Hysterectomy: What You Need To Know

Hysterectomy: What You Need To Know

In some cases, when treating severe gynecological or women’s conditions, the doctor may need to perform a hysterectomy – an operation to remove a woman’s uterus. After this procedure, a woman will no longer menstruate or be able to become pregnant; therefore, it is necessary for women to have valuable information about the hysterectomy procedure. It is important that women, when faced with this difficult decision, be as educated as possible, so that they can avoid unnecessary concern.

Why would I need a hysterectomy?

A hysterectomy is usually performed when a patient is suffering from the following conditions: 

  • Endometriosis – endometriosis is a disorder in which the endometrium (tissue lining of a woman’s uterus) grows outside the uterus. If the displaced endometrial tissue becomes lodged on the ovaries, blood during the menstrual cycle becomes trapped and has nowhere to go, thus accumulating more and more until it forms cysts.
  • Uterine fibroids – fibroids are different sizes of non-cancerous tumors which usually shrink after a woman enters menopause. A hysterectomy is usually performed when these fibroids cause severe symptoms such as bleeding, pelvic pain, pain during intercourse, pain during period or bladder pressure.
  • Abnormal uterine bleeding – this condition can be caused by endometriosis, hormonal imbalances, infections or polyps. Symptoms that might accompany this condition include bleeding between periods, long periods or heavy periods.
  • Chronic pelvic conditions or infection – includes pelvic pain or other pelvic inflammatory diseases. Infections of the pelvic area can also be caused by a dilation of the uterus as a result of an abortion.
  • Uterine prolapse – a condition in which the tissues holding the uterus weaken, causing the uterus to move down into the vagina. The condition can lead to issues regarding urination, pelvic pain, or bowel movements.
  • Blockage – the bladder or intestines are blocked by the uterus or an abnormal growth
  • Cancer – hysterectomy can prevent endometrial, ovarian and cervical cancer from spreading to other organs  
  • Fibrosis on the wall of the uterus – normally occurs after surgery on the pelvic cavity, including cesarean section, myomectomy, and surgery for intestinal obstruction. The condition leads to the inability to hold urine for as long as usual or pain in the lower abdomen when exerting energy.
  • Irregular menstrual bleeding that cannot be permanently cured by taking hormonal treatment.
  • Chronic lower abdominal pain – for longer than three months, leading to a poor quality of life, pain during menstrual period, pain during sexual intercourse, or pain in the coccyx or rectum during defecation
  • Postpartum hemorrhage

What are the different types of hysterectomies?

The different types of hysterectomies include the following: 

  • Total hysterectomy  the most common type of hysterectomy, it is the removal of the whole uterus including the cervix. The fallopian tubes or ovaries are not removed.
  • Hysterectomy with salpingo-oophorectomy  the removal of one or both ovaries, along with the uterus and the fallopian tubes
  • Supracervical hysterectomy  the removal the body of the uterus while the cervix is left whole. This surgery is also called partial or subtotal hysterectomy.
  • Radical hysterectomy  the removal of the cervix, the uterus, and the top part of the vagina. In some cases, the pelvic lymph nodes are removed as well. This surgery is often used to treat cancer.

How is a hysterectomy performed?

A hysterectomy can be performed using the following techniques: 

  • Abdominal hysterectomy  an incision is made on the abdomen to remove the patient’s uterus. This method is often used in cases of pelvic tumors or cancer. The fallopian tubes might also be removed if the uterus is enlarged. This procedure can leave a scar in the lower abdomen, ranging from 5-15 cm.
  • Vaginal hysterectomy  the removal of the uterus through the vagina with no need for an incision, providing faster recovery and causing less pain than abdominal hysterectomy. This method is usually used in cases of uterine prolapse, vaginal repairs or early cervical cancer. This procedure leaves a surgical scar in the vagina without a surgical scar in the lower abdomen. In some cases, laparoscopic hysterectomy might be used in combination, leaving one to five surgical scars of 0.5-1.0 cm in the vagina and the lower abdomen.
  • Conventional laparoscopic hysterectomy – During this procedure, 2-4 very tiny incisions are made in the abdomen. The range in size is 0.5-1 cm, and through these small openings a hysterectomy can be performed with much less pain, less scarring and a much quicker recovery period.
  • Single-Port Laparoscopic Surgery – One step further than a Conventional laparoscopic hysterectomy, this procedure only requires one incision in one port of entry; the umbilicus. After the hysterectomy has been performed, the umbilicus is simply placed back in it’s original position, and the single incision heals to leave barely any scar behind. This method is highly modern and very superior in the way of minimally invasive surgery. Cosmetically, it leagues ahead, leaving almost no traces of the incision behind.  
  • Hysterectomy using Natural Orifice Transluminal Endoscopic Surgery (NOTES)  a new form of minimally invasive surgery (MIS) for performing hysterectomies. The technique is developed from conventional laparoscopic surgery, but unlike traditional surgery; a tiny camera and the necessary surgical instruments are inserted through a small vaginal opening. The process leaves no external scars, offers less pain and faster recovery than any other methods. The patient can return to work within a day or two. The risks of infection and hernia are also very low due to the high blood flow to the vaginal area and the method’s quick recovery time. This technique is often used for patients with uterine fibroids, abnormal vaginal bleeding and early stage of cervical and endometrial cancer. For more information about the NOTES technique, click here. 

The choice of surgical approach depends on the developmental stage of the disease, the surgeon’s specialization, and the decision made by the patient.

The risks and complications

The possible risks involved in a hysterectomy are as follows: 

  • Infection
  • Hemorrhage  if the bleeding is excessive, the patient might require a blood transfusion or a return to the operating room where the doctor can detect the root of the problem and stop the bleeding.
  • Constipation
  • Urinary retention
  • Blood clots
  • Early menopause
  • Injury to other organs  these injuries can be spotted and corrected during the surgery. If something is detected after the hysterectomy, another operation might be needed.

Most complications which can arise during a hysterectomy can be easily resolved and do not pose long-term issues for the patient.

Preparation for a hysterectomy

Here are the key preparations you need to make before undergoing a hysterectomy: 

  • Necessary tests as required by your doctor, such as blood tests, urine tests, x-rays or ultrasounds
  • On the night of the surgery, do not eat or drink after midnight 
  • Read the consent form carefully and ask questions if you do not understand any part of the form 
  • Ask your doctor questions regarding the procedure; do not hesitate to question processes that you do not not understand. 
  • Inform your doctor beforehand if you are pregnant, or if you are allergic to any medications. 
  • Inform your doctor of any medicines or supplements you might be taking. 
  • Inform your doctor if you have a history of bleeding disorders. 
  • Do not use tampons on the day of the surgery. 
  • The doctor will instruct you on how to cleanse your bowels before the surgery. 
  • Arrange for someone to take you home after the surgery; someone should also help you around the house for one week or two after the surgery.

What happens during a hysterectomy?

What happens during a hysterectomy can depend on the specific technique used and the patient’s condition. However, most of them start with the same general process. After you have removed all jewelry and have changed into a hospital gown, an intravenous line (IV) will be inserted into your hand or arm. Hair at surgical site might have to be shaved off if there is too much. For a standard hysterectomy, you will be lying on your back. For a vaginal procedure, your feet will be on stirrups. Your blood pressure, breathing, heart rate, and blood oxygen level will be monitored throughout the procedure by the anesthesiologist. A thin, narrow tube called a catheter will also be inserted into your bladder to drain your urine. Then, an antiseptic solution will be used to clean the skin over the surgical site. 

After the doctor has made an incision and carried out the procedure according to the specific technique chosen, stitches or surgical staples will be used to close any incision. The doctor will provide sterile bandages or dressing, and a sanitary pad to absorb any drainage from the vagina.

Recovering from a hysterectomy

There might be some pain for the first few days after the surgery, for which the doctor might provide medication. Constipation is a common occurrence after hysterectomies, and there might be bleeding and discharge from the vagina for several weeks. Sanitary pads and tampons can be used. The length of your stay at the hospital is determined by the type of the operation you have. If you had undergone a Hysterectomy using Natural Orifice Transluminal Endoscopic Surgery (NOTES), you might only have to stay in hospital for a day or two. 

After leaving, make sure to ease slowly into your normal day-to-day routine. Consult the doctor immediately if you start displaying any of the following symptoms: 

  • Fever 
  • Abdominal pain 
  • Cramps
  • Swelling 
  • Increased vaginal bleeding
  • Pain in the legs

Life after a hysterectomy

  • Some might experience a better sex life since previous symptoms, such as vaginal bleeding or pain, have been relieved due to the hysterectomy.
  • If both ovaries are removed, you might be at risk of developing other health conditions, such as bone loss, heart disease, and urinary incontinence. Consult your doctor to prevent such conditions.
  • Some women experience a sense of loss over the change in their bodies or a sense of grief and depression over their infertility. If this is the case, seek support from your loved ones and consult your doctor, especially if this emotional change lasts longer than several weeks after surgery.
  • If the ovaries are removed, some women might experience vaginal dryness or less interest in sex, begin menopause or exhibit the symptoms of menopause.
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