What is hysterectomy?
Hysterectomy is the surgical removal of the womb (uterus) including the cervix. This can be done in a number of ways and the most suitable method for you will be used.
1. Vaginal hysterectomy?If the muscles holding the womb in place are slack then it is possible to remove it via the vagina and so no stitches are visible on the outside.
2. Abdominal hysterectomy?If it is not possible to remove the womb via the vagina then it will be removed via an incision (cut) in the abdomen. This is usually low down and is known as a bikini line cut because it won’t be visible if or when you wear a bikini.??However sometimes it is necessary to do a midline,, up and down, incision. This is usually if the womb is very large of if there is a need to inspect other areas inside the abdomen
Laparoscopic hysterectomy?This is a new method. Four tiny incisions are made in the abdomen, one near the pubic hair line, one near the navel and one on either side of the abdomen. A laparoscope (a telescopic instrument which allows the organs in the pelvis to be seen) is inserted into the incision in the navel, whilst instruments are inserted via the other incisions. This approach is particularly useful if there is a need to remove adhesions, endometriosis or the ovaries. The uterus (± ovaries) is finally removed via the vagina.
How will a hysterectomy affect me?
The positive ways in which a hysterectomy can affect you are:
If you were suffering from heavy menstrual bleeding, this will stop.
If you had a prolapse, the dragging sensation and discomfort that this caused should improve.
If your sex life was affected by either of these two problems then this will improve.
If you suffered period pain during your periods then this will also disappear.
If you were worried about getting pregnant then you no longer need to worry about using contraception as you can no longer get pregnant.
HOWEVER you may be upset that your ability to become pregnant has been removed. You may have no children and this marks the end of the possibility of you having a child naturally. Even if you already have children and you are approaching menopause, you may be surprised at your emotional response to having a hysterectomy and the loss of your uterus.
Before you make the decision to have a hysterectomy you need to be aware of what it can’t do for you:
It will not stop premenstrual tension if your ovaries are not removed.
So any mood swings, breast tenderness, etc that you may have experienced will not be sorted out.
What do I need to know before the operation?
If you smoke you will be advised to try and stop or at least cut down before coming into hospital.
If you are taking the oral contraceptive pill you may need to discontinue this six weeks prior to your operation. Clearly you need to use reliable alternatives in the interim.
Having a period makes no difference to your operation date
What about my ovaries?
It may be advisable to remove the ovaries at the same time, especially if you are over 45 years of age. There are several possible reasons for doing so. ??Firstly, if the ovaries are left behind, there is a 3% chance that you will develop an ovarian cyst which requires further surgical intervention by the time you reach 70 years of age; in approximately half of the cases the cyst will be benign, in the remaining half the cyst will be malignant. The risk is increased if there is a family history of ovarian cancer. ??Secondly, ovaries which are left behind sometimes may produce pain.??Thirdly premenstrual syndrome often disappears following removal of the ovaries.
If your ovaries are removed, you may wish to consider hormone replacement therapy (HRT).
On the other hand, if you are left with one ovary or only part of an ovary you will still produce female hormones in the normal way.
What happens before the operation?
You will need a shave of your pubic hairs. Nursing staff will tell you how far and where you need to shave. You can do this yourself but if you prefer then a nurse will do it for you.
Your bowels need to be empty and so you may need some suppositories especially if you feel that you are constipated
You will have been asked not to eat or drink for at least six hours before your operation.
SOn the day of your operation you will be given an operation gown to put on and also some strong support (TED) stockings which will help your circulation.
You may be given a pre-med a few hours before your operation to help you to relax, and also an injection – heparin (one of a course) to “thin down” your blood and to help prevent deep vein thrombosis.
You may have been given some breathing exercises and some leg exercises by the physiotherapist to aid your recovery after the operation.
What about after the operation?
On return to the ward you may feel drowsy for some time.
You will have a small tube connected to a bag of fluid running into a vein in your arm. This is to give you fluid whilst you can’t drink and will be removed once you begin to drink normally. This is usually the day after your operation.
Sometimes there is a small tube called a drain which helps to drain away any blood which may have accumulated around the wound site. This is put in at the time of the operation and removed one to two days after.
You may have a small tube from your bladder which drains your urine away. This is called a catheter and usually only stays in for 24 hours.
If you had your hysterectomy removed via your vagina then you may have a pack (like a large tampon) in your vagina to help settle the bleeding.
You may also have something called a PCA pump (patient controlled analgesia). You have a button to press to give yourself pain killer when you experience pain. Don’t worry, you can’t overdose yourself on it as there is a special programme that controls it.
If you don’t have a PCA pump you will be able to have pain killers either via a suppository or by injection.
You may feel sick and special drugs can be given to help with this, either via your PCA pump or by injection.
On the evening of the operation it is a good idea to only have one visitor as you may feel drowsy and tired. However, you will be able to cope better on the next day. Nursing staff will have encouraged you to get up for a short while and you will have had the chance to have a towel bath, so, you’ll feel fresher too.
Each day you will be encouraged to do a little more and soon you will be getting into the bath yourself and walking about quite easily.
You will also progress from just drinking fluids, to a light diet the following day and then to a normal diet about 3 days after the operation. Most patients get some wind as their bowel begins to work properly again. This wind can be quite painful, like colic, but there are medications available to relieve your discomfort. Walking about often helps.
If you have a cut then your stitches or staples are usually removed on the fifth day after your operation.
You may experience a small amount of discharge or light vaginal bleeding and this may last for a few weeks. However, if it becomes heavy, smelly or bright red then it must be reported. It is best to use pads rather than tampons. Routine cervical smears are no longer necessary after a hysterectomy.
Although it is a major operation, you are usually well on the way to recovery after about 5 days and you may leave hospital about 5-6 days after your operation.
What about the follow up?
You will be given an appointment to see Mr Li in six weeks time. If you have not heard from Mr Li or his secretary a week after you have left hospital, feel free to contact his secretary, on 2550365 (10-2 noon)
What about convalescence?
For two weeks after leaving hospital you should convalesce. Convalescence means plenty of rest: out of bed late, into bed early, with a rest in the afternoon. Only very light housework should be attempted. If you do too much too soon you will feel tired very quickly. Build up gradually and only do a little more each day.
In the following two weeks you can begin to do more but avoid heavy shopping, lifting furniture, hoovering and energetic sports. Short walks are good exercises to start with. Try sitting rather than standing while you are doing some work.
You may resume swimming. You may drive a car for short journeys but do not attempt too much – it takes several weeks after an operation for concentration and reflexes to return to normal. It is also advisable to check with your insurance company regarding this.
After 6-8 weeks some women are fit for work, but this is very much an individual thing and depends on your rate of recovery, type of job, distance travelling etc. Women in heavier jobs often need up to 3 months off work.
Be sensible, build up gradually and don’t hesitate to seek advice if you are unsure about any activities. Well meaning relatives, friends or even patients may tell you things that are alarming or even inaccurate.
What about sex afterwards?
Having your womb removed should not affect your sexual desire. For some women there are real advantages to having had the operation as they are no longer tired or uncomfortable or bleeding all of the time, and all of these things obviously affect your feelings towards sex. Some women do say that sex feels a little bit different after a hysterectomy but there is no reason why you cannot have a fulfilling and normal sex life. One problem you may encounter is that your vagina may feel a little drier than usual but this can be remedied by using aloe vera gel or KY gel. This can be bought in tubes but it is also available as pessaries which are easier to use.
You may attempt intercourse just before your six week post operative visit and if there are any problems in this area you will have a chance to discuss them at the follow up visit. However, it is also important not to rush things.
What about all of the myths that you hear about?
Removal of the womb does not cause any serious effects. Many women feel better than ever once they have had time to convalesce and to build up their strength. You will not automatically put on weight – only if you eat more and don’t exercise enough. Your tummy muscles may be flabby at first but they will soon recover especially if you remember to continue with your physiotherapy exercises.
You will not change as a person, grow unwanted hair or change your attitude towards sex. You will not develop a deep voice.
A leaflet produced by The Women’s Health and Reproductive Rights Information Centre. A very informed and easy to read leaflet available by post from:
52 Featherstone Street
Telephone: 0171 251 6580
At present it is 40p. You need to send an SAE
HYSTERECTOMY AND THE ALTERNATIVES
Jan Clark. Virago Press. £7.99. A comprehensive book that helps you to decide and takes you through your stay in hospital and afterwards.
HYSTERECTOMY, WHAT IT IS AND HOW TO COPE WITH IT SUCCESSFULLY
Suzie Hayman. Sheldon Press 1986. Written by a woman who is a journalist and has had a hysterectomy herself.
HYSTERECTOMY – YOUR QUESTIONS ANSWERED
Pat Webb. Royal Marsden Hospital and distributed by Haigh and Hockland Ltd. Manchester 1985.
OOPHORECTOMY AT THE SAME TIME AS HYSTERECTOMY
Li TC and Saravelos H, British Journal of Obstetrics and Gynaecology (1994) Vol 101; 934-936
Available from Mr Li’s secretary.
Prof T C Li
7 Williamson Road
Tel: 0114 2550365