Surgical Procedures: Hysterectomy

What is a hysterectomy and how is it done?

A hysterectomy is a surgery to remove the uterus and, at times, the ovaries and fallopian tubes. The uterus (womb) is the hollow reproductive organ found in a woman’s pelvis. It is where a baby grows during pregnancy. The ovaries are two almond-shaped organs that make and release eggs during ovulation. These eggs travel down the fallopian tubes and into the uterus, where if fertilized, they will be implanted into the uterine lining. If the egg is not fertilized, a woman will get her period.

A hysterectomy may be used to treat:

• Cancers of the ovary, uterus, endometrium, and cervix.
• Endometriosis.
• Adenomyosis.
• Chronic pelvic pain.
• Abnormal uterine bleeding.
• Uterine fibroids and/or prolapse.

There are a few types of hysterectomy:

• Total Hysterectomy: Removal of the uterus and the cervix. In some cases, the ovaries and fallopian tubes are not removed.
• Partial/Subtotal/Supracervical Hysterectomy: Removal of only the upper part of the uterus just above the cervix. The cervix stays . The ovaries and/or fallopian tubes may or may not be removed.
• Radical Hysterectomy: Removal of the uterus, cervix, tissue around the cervix, and the upper part of the vagina. The fallopian tubes may or may not be removed.

During a hysterectomy, the decision may be made to leave the ovaries. At times, taking the ovaries out can lower the risk of getting ovarian and/or breast cancer. The fallopian tubes may be removed to lower the risk of fallopian tube cancer. If the fallopian tubes are taken out, the ovaries may not be taken out.

A hysterectomy can be done in many ways, such as:

• Abdominal: An incision (cut) is made in the abdomen to remove the uterus.
• Vaginal: An incision (cut) is made in the upper vagina, and the uterus is removed through the cut.
• Laparoscopic: A laparoscope, a lighted tube with a camera, will be used. Many small incisions will be made in the abdomen where the tool(s) is inserted.
• Robotic: The surgeon controls a robotic arm to do the surgery through small incisions.

What are the side effects or risks of having a hysterectomy?

• The main side effect is no longer being able to become pregnant and carry a baby.
• Because the uterus is removed, menstrual periods will stop.
• If you keep the ovaries, you may not have menopausal symptoms as estrogen is still being made by the ovaries. If the ovaries were removed during surgery, the signs of menopause will happen right away.
• If menopause occurs, there is a greater risk of osteoporosis, heart disease, and urinary incontinence.

The risks of a hysterectomy include:

• Fever.
• Infection.
• Bleeding.
• Injury to the urinary tract and/or surrounding organs.
• Nerve damage.
• Blood clots.
• Bowel obstruction (block).
• Reaction to anesthesia. (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it, and to manage pain. Reactions are wheezing, rash, swelling, and low blood pressure.)
• Sexual changes such as vaginal dryness and/or loss of interest in sex.

What is recovery like?

A stay in the hospital may be needed, based on the type of hysterectomy you have had. You may have a bladder catheter in place for one to two days to drain your bladder of urine. In certain situations, you may need to go home with the catheter in place.

Early walking and deep breathing will be encouraged to prevent blood clots and pneumonia.

Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clots, infection, and constipation prevention and/or other conditions.

Your provider will tell you what you should and should not do when you go home. This will often include:

• Get plenty of rest.
• Avoid heavy lifting.
• No tub bathing, sexual intercourse, or anything in the vagina (tampons, douching, etc) for 4-8 weeks or until you are told by your healthcare provider.
• Bloody to light vaginal discharge can be expected for several weeks.
• Do not drive if you are taking narcotic pain medication.
• If you have constipation, you can make changes to your diet, drink more fluids, and take over-the-counter medication. You should not strain to have a bowel movement.

Women generally can expect to recover from an abdominal hysterectomy in 4 to 6 weeks. Recovery after a vaginal hysterectomy is about 3-4 weeks.

What will I need at home?

• A thermometer to check for fever, which can be a sign of infection.
• Loose clothes and underwear.
• Incision care items, often times supplied by the hospital/physician office.
• Sanitary pads for vaginal bleeding/discharge.

Care of Incision

Incisions should be kept clean and dry. You can shower but do not scrub the incision. Allow the water to run over the incision, gently clean it with a mild soap, and pat dry.

Be sure to look for signs of infection such as redness, swelling, drainage or separation (opening) of the incision, and report these to your provider.

At times, drains may be left in place, making careful attention to gentle drying important.

If you have staples, they will be removed at your post-operative visit (approx. 10-14 days after surgery), steri-strips (special tape) will then be placed. You can shower with either staples or steri-strips.

Wear loose fitting clothes to avoid incisional irritation. Avoid sun exposure to the incision.

Do not use lotions or ointments on your incision unless instructed by your healthcare team.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as told to prevent pain, infection, and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and help to drain lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.