ in that vicinity that cramps is the GI tract, and this also could be a result of post surgical adhesions. You don’t mention whether or not you retained your ovaries, if you still have ovaries they too could cause some cramping. Generally we don’t think of cramping as a particularly worrisome symptom.

Shawna
Shawna

January 16, 2020

I had a hysterectomy at 26 and I am now 36 I do biote pellets every 3 months but I have started cramping almost like I am going to have a period. I had to have everything removed so there is nothin left for me to even have cramping. What could be causing this, I have been doing biote for a year and have a wonderful Dr that has been my dr for 20 years but I am really nervous about why this cramping has started.

Dr Barb
Dr Barb

December 03, 2019

Michelle, I suspect the residual pain and cramping may be related to post-infectious adhesions involving bowel. There aren’t many other organs remaining that would cause cramping. Please follow up with your surgeon.

Michelle
Michelle

December 03, 2019

I had a hysterectomy using 4 small incisions (kept my ovaries) on April 8, 2019. My friends told me I would feel so much better after I healed from the procedure. Sadly, I did not feel better. I had pains in my right side like cramping shortly after going back to work, 4 weeks post-op. I frequently felt sick to my stomach and also ended up with an upper respiratory infection.
Then on July 4th, I woke up in extreme pain on my right side. I thought I was having an appendicitis attack. I went to the ER. They did blood tests, a scan of my abdomen, and an ultra sound of my ovaries. They sent me home with pain medicine.
The next afternoon I went cak to the hospital because I could not breathe. The ER doctor had me admitted thinking I had pneumonia. Later that evening after doing more scans and ultrasounds, they realized that my abdomen was full of infection and scheduled me for an emergency surgery the next morning.
So, on July 7th, just 3 months from my first surgery the surgeon opened me up with a c-section type of incision and said infection began seeping out immediately! He removed both ovaries, the right one was very swollen and full of infection, had another surgeon check my bowels to make sure everything else was free of lesions.
I spent a week in the hospital, 4 weeks with a pic-line and going in daily for antibiotics, with a total of 6 1/2 weeks off of work.
Now, almost 5 months later, I am having cramping pain in my lower right abdominal area, similar to what I dealt with when having periods.
How is this possible?

Dr Barb
Dr Barb

November 13, 2019

Stephanie, an examination with your provider is the best route to find out what is causing this pain.

Stephanie
Stephanie

November 13, 2019

I had a total hysterectomy on the 10/29/19 for endometrial cancer. They left my ovaries. Before I had no cramping and no I am having pelvic cramping as if I was getting my menstrual cycle. They hurt so bad but I know it can’t be a menstrual cycle since I don’t have a uterus anymore. What can this be? And is it normal?

Dr Barb
Dr Barb

November 08, 2019

Linda, this is the kind of diagnosis that can really only be made after a careful exam. We encourage you to see your provider to find the cause and treat your pain.

Linda
Linda

November 08, 2019

I have heard from you. Your suggestion why still having cramps one year after surgery. I had cancer 7% on wall of uterus why did a hysterectomy not solve the problem?.

Dr Barb
Dr Barb

October 28, 2019

Linda, I can’t explain the connection between your hysterectomy and now the presence of pain or cramping. It might be post operative adhesions, but a thorough exam should be done to assess for any conditions that may cause this.

Linda
Linda

October 28, 2019

It has been one year, since complete hysterectomy a cancerous spot was found 7 percent into the wall of uterus. Now a year later why am i having pain/cramps.

Dr Barb
Dr Barb

August 26, 2019

Vicki, I am so sorry this is your journey. I do not have any further insights for your current condition and hope that you have success with your neurosurgeon. Women advocating for women is an important avenue for advancement in our healthcare. Thank you for using your voice.

Victoria
Victoria

August 26, 2019

Hi Dr Barb

Im Vicki from post above. I have an update have seen several drs. I spent 22 days in hospital after hysterectomy had another surgery my ovary adhered to my cuff was removed very painful. This was never told to me could happen. Im the post above its now 9 months post hysterectomy. Im now under care a of neurosurgeon who specializes in pelvic pain. What I have endured after this surgery has been nothing short of a nightmare. I keep going and going. I have nerve and muscle damage from da vinci robotic that would bring you to your knees. Misdiagnosed with pfd. Therapy only agitated the nerve. That only made me worse.

My obgyn promised i would feel better post adenomyosis and Hysterectomy and Im suffering horribly. Im hopeful this neurosurgeon will find cause because drs are boggled. All i know is I walked in with painful periods walked out disabled by pain. Im not alone. There are millions like me. HERS foundation.

Dr Barb
Dr Barb

July 19, 2019

Vicki, these symptoms are cause for concern. Please visit your provider to address them.

Vicki
Vicki

July 19, 2019

I’m 7 months post op-kept my ovaries. I’m having horrible muscle spasms and labor contractions when I walk. I push like I’m in labor, I cramp and have burning and tingling up my sternum that shoots me out of my sleep. The spasms go all the way up my abdomen I cant move without pain and sitting in a car is impossible.

Dr Barb
Dr Barb

May 28, 2019

Catherine, unfortunately I can’t really answer how long symptoms like this may last. Healing is a varied event that is difficult to predict. If there is bleeding in the area, that can cause pain, until that blood absorbs there will likely be continued discomfort. Please do follow up with your provider if you continue to feel pain so they can help you manage your pain and recovery.

Catherine
Catherine

May 28, 2019

I had a laparoscopy for my hysterectomy on monday may 20th exactly 7 days ago. Last night i began to feel contractions like if I was in labor. Worst feeling in the world. With xtra dosage of meds n heating pad slowly did the pain go away but this lasted hours. This morning as soon as I woke up the pain came back. My doctor said its spasms and common but my question is how long will they last. I can’t take anymore of it. There’s a reason a had epidurals wirh my children. How can I prevent from getting these spasms.

Dr Barb
Dr Barb

March 15, 2019

Trish, I really don’t know what the cause of your pain might be. I assume the hysterectomy was done in an attempt to alleviate the pain, so presumably it was not uterine in origin. A post-operative visit/exam would be important to make sure there is no obvious surgery related issue. Then I think an assessment with a pelvic floor physical therapist would be an important consideration.

Trish
Trish

March 15, 2019

I had severe cramping and lower back pain prior to a total hysterectomy (kept cervix) which was performed on Feb 6, 2019. So I’m 5 weeks out. I am having severe cramping and it feels like it did before hysterectomy. I can’t hardly work due to the pain and I have a desk job. I had a colonoscopy about 3 months ago as well. All was good. I have been diagnosed with IBS years ago. Could this be where the pain is coming from?

Dr Barb
Dr Barb

March 05, 2019

Denise, Given your history, it would be worthwhile to have an evaluation by your health care provider. Don’t be shy about describing your symptoms! More information will help him or her understand what’s causing your discomfort and determine what therapy would be beneficial.

Denise
Denise

March 05, 2019

I am almost 5 years post op from a partial hysterectomy in 2014. I am also a cervical and vaginal cancer survivor! I am experiencing a lot of menstrual cramping and vaginal pain every month. I just don’t know or understand what’s going on?

Dr Barb
Dr Barb

February 15, 2019

Jenny, it’s difficult to say why you may have cramping. If you are premenopausal and there is still ovarian function then this wouldn’t be a big surprise, but if you are postmenopausal it is less likely. The next step should be a pelvic exam to determine if there is anything going on to contribute to the discomfort. It can be pelvic floor muscles, it could be GI related so make sure you see your provider to try to determine what might be going on.

Jenny
Jenny

February 15, 2019

I had a partial hysterectomy Nov. 13 of 04. I’m having a lot of cramping. Could I be having trouble with my Ovaries now?

Dr. Barb
Dr. Barb

October 23, 2018

Autumn, it isn’t too surprising that intercourse wasn’t completely comfortable this soon after surgery. That doesn’t necessarily mean there was any harm done, 6 weeks following surgery a lot of healing has occurred and it isn’t likely you can cause any ‘damage’. The cause of pain after surgery can be from an array of possibilities and likely just the healing process that will improve over time. An exam by the surgeon would be helpful to carefully assess to make sure there aren’t other factors that may be causing pain, and that it is just in fact a healing/time related matter.

 Autumn
Autumn

October 23, 2018

I am finally 6 weeks out of a complete robotic hysterectomy and was intimate with my partner last night but this morning I’m experiencing major cramping and pain, my partner noticed I still have some stiches left over from the surgery and I’m now wondering if we caused any damage or if pain is normal

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