Back Pain After Hysterectomy: Common Causes, Warning Signs and What Helps
Back pain is a common complaint in the weeks after a hysterectomy, and most of the time it’s part of normal recovery: the way you lay on the operating table, the way you hold your body to protect the incision, and the days of moving less than usual. It usually improves steadily as you heal. Less often, back or side pain can be a sign of a complication that needs prompt attention. This guide explains the usual causes, the warning signs, and what actually helps.
Common causes of back pain in the first weeks
Your position during surgery
During a hysterectomy you lie in the same position for a long time, often with your legs raised and supported, and sometimes tilted with your head lower than your hips for laparoscopic surgery. Under anesthesia your muscles are fully relaxed, so your back and hips can feel stiff and sore for a few days afterwards.
Protective posture and muscle tension
After abdominal surgery, most people instinctively hunch forward and tense up to protect the incision. Walking bent over, avoiding twisting, and getting in and out of bed awkwardly all load the back muscles in unusual ways. This is one of the most frequent reasons for lower back pain during recovery, and it eases as you gradually stand straighter.
Moving less than usual
Spending more time in bed or on the couch stiffens the back and hips. Unsupportive mattresses, sofas and recliners can make it worse.
Gas and constipation
Anesthesia, pain medication and reduced activity slow the bowels. Trapped gas and constipation can cause pressure and aching that you may feel in your lower back.
Shoulder and upper back pain after laparoscopic surgery
In keyhole surgery, the abdomen is inflated with carbon dioxide gas so the surgeon can see. Leftover gas can irritate the diaphragm, and that irritation is often felt as pain in the shoulders or upper back. It’s common, it isn’t a sign of damage, and it usually fades within a few days. Walking around helps the body absorb the gas.
A common myth: “the pelvic bones shift”
You may read online that removing the uterus makes the pelvic bones shift or the spine lose its support. There’s no evidence for this. The uterus isn’t part of the skeleton and doesn’t hold the spine or pelvis in place. The ligaments cut during a hysterectomy support the pelvic organs, not the bones. Pelvic floor muscles and connective tissue do change after surgery, which is why pelvic floor rehabilitation can be helpful, but your skeleton doesn’t move.
When back pain can be a warning sign
The ureters are the thin tubes that carry urine from the kidneys to the bladder. They run very close to the uterus, and in a small number of hysterectomies one is injured. Studies report rates of roughly 0.3% for laparoscopic and abdominal hysterectomy, and around 1% in one national Norwegian registry. Many of these injuries aren’t noticed during surgery and only show up days later, often after the patient has gone home. Pain is the most common symptom.
Contact your surgical team or seek urgent care if back or side pain comes with any of the following:
- Pain in your side or flank (between the ribs and hip), especially on one side, that’s getting worse rather than better
- Fever or chills
- Nausea or vomiting
- Passing much less urine than usual, or none at all
- Watery fluid leaking from the vagina
- Burning when urinating or blood in the urine
- Numbness, weakness or shooting pain down a leg
Most of these symptoms turn out to have simpler explanations, such as a urinary infection, but they should always be checked. Caught early, problems like a ureter injury are much easier to treat.
When pain lasts for months
Most women find their pain steadily improving over the weeks after surgery. However, studies report that 5% to 32% of women have some form of chronic pain after a hysterectomy. In a Danish prospective study, about 1 in 6 women still had pain four months after surgery. That pain was mostly pelvic rather than back pain, and the strongest predictors were having pain problems elsewhere in the body before surgery and having intense pain in the days right after the operation.
Possible causes of longer-lasting pain include pelvic floor muscle tension or dysfunction, adhesions (scar tissue), nerve irritation, endometriosis that remains after surgery, or a back problem that existed before and was aggravated during recovery. Pain that persists beyond three months deserves a proper evaluation, not just reassurance. A gynecologist, a pain specialist or a pelvic floor physical therapist can help identify the cause.
If your ovaries were removed, it’s also worth asking your doctor about bone health. ACOG notes that removing both ovaries before menopause can increase the risk of osteoporosis, which over the long term can contribute to back problems. Our article on ovary and pelvic pain after hysterectomy covers other sources of ongoing discomfort.
What helps
- Walk a little, often. Short, frequent walks are one of the best things for back stiffness, gas pain and overall recovery. Increase the distance gradually.
- Stand up straighter, bit by bit. Try to avoid staying hunched over. Holding a small pillow against your belly when you cough, sneeze or stand up can make it feel safer to straighten up.
- Get in and out of bed the gentle way. Roll onto your side, then push yourself up with your arms while lowering your legs over the edge, instead of sitting straight up.
- Support your back when sitting and sleeping. A firm chair with a cushion behind your lower back, and a pillow between your knees when sleeping on your side, can reduce strain. See our guide on how to sit after a hysterectomy.
- Use heat. A warm (not hot) heating pad on the lower back can relax tight muscles. Don’t place heat directly on your incisions.
- Take pain relief as prescribed. Staying on top of the pain in the first days makes it easier to move, which in turn helps recovery. Ask your doctor which medications are right for you.
- Prevent constipation. Drink fluids, eat fiber, and ask about a stool softener, especially while taking opioid pain medication.
- Consider pelvic floor physical therapy. If pain or stiffness lingers, a physical therapist who specializes in the pelvic floor can assess how your core and pelvic muscles are working together.
For a timeline of what you can safely do at each stage, see our week-by-week recovery guide.
Frequently asked questions
How long does back pain last after a hysterectomy?
Back pain from positioning, posture and reduced movement usually improves within the first few weeks and continues to ease as you become more active. Pain that is getting worse, or that hasn’t improved after several weeks, should be checked by your doctor.
Why do my shoulders hurt after a laparoscopic hysterectomy?
It’s most likely leftover gas from the surgery irritating the diaphragm, which is felt as pain in the shoulders. It’s common and usually goes away within a few days. Walking helps.
Can a hysterectomy cause pain down my leg?
Rarely, nerves in the pelvis or legs can be irritated by surgery or by positioning on the operating table, causing numbness, weakness or shooting pain. Tell your doctor about any of these symptoms. Most nerve problems of this kind improve over time, but they should be assessed.
Is lower back pain a sign of prolapse after hysterectomy?
Prolapse more typically causes a feeling of heaviness, pressure or a bulge in the vagina, sometimes with a dull ache in the lower back. If you notice those symptoms, see your doctor. You can read more in why prolapse occurs after a hysterectomy.
Sources
- Brandsborg B. Pain following hysterectomy: Epidemiological and clinical aspects. Danish Medical Journal, 2012 (doctoral thesis summarizing the author’s research on chronic pain after hysterectomy).
- Acta Obstetricia et Gynecologica Scandinavica, 2022. Study of ureteric injuries during hysterectomy in Norway (compensation claims and national patient registry).
- OBG Management. Clinical article on the diagnosis and management of ureteral injuries after hysterectomy.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention. Obstetrics & Gynecology, 2019.
This article is for general information and is not a substitute for medical advice. If you have pain after surgery, please talk to your surgical team or your own doctor.
