Today’s blog is a guest blog on the uses and benefits of physical therapy when preparing for bottom surgery by Ken McGee, PT, DPT (they/he.)
Just like there is no one right way to be transgender, there is no one right way to prepare for bottom surgery. Physically getting ready for surgery will look different for everyone. Yet, there are some common challenges that most people will encounter as they go through bottom surgery, regardless of their gender or surgery type. These challenges include
(1) pelvic floor muscle tension,
(2) bodily pain, and
(3) deconditioning due to movement restrictions.
This article goes over some activities to try before surgery in order to reduce the negative impact of these three challenges.
Recommended Activities For Preparing For Bottom Surgery
Pelvic Floor Muscle Relaxation
After bottom surgery, the muscles at the bottom of the pelvis may become irritated. This can lead to additional pain on top of surgery pain. Irritated pelvic floor muscles can also increase the chance of having issues with constipation, bladder leakage, and urinary urgency. By working on pelvic floor muscle relaxation before surgery, it can be easier to let go of tension in the pelvis after surgery. Here are three activities I recommend to people before bottom surgery. These can be started any time before bottom surgery.
Activity 1: Beach Ball Breath
Directions:
- Imagine you’ve swallowed a big beach ball and it’s taking up space in your belly. Breathe in and expand the beach ball in all directions—down towards your sit bones, out towards your back, and forward to your belly.
- How often to do this: Many people aim for 10 breaths per day. It can be done lying down, sitting, or standing.
- Alternative: Some people find visualization difficult. As an alternative, you can lie on your back and place a smartphone or a small book on your belly. Breathe in and lift the item up; exhale and let the item sink back down. Repeat 10 breaths per day.
Activity 2: Child’s Pose Stretch
Directions:
- Sit on your heels and round your head and chest forward. Feel free to get extra cozy—you might hug a pillow, reach your arms out in front, or place your arms by your side. You can also place a pillow behind your knees for comfort, if desired.
- How often to do this: 1 to 5 minutes at a time; can be done multiple times per day.
- Alternative: If child’s pose is uncomfortable, many people can also experience pelvic floor relaxation by lying down on the floor and resting their calves on a chair or couch. Hold this position for 1 to 5 minutes.
Interested in more stretching to prepare for bottom surgery? The Australian Pelvic Pain Foundation has a great gender-neutral handout on stretches to relax the pelvic floor.
Activity 3: Move Your Hips!
- Directions: When we move our hips, it helps to increase blood flow to the pelvis. Movements such as hip circles, dancing, and walking can all help the pelvic floor stay more relaxed.
- How often to do this: Aim to move your hips an extra few minutes per day. This might mean dancing to just one song—even if you do it in your chair or car.
Pain Coping Strategies
Mental relaxation techniques can help with reducing pain, as well as reducing the distress we feel when we have pain. Practicing mental relaxation techniques before bottom surgery can make it easier to do them effectively when pain is present. Additionally, progressive muscle relaxation has been shown to reduce pain related to fibromyalgia, as well as help people with insomnia to fall asleep more easily.
Activity 4: Progressive Muscle Relaxation
Directions:
- Lie down or sit in a chair
- Scrunch your toes and hold for 5 seconds, relax for 10 seconds
- Tense your calves for 5 seconds, relax for 10 seconds
- Tense your thighs for 5 seconds, relax for 10 seconds
- Squeeze your buns for 5 seconds, relax for 10 seconds
- Pull in your belly button for 5 seconds, relax for 10 seconds
- Clench your fists for 5 seconds, relax for 10 seconds
- Tense your biceps for 5 seconds, relax for 10 seconds
- Pull your shoulders up for 5 seconds, relax for 10 seconds
- Scrunch your face for 5 seconds, relax for 10 seconds
- Notes: Don’t squeeze so hard you cause yourself extra pain or cramping. It’s okay if you want to extend the ‘relax’ time beyond 10 seconds. If it’s easier for you to listen to directions, YouTube has many guided progressive muscle relaxation videos.
- How often to do this: You might aim to do this daily, but even practicing a couple times before surgery should be helpful.
- Alternative: Not everyone has the time or the bandwidth to do a full progressive muscle relaxation session. Simply breathing IN for 4 counts, and OUT for 8 counts can help take the edge off pain. Practicing this a few minutes prior to surgery will make it easier to do after surgery.
Capacity Building Activities
Bedrest refers to being confined to the hospital bed with no sitting, standing, or walking. Most (but not all) bottom surgeries involve bedrest. Every day of bedrest is known to reduce muscle mass. To counteract this muscle loss, it can be helpful to exercise ahead of time. The two most common types of exercise I recommend for addressing bedrest are (1) strength training and (2) cardiovascular exercise.
Important note: Not all people can tolerate increases in strength training or cardiovascular exercise, especially if they have conditions such as long COVID, fibromyalgia, and/or chronic fatigue syndrome. In these situations, it may be helpful to think of capacity building in terms of modifications to the environment rather than the body.
For example, someone might consider a shower chair for ease of getting through bathing (as opposed to working on squats to build up leg strength). Another example might be to use a reacher tool for picking things up from the floor so that the body doesn’t have to use up as much energy (link). If you are someone with a movement-related disability, bottom surgery is a good time to give yourself extra grace around using aids such as canes, walkers, and wheelchairs. If you need more help planning how to save energy after bottom surgery, it could be worth consulting with an occupational therapist (aka OT) or a disability-aware physical therapist.
Activity 5: Strength Training
Directions: If you are someone with little or no experience doing strength training, I highly recommend taking a class or finding a queer-friendly personal trainer. When it comes to picking a starting point, I love the YMCA for several reasons:
- Gender-neutral bathrooms and the ability to use the bathroom of your choice in states where it is legal to do so
- Commitment to transgender rights as an organization
- Scholarships for gym memberships
- Free childcare during certain hours
Another great option for accessing free and low-cost trans-friendly exercise is through the website Nonnormative Body Club. This hub includes links to all sorts of options, from bodyweight classes to chair workouts. Online classes can be particularly great for people who don’t like to be watched while working out.
Decolonizing Fitness, by Ilya Parker (he/they) maintains a list of queer fitness professionals.
Have a lot of strength training experience? Great! I don’t recommend anything special for bottom surgery other than maintaining your current fitness level.
- How often to do: Starting with one day of strength training per week is great. Many exercise guidelines encourage 3 to 4 days of strength training per week.
- Alternative: Yoga! Research suggests that simply stretching muscles (rather than exerting effort) can help build strength. If lifting weights isn’t your thing, consider going to a yoga class or following along with a yoga video online.
Activity 6: Cardiovascular Exercise
- Directions: The most important thing when it comes to cardiovascular exercise is to choose something that feels good to you. Examples of cardiovascular activity include using an arm bike, stationary cycling, hiking, and gardening.
- How often to do: The benefits of cardiovascular exercise start at one minute. If there aren’t medical reasons to avoid cardiovascular exercise, people preparing for surgery are encouraged to aim for 20 to 30 minutes of cardiovascular exercise, 5 days per week.
- Alternative: Rest! Lie down and listen to a favorite song, rest in a favorite chair, or simply do nothing. Rest = restoration. If someone has not slept at least 7 hours, I definitely recommend taking the day off from exercise.
Need more help?
Do you have more questions about physically preparing for bottom surgery? Consider reaching out to a physical therapist knowledgeable in transgender health. Check out the Academy of Pelvic Health’s PT Locator tool and select Transgender Pelvic Health from the drop-down menu.
Dr. Ken McGee, PT, DPT (they/he) is a highly experienced transgender physical therapist who practices from a trauma-informed perspective. They help people of all ages and genders live more active, fulfilling lives. Dr. Ken’s favorite moments are hearing clients say that they are finally back to doing what they love—be it running, playing with their kids, or getting outside.
Dr. Ken McGee received their Doctor of Physical Therapy from the University of Washington in 2014. In 2018, they became one of the few physical therapists in Washington to be board-certified in pelvic health. Dr. Ken enjoys teaching for the Herman and Wallace Pelvic Rehabilitation Institute. Click here to read about Dr. Ken’s perspective on supporting transgender clients.
Dr. McGee’s practice is B3 Physical Therapy & Wellness.
We’re thrilled to have Dr. Ken McGee back to write with us! Previous articles they have contributed to:
