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Expert Speak

Hysterectomy Basics

By Dr Uma Ram

What is Hysterectomy?
Why is hysterectomy advised?
Effects of a hysterectomy
Types of hysterectomy
The Surgery
After the surgery
Common problems after surgery
Medication
Visiting the doctor

What is Hysterectomy?

A hysterectomy is the surgical removal of the uterus, and is one of the most common operations performed on women. One or both ovaries and fallopian tubes may also be removed at the same time. The operation removing the tube and ovary is called a salpingo-oopherectomy. Depending on the reason for surgery and your age, decision will be made about removing or retaining the ovaries. The surgery is always performed under anaesthesia.

Why is hysterectomy advised?

Some of the reasons for which a hysterectomy is done are fibroids, abnormal or heavy bleeding, pelvic pain, endometriosis, pelvic support problems or cancer. Most of these conditions also have alternate non-surgical methods of treatment. In some situations surgery may be the only option. What treatment you require will depend on factors such as severity of disease, intention to have children, ability to take medications, response to medications and cost of therapy. In most situations, medications will be tried before surgery is offered. The reason for which you need the surgery would have been discussed with you and any doubts as to the need for it clarified before you go in for the operation.

What are the effects of a hysterectomy?

A hysterectomy puts an end to menstrual periods and the ability to have children but does not affect the woman’s health in any other way. If ovaries are not removed, then the hormonal cycles continue. The ovaries continue to produce eggs, but these are released into the abdomen and are absorbed within 24 hours.

If both the ovaries are removed at the time of surgery, prior to menopause, then the woman becomes menopausal. That is, she may experience symptoms of menopause following the surgery. In such situations, it may be important to consider hormone replacement therapy, to avoid these effects and this is something you can discuss with your doctor.

Depending on the reason for which the hysterectomy is done, and the timing of surgery, some women undergo depression due to “loss of the uterus” and the surgery itself. If this persists or is severe, you may need help.

Removal of the uterus does not necessarily affect sexual function in any way. Some women may have decreased sensation resulting from the removal of the cervix (mouth of the uterus). Some may find improvement because the condition causing pain or discomfort earlier is removed and also there is no fear of pregnancy.

Are there different types of hysterectomy?

There are different types of hysterectomy, depending on what is removed. If the uterus and cervix are removed it is called a total hysterectomy. If the cervix is left behind, it is called a subtotal hysterectomy. In conditions like certain cancers, it may be necessary to remove the uterus and cervix along with supporting structures and lymph nodes and this is called a radical hysterectomy.There are different methods of performing a hysterectomy. Depending on the reason for the surgery, the optimal method is decided. The ways in which a hysterectomy can be done are:

Abdominal hysterectomy: Here the surgeon removes the uterus through an incision (cut) in the abdomen. The incision may be up and down or side to side.

Vaginal hysterectomy: Here the uterus is removed through the vagina and there is no scar on the abdomen at all. This is usually done if there is “ prolapse” or descent of the uterus but can be done in certain other situations also.

Laparoscopic assisted hysterectomy: Here the surgeon uses a laparoscope to do part of the surgery and completes the hysterectomy vaginally. Therefore there are a few small scars on the abdomen and the uterus is removed through the vagina.

Recovery is faster after a vaginal or Laparoscopic assisted vaginal hysterectomy, but these are not always feasible.

What happens in the hospital?

You will be asked to get admitted to the hospital the day before the surgery. You will be asked to sign a consent form. If the nature of the operation, type of incision etc has not already been discussed with you, it will be done at this point. The doctor can clarify any doubts that you have. Depending on the nature of surgery, blood may have to be reserved in case a transfusion becomes necessary.

You will be asked to have nothing to eat or drink for at least 6 hours prior to surgery. You will be given an antiseptic vaginal tablet the night before surgery. The nurse will inform you of the preparations to be done before surgery. This will include a bath, and possibly a shave of the lower abdomen.

What happens during the surgery?

Once you are inside the operation theatre, an intravenous drip will be started. You will get bottles of fluid through this on the day of the surgery and the day following it. A catheter will be inserted so that you can pass urine freely after surgery and this will be removed in 24 to 48 hours depending on the type of surgery performed. An antibiotic is usually given prior to surgery.

The nature of anaesthesia will be discussed with you prior to the surgery. In most cases the surgery will be done under a general anaesthetic. Here injections will be given into the drip that has been started and you will fall asleep and wake up only after the surgery is over. A tube is placed in your throat to help you breathe during the surgery and maintain the anaesthesia. You will not feel this.

In some cases, a spinal or epidural anaesthesia is used. Here a small needle is introduced into the space around the spinal cord and the anaesthetic drug is given. After this, the lower part of your body becomes numb and you will be unable to feel pain or move your legs until the anaesthetic wears off. If this type of anaesthesia is used you will feel no pain, but will be awake during the operation.

You will be shifted to your room once you are fully recovered from the anaesthetic.

What happens after surgery?

On the day of the surgery, you will be a little drowsy from the anaesthetic and pain relief medications. You may feel nauseous or sick and will be given medication for the same. You will have drips and will be asked to have nothing to eat or drink through that day.

Subsequently over the next few days, depending on your condition, the doctor will let you have liquids and then solid food. You will be encouraged to sit up even on the day after surgery and can walk to the toilet with nursing help. You will be encouraged to walk more from the second day onwards. Depending on your recovery, you will be sent home 4 or 5 days after the surgery.

What are the common problems after surgery?

There is usually pulling pain at the sides of the abdomen when the wound is healing. This is normal and is felt more while turning or changing posture. There may be ‘gas’ or ‘wind’ pain on the 3rd or 4th day after surgery. Sometimes there may be difficulty in passing urine and a catheter may be needed again for a few days. It is common to have a mild temperature on the first couple of days after surgery. Any persisting or high temperature may indicate infection and need attention. About a week to ten days after surgery there may be spotting or slight discharge as the sutures get absorbed.

This is normal.

Though hysterectomy is a fairly common operation, it is major surgery. Occasionally more serious complications may occur especially if earlier surgeries have been done and depending on the nature of the underlying problem.

What can I do once I get home?

The first two weeks at home you will be advised to take as much rest as possible. You can walk around the house, but will need help with household work. You can climb stairs if you must , once or twice a day in the first week. It is safe to climb stairs as many times as needed after 2 weeks. The third week after surgery, you can start doing light jobs like making coffee, cutting vegetables, making chappathis etc. Four weeks after surgery you can get back to doing normal house work except lifting weights. Avoid lifting heavy things, such as a bucket of water or clothes, a heavy pressure cooker , a young child etc, for 2 months after surgery.

It is advisable to avoid driving for up to 6 weeks after surgery. Intercourse is safe 6 weeks after surgery. One can start going for short walks 4 weeks after surgery. The doctor will teach you simple pelvic and abdominal exercises to be done regularly after surgery. If done regularly, these improve muscle tone and decrease the chance of future prolapse and hernias from developing. Each woman has a different speed of recovery. So if any activity unduly tires you, take it easy.

What medication will I need after surgery?

You will be given some painkillers to take after surgery at home. Besides this there may be no other medication needed. If you have had both your ovaries removed before menopause, you may be placed on hormone replacement therapy when you are discharged or one month after surgery.

When will I need to see the doctor again?

The doctor will review you 4 weeks after surgery. If there is any special reason to see you earlier, you will be told about it. Sometimes if sutures need to be removed, you will be asked to come back a week from the date of surgery.

If you have any excessive vaginal bleeding, fever, urinary problems or constipation, please contact your doctor earlier.

Dr. Uma Ram DGO, Dip. NBE, MRCOG

A Consultant in Obstetrics & Gynaecology, Seethapathy Nursing Home, Chennai, Dr Uma Ram graduated from Madras Medical College, Chennai and had her speciality training at Kasturba Gandhi Hospital for Women and Children, Chennai. She has done her Clinical Research on Amniotic Fluid Index in Postdated Pregnancies. Her areas of interest are: High risk obstetrics Urogynaecology and Minimally invasive surgery.

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