Hysterectomy

What is a hysterectomy?

A hysterectomy is surgery to remove the uterus The uterus is the part of a woman’s body that carries a baby if she is pregnant. Another word for uterus is “womb.” If you have a hysterectomy, you will never be able to carry a pregnancy.

Are there different kinds of surgery for hysterectomy?

Yes, there are 4 main kinds of surgery:

• Abdominal hysterectomy –

  To do an abdominal hysterectomy, the doctor makes a cut in the belly and removes the uterus through that opening.

• Laparoscopic hysterectomy – To do a laparoscopic hysterectomy, the doctor inserts a tiny camera and tools through small openings in the belly. Then he or she removes the uterus bit by bit through one of the holes or through the vagina.

• Robotic hysterectomy – In a variation of the laparoscopic approach, the tools used for the surgery are attached to a robot that the doctor controls. This is called “robot-assisted laparoscopy.”

• Vaginal hysterectomy – To do a vaginal hysterectomy, the doctor makes cuts inside the vagina and removes the uterus through the vagina

Vaginal hysterectomy leaves no visible scars, but it is not always possible. Sometimes doctors do vaginal hysterectomy but also use the tools used in laparoscopic hysterectomy. This is called a “laparoscopic-assisted vaginal hysterectomy.” If this approach is used, the uterus is removed through the vagina.

Why might a woman need a hysterectomy?

 A hysterectomy might be done to treat and of the following:

• Abnormal bleeding – Some women bleed too much during their period or at times when they should not be bleeding. This can lead to a condition called anemia, which can make you feel very tired.

• Fibroids – Fibroids are tough balls of muscle that form in the uterus. They can get very big and press on the organs inside the belly. They can also cause abnormal bleeding.

• Pelvic organ prolapse – Pelvic organ prolapse is when the uterus falls down into the vagina.

• Cancer or conditions that could lead to cancer – Cancer can affect the uterus or the cervix, the organ that separates the uterus and the vagina. Sometimes doctors suggest removing these organs if they show signs that cancer is about to form.

• Ongoing pelvic pain – Some women feel pain that will not go away in the area just below the belly. This is called “chronic pelvic pain.” Hysterectomy can sometimes help cure this pain.

What if I do not want a hysterectomy?

Many of the conditions that are treated with hysterectomy can be treated in other ways instead. If you do not want the surgery, ask your doctor or nurse if you have other treatment options. Ask, too, what will happen if you do NOT have a hysterectomy.

What if I want to get pregnant?

If you have a hysterectomy, you will not be able to get pregnant. Unfortunately, if you have cancer or another serious problem, you might not be able to avoid having a hysterectomy. If you want to have children, speak to your doctor or nurse about your options.

Is the uterus the only organ that is removed during a hysterectomy?

That depends on what you want and why you are having a hysterectomy. During a hysterectomy, doctors sometimes also remove the:

• Cervix – For a vaginal hysterectomy, the cervix must be removed. For an abdominal or laparoscopic hysterectomy, the cervix can be removed or left in place. If the cervix is removed, it is called a total hysterectomy. If the cervix is left in place, it is called a subtotal or supracervical hysterectomy.

• Ovaries and fallopian tubes – The ovaries are the organs that make eggs (which can become a baby) and female hormones, including estrogen and progesterone. The fallopian tubes carry eggs from the ovaries to the uterus. The hormones made by the ovaries help keep bones healthy and are important for other aspects of health. Women who have their ovaries removed sometimes need to take hormone pills.

If you are planning to have a hysterectomy, ask your doctor whether he or she is planning to remove your cervix and your ovaries and fallopian tubes. It is important to know this, because women who do not have a cervix need different medical care than women who do. Likewise, women who do not have ovaries sometimes need different medical care than women who do.

Should I have my ovaries and tubes removed if I have a hysterectomy?

 Deciding whether or not to have your ovaries removed can be tough. You will need to think about how old you are, and about how not having ovaries might affect you.

In women who have not yet been through menopause, having the ovaries removed can lead to hot flashes, bone loss, reduced interest in sex, and other problems. In women who have been through menopause, having the ovaries removed might also increase the risk of health problems, such as heart disease, but the research is still not clear. On the other hand, women who have health problems that get worse at certain times in the menstrual cycle sometimes feel better without their ovaries. Plus, in rare cases, the ovaries can develop cancer, so women sometimes choose to have them removed. Before you have surgery, ask your doctor about the pros and cons of having your ovaries removed.

The fallopian tubes are not needed if a woman is not going to get pregnant. They can be removed at the time of hysterectomy, even if the ovaries are left behind. This can lower the risk of a rare type of cancer that can start in the fallopian tubes.

What will my life be like?

 Studies show that women can have happy, full lives after a hysterectomy. Many women feel better after the surgery, because they no longer have the symptoms that bothered them before.

Recovering from Hysterectomy

Who is this information for? This information is for you if you are about to have, or you are recovering from, an abdominal hysterectomy (an operation to remove your uterus (womb) through a cut in your tummy). You might also find it useful to share this information with your family and friends.

What can I expect after an abdominal hysterectomy?

Usual length of stay in hospital In most instances, you will be admitted to hospital on the day of your operation. Most women are able to go home between two and four days after their operation.
After-effects of general anaesthesia Most modern anaesthetics are short lasting. You should not have, or suffer from, any after- effects for more than a day after your operation. During the first 24 hours you may feel more sleepy than usual and your judgement may be impaired. You are likely to be in hospital during the first 24 hours but, if not, you should have an adult with you during this time and you should not drive or make any important decisions.

Catheter You may have a catheter (tube) in your bladder to allow drainage of your urine. This is usually for up to 24 hours after your operation until you are easily able to walk to the toilet to empty your bladder. If you have problems passing urine, you may need to have a catheter for a few days.
Scar An abdominal hysterectomy is usually carried out through a cut that is approximately 10cm long. This is usually made across the top of your pubic hairline, but sometimes it may run down from your tummy button to your pubic hairline instead.

Stitches and dressings Your cut will be closed by stitches, staples, clips. Your cut will initially be covered with a dressing. Some stitches dissolve by themselves. Other stitches, clips or staples need to be removed. This is usually done about five to seven days after your operation. You will be given information about this. You should be able to take a shower.

Any stitches in your vagina will not need to be removed, as they are dissolvable. You may notice a stitch, or part of a stitch, coming away after a few days or maybe after a few weeks. This is normal and nothing to worry about.

Drain Occasionally, a drain (small tube) is inserted through your lower abdominal wall to drain off any blood or fluid that may accumulate immediately after your operation. This will be removed by a nurse after your surgery while you are still in hospital. Vaginal bleeding You can expect to have some vaginal bleeding for one to two weeks after your operation. This is like a light period and is red or brown in colour. Some women have little or no bleeding initially, and then have a sudden gush of old blood or fluid about 10 days later. This usually stops quickly. You should use sanitary towels rather than tampons as using tampons could increase the risk of infection. Pain and discomfort You can expect pain and discomfort in your lower abdomen for at least the first few days after your operation. When leaving hospital, you should be provided with painkillers for the pain you are experiencing. Sometimes painkillers that contain codeine or dihydrocodeine can make you sleepy, slightly sick and constipated. If you do need to take these medications, try to eat extra fruit and fibre to reduce the chances of becoming constipated. Taking painkillers as prescribed to reduce your pain will enable you to get out of bed sooner, stand up straight and move around – all of which will speed up your recovery and help to prevent the formation of blood clots in your legs or your lungs.

Trapped wind Following your operation your bowel may temporarily slow down, causing air or ‘wind’ to be trapped. This can cause some pain or discomfort until it is passed. Getting out of bed and walking around will help. Peppermint water may also ease your discomfort. Once your bowels start to move, the trapped wind will ease. Starting to eat and drink After your operation, you may have a drip in your arm to provide you with fluids. When you are able to drink again, the drip will be removed. You will be offered a drink of water or cup of tea and something light to eat. If you are not hungry initially, you should drink fluid. Try eating something later on.

Washing and showering You should be able to have a shower or bath and remove any dressings the day after your operation. Don’t worry about getting your scars wet – just ensure that you pat them dry with clean disposable tissues or let them dry in the air. Keeping scars clean and dry helps healing.

Do’s & Don’ts after hysterectomy

After a hysterectomy, a full recovery will have you enjoying your favorite physical activities in two weeks to two months.

1. Don’t starting walking too soon

   The surgical incision from an abdominal hysterectomy is very sensitive and tender for the first two to three days. Stay in bed and relax. You may have to stay at the hospital for three or more days. If you are released the day after your surgery, plan to have a friend, family member or daycare help with childcare. This is also a great time to have family assist with meal preparation and daily chores since your mobility is limited to going to the restroom.

2. Do exercise while resting
   To keep your muscles toned and increase your energy levels, do gentle exercises from your bed. Ankle rolls reduce swelling and lifting small weights can keep your arms toned. Avoid any exercises that require bending at the waist or sitting up. Talk with your doctor about Kegel exercises to strengthen vaginal muscles.

3. Don’t dismiss recovery medications

   Your doctor will prescribe pain-killing medications and possibly an antibiotic to reduce the risk of infection after your surgery. Have a family member help you take these medicines on time. A lapse in painkillers can leave you feeling extremely uncomfortable and unable to sleep.

4. Do increase movement after day three

   With your doctor’s approval, it’s normal to start walking around the house and doing small movements by the third day after your surgery. Bending and squatting are still restricted, but spending time outside getting fresh air and going for short walks will improve your mood and health.

5. Don’t venture out alone

   Although you’re starting to feel better, ask someone else to drive and be with you at all times. Your mobility is limited and shouldn’t be overly strained right away. It’s best to enjoy areas around your home. Sit on a porch, relax in the sun on a patio or visit a nearby neighbour.

6. Do consider hormone replacement therapy

   Talk with your doctor about taking medications to balance your hormones. This can ease the mood swings and hot flashes associated with menopause–which will occur after your surgery if your ovaries were removed. If your ovaries remain intact, you won’t experience menopause until your body naturally reaches this turning point.

7. Don’t bend or lift

   Your doctor will let you know when you can return to normal physical activity. This may be as short as two weeks for a vaginal hysterectomy, or as long as two months if your hysterectomy was an abdominal surgery. Instead, ask for help around the house or consider recovering at a short-term rehabilitation center.

8. Do use topical ointments on scars

   If you had abdominal surgery, consider using topical ointments to lighten the scar near your bikini line. Your doctor can prescribe skin-lighting creams. Or go natural and try cocoa butter to smooth the healing skin. Coconut oil can soften the scar tissue. Plus, coconut is a natural antibacterial and wards off infection.

9. Don’t skip check-up appointments
   Although your scar appears to be healing properly and you feel good, don’t neglect doctors appointments during your recovery. If your hysterectomy was due to medical issues, your doctor will do follow-up blood tests to watch for internal infections and perform physical exams to make sure the healing process is going as planned.

10. Do resume sexual relations

    Most women get the approval of a gynecologist to become intimate within six weeks after a hysterectomy, according to WebMD. Since your abdominal organs have shifted, it’s best to explore sexual contact slowly. What was once a favorite position may now be uncomfortable. Don’t get discouraged. Think of this as a chance to experiment and revitalize your sex life.

11. Don’t dismiss new symptoms

    After the surgery, you may encounter new medical issues. Let your doctor know if you start to experience urinary incontinence, problems with your bowel movements, pain during sexual relations or general pelvic weakness.

12. Do seek mental support

    Having a hysterectomy is not only a physical change, but can also weigh heavily on your emotions. Talk with your local Atlanta-area gynaecologist about group counselings or individual therapy sessions to discuss the changes in your body, the option of adopting future children and how to regulate hormones as you go through menopause.