What is hysterectomy?
A hysterectomy is surgery to remove the uterus (womb), which means that you can no longer get pregnant after surgery. There are different types of hysterectomy and the type that would be recommended to the patient would depend on the reason for the hysterectomy.
The procedure is a major operation using general anesthesia with long recovery periods and is recommended after other less invasive procedures have been tried.
Why would a hysterectomy be done?
There are different reasons why a woman would have to have a hysterectomy, which are:
- Endometriosis: a condition where uterine lining tissue develops outside the uterus, causing pain, heavy periods and infertility.
- Cancer of the cervix, uterus or ovaries.
- Non-cancerous tumors (fibroids)
- Chronic pelvic pain
- Heavy periods
- Uterine prolapse: when the uterus moves from its proper position into the vaginal canal.
In the case of non-cancerous disease, a hysterectomy would only be offered if all other treatment options have been tried first.
There are different reasons why a woman might need to have a hysterectomy.
What is a hysterectomy?
There are different types of hysterectomy and which one a patient undergoes will depend on the reason the surgery is needed.
The types of hysterectomy are:
- Subtotal hysterectomy: the upper part of the uterus is removed, but the cervix is left in place.
- Total hysterectomy: the most common hysterectomy procedure, the uterus and cervix are removed.
- Radical hysterectomy: the uterus, surrounding tissue, fallopian tubes, ovaries, lymph nodes, fatty tissue and a section of the vagina are removed. This type is usually only performed when cancer is present.
If you have a total or radical hysterectomy, immediately after surgery you may experience what is called surgical menopause, regardless of your age. This is because the ovaries have been removed and the hormones that were released are gone.
Symptoms of menopause may include:
- Fatigue
- Hot flushes
- Sleep problems
- Vaginal dryness
There are three ways to perform a hysterectomy:
- Open surgery: the lower abdomen is opened and the uterus is removed through this incision.
- Vaginal hysterectomy: The uterus is removed through a cut made in the vagina. This incision is closed and rarely leaves scars.
- Laparoscopic (keyhole) hysterectomy: the uterus is removed through several small incisions in the abdomen.
Compared to open surgery, a vaginal and laparoscopic hysterectomy require shorter hospital stays and the result is less painful and less scarring. There is also less chance of infection. However, not all women are suitable candidates for these less invasive procedures, and sometimes open surgery is the best option. This may be due to the presence of scar tissue from previous surgeries or obesity.
How to prepare for it
Before undergoing a hysterectomy, it is important to make sure you are well hydrated, have eaten lightly the day before, and have usually stopped drinking and eating after midnight the day before surgery. Most hysterectomies will involve staying in the hospital, but it is also recommended that someone drive you home since you will not be able to drive for up to two weeks after the operation.
Since a hysterectomy is a large procedure, it is important that you are comfortable and have asked as many questions as possible to address any concerns you may have. The doctor will have set expectations and given a detailed explanation of the procedure as well.
Aftercare
Once the patient has awakened from the effects of the anesthesia it is normal to feel tired and experience some pain. Analgesics will be administered to reduce any discomfort.
The wound will have a dressing over it, and if you have had open surgery, a drainage tube will be inserted under the wound to drain the blood from the wound for a day or two.
A few days after surgery, you will be encouraged to start walking, as this helps blood flow normally around the body.
Hospital stays and recovery times for the different types of hysterectomy are as follows:
- Open surgery: up to 5 days in the hospital with a recovery period of 6 to 8 weeks.
- Vaginal hysterectomy: 1 to 4 days in the hospital with a recovery period of 2 weeks.
- Laparoscopic hysterectomy: 1 to 4 days in the hospital with a 2-week recovery period.
Patients are advised not to drive until they are comfortable with the seat belt and can safely make an emergency stop. Heavy lifting and sexual intercourse should also be avoided until the scars heal.
In addition, it is important that patients are reminded that contraception is no longer necessary; however, barrier methods, such as condoms, should still be used to protect against sexually transmitted diseases (STDs).