Hysterectomy - Why It Is Done?

A hysterectomy is an operation to remove the uterus and, usually, the cervix. The ovaries and tubes may or may not be removed during this procedure, depending on the reasons for the surgery being performed. If the ovaries are removed, you will commence menopause. A hysterectomy is a major surgical procedure with physical and psychological consequences.

Why is a hysterectomy performed?

Common reasons include painful or heavy periods, pelvic pain, fibroids or as a part of therapy for cancer. You should have a clear understanding of your reason for this surgery.

How is this done?

The procedure is normally performed under a general anesthetic and takes approximately one hour. To commence your anesthetic a drip is inserted into your arm. Once you are asleep, you will have a urinary catheter inserted. The importance of the catheter is to reduce the size of your bladder, keeping it away from the operation site and reducing the risk of complications.

There are three ways to remove the uterus:

1. Vaginal hysterectomy - The removal of the uterus and the closing of the wound is performed through the vagina. There is no cut in the abdomen. 
2. Laparoscopic hysterectomy - About four small keyhole cuts are made in the abdomen to divide the attachments of uterus, ovaries, and tubes in the pelvis. The uterus is usually then removed through the vagina.
3. Abdominal hysterectomy - The uterus is removed through a cut in the lower abdomen. The cut is about 15–20 cm in length and runs across your abdomen, usually below the bikini line. Less commonly, it may be necessary to have a cut that runs from the belly button down to the pubic area.

What are the risks of undergoing this procedure?

• Although the risks associated with hysterectomy are low, you should be aware that every surgical procedure has some risk. This may also depend upon the type of surgery you have. 
• Severe bleeding from large blood vessels around the uterus or top of the vagina. This is not common. A blood transfusion may be required to replace blood loss. A vaginal pack may also be used to control the bleeding.
• Infection in the operation site, pelvis or urinary tract.
• Nearby organs such as the ureter (tube leading from kidney to bladder), bladder or bowel may be injured—expected to happen to approximately one in every 140 women. Further surgery will be needed to repair the injuries.
• The bowel may not work well after the operation; this is usually temporary. Treatment may include a drip to give fluids into the vein and no food or fluids by mouth.

Things to do before you come to the hospital

• It is important for you to have all the tests ordered at your outpatient clinic appointment completed prior to coming to the hospital these include blood tests and an ECG and chest X-ray, if you are more than 50 years old

• You may be required to have a bowel preparation, which will empty your bowel prior to the surgery.

• You should stop eating and drinking at the following times on the day of your surgery unless otherwise notified

  • At midnight if your procedure is in the morning

  • At 6 am if your procedure is in the afternoon.

• You will need to shower and dress in clean clothes prior to coming into hospital. It is important that you do not shave your operation site as this increases the risk of wound infection.

• Please remove all body jewellery.

After your surgery

• When you wake from the anesthetic, you will be ready to be transferred, in your bed, for recovery.

• Having an anesthetic can make you feel sick and may cause vomiting. You will have a drip in your arm which is necessary to maintain fluid intake and provide pain relief. This will remain in until you can tolerate food and fluids and your pain control is changed to oral medication.

• Your nurse will take frequent observations of your vital signs e.g. temperature, pulse, blood pressure.

• You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated.

• If you have pain or nausea, please tell your nurse. Effective pain management is important.

• You will have a urinary catheter in place. The catheter will normally be removed the day following your surgery.

Recovering at home

What to expect

• You may have a blood-stained vaginal discharge which is similar to a light period. This will gradually reduce to nil over 4-6 weeks as your internal wounds heal

• You may need to take some simple analgesia for pain/discomfort, especially on waking and settling at night

• You may feel fatigued

• You may require up to four to six weeks off work. You should have returned to normal activity by two to three months, depending on the type of surgery, although full recovery may take longer

• After the operation, you will no longer have a period

• For the majority of women, hysterectomy surgery does not have a negative effect on sexual function

What to avoid

• For the first two to three weeks lift nothing greater than two kilograms. Increase gently as tolerated over six weeks.

• It will take about three weeks before you should drive a car. Only when you know you can act confidently with emergency breaking should you attempt driving the car.

• Avoid sexual intercourse for six weeks to allow healing to take place.

• Avoid inserting anything into the vagina for six weeks to allow time for healing to take place (e.g. use sanitary pads and not tampons).

It is important to avoid constipation and straining immediately after your surgery as this will assist healing and improve your comfort.

Contact your doctor if you develop any of the following complications:

• Your wound becomes red or inflamed, painful.

• You have heavy vaginal bleeding—heavier than a normal period.

• You have offensive vaginal discharge.

• You develop a fever i.e. temperature of about 38° C, or you are feeling unwell.

• You have pain that is not relieved by simple analgesia.

• You are having difficulty passing urine or opening your bowels.