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Q: Why do I have cramps after a hysterectomy?

by Dr. Barb DePree MD

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.


  • Andrea, The bleeding after a BM raises the question of is the origin rectal or vaginal. I think this is really only a concern if there is persistence of the bleeding. A single episode is likely not worrisome. The next step if it recurs/persists is a physical exam.

    Dr Barb on

  • I have a hysterectomy July 2020. Today I had light spotting after a bowel movement. There is no more spotting but having light cramping. I feel OK otherwise. I did have sex last night but felt fine last night and all day until the cramps started around lunch. I usually use the restroom afterwards and then is when I noticed very little light pink spotting. I checked again 30 min afterwards and it had resolved . It is now 5 pm and I only have mild cramps.Should I be concerned?

    Andrea on

  • 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.

    Dr Barb on

  • 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?

    Casey on

  • 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.

    Dr Barb on

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