Therapeutic: Hysterectomy

There are different approaches used to perform a hysterectomy. Likewise the reason for hysterectomy may vary and both that and what else might need to be done will have some relevance to the method I suggest to you. Most often hysterectomy includes the uterus and cervix. Whether or not the ovaries and tubes are removed will depend on your age, the reason for the procedure and any other risks or symptoms you may have.

The methods I use are as follows:

  • Laparoscopically Assisted Vaginal Hysterectomy which usually takes about 1 ½ hours
  • Vaginal hysterectomy takes 30-60 minutes and is considered the lowest risk way to perform hysterectomy if your anatomy is suitable
  • Abdominal hysterectomy which takes about an hour

There is least pain with a vaginal hysterectomy and usually a shorter stay, but it is often combined with surgery for prolapse so sometimes this delays going home until your bladder and bowel start working again. The average stay after hysterectomy is 2-5 days.

Regardless of the method used, the same structures are being operated on internally and so full recovery is six weeks and it is common to feel tired for up to three months after surgery.

The type of operation you have determines how rapidly you can return to normal activities for example walking and general mobilisation around the home. With regard to driving check what your insurance company advise.

Complications

All operations carry a risk of complications.

For hysterectomy the most common short term complications are:

  • Bleeding and if significant you may require a blood transfusion.
  • Note that some medications increase the risk of bleeding such as warfarin, heparin, aspirin, non steroidals and some herbal medicines and it is wise to stop them where possible prior to surgery.
  • Wound infection
  • Deep vein thrombosis
  • Injury to the bladder
  • Injury to blood vessels
  • Injury to the ureter (tube which connects your kidney to your bladder)
  • A vault haematoma (bruise)
  • A urinary tract infection
  • Trouble emptying the bladder

Long term complications can include:

  • Pain secondary to scar tissue (adhesions)
  • Granulation tissue which is slowly healing tissue at the top of the vagina
  • Constipation and I will start you on medication in hospital to reduce the risk of this which you should continue after going home

You can expect some vaginal discharge for several days after the procedure. You should wear sanitary pads during this time. The good news is there will be no more periods! It is normal to feel a little low in mood after this procedure. Some of that is what the surgery represents psychologically and some will be the effect on your hormones and of course some relates to pain. You are likely to require six weeks off work. You should have returned to normal activity by three months if everything has been straight forward. Sex can usually resume at 6 weeks. If you had an abdominal wound it is common for it to feel numb around this and still have occasional twinges of pain for up to 1 year. Most women do not have ongoing issues with their wound however.

For women who were still having periods prior to surgery, identifying the time of menopause is not as easy after hysterectomy. It generally happens about 12 months earlier than it would have otherwise. If required, Hormone Replacment Therapy (HRT) can be used for menopause symptoms and is usually more straightforward.

Bowel and bladder function may be different after hysterectomy. There is also an increased risk of developing prolapse of the vagina. Maintaining pelvic floor muscle strength and avoiding constipation and heavy lifting will reduce this risk. The effect on your sex life once fully recovered is usually positive, but is not always predictable.