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Abdominal hysterectomyPublished by BUPA's health information team, healthinfo@bupa.com, September 2007. This factsheet is for women considering having an abdominal hysterectomy. An abdominal hysterectomy involves removing the womb through a cut in the abdomen. Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.
What is a hysterectomy?A hysterectomy is an operation to remove your womb and is done to treat conditions such as:
Types of hysterectomy
There are three types of hysterectomy.
Your ovaries are usually left in place because they produce oestrogen. If your ovaries are removed, you will immediately go through the menopause. After a hysterectomy, you will no longer have periods and won't be able to become pregnant. The operation is usually recommended only when other treatments are considered unsuitable or have not been effective. A hysterectomy can be done through a cut in the lower abdomen (abdominal hysterectomy) or through the vagina (vaginal hysterectomy). Your surgeon will discuss with you the type of operation you need and how it will be done. Preparing for your operationAn abdominal hysterectomy requires a hospital stay of up to five days. Your surgeon will discuss how to prepare for your operation. For example, if you smoke you may be asked to quit, as smoking can increase your risk of getting a chest or wound infection and slow your recovery. You may be asked to stop taking oral contraceptives or hormone replacement tablets four weeks before your operation. If you are sexually active and premenopausal, you should use an alternative method of birth control during this time to prevent pregnancy. The operation is done under general anaesthetic. This means you will be asleep during the procedure. You will be asked not to eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand. At the hospital, your nurse will explain how you will be cared for during your stay, and may do some tests such as checking your heart rate and blood pressure and testing your urine. Your surgeon will usually visit you to discuss the operation and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs (deep vein thrombosis, DVT). You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, stockings. You may be given antibiotics to help reduce the chance of getting an infection after surgery. These are usually given at the same time as the general anaesthetic. About the operationYou will have a cannula (a fine plastic tube) put into a vein, usually on the back of your right hand or in your arm. This causes a sharp sensation, like an injection, that passes quickly. The cannula allows your anaesthetist to give the medicines that put you to sleep and control pain and nausea, without repeated injections. You may also be put on a drip to keep you hydrated. The operation usually takes about an hour. Once the anaesthetic has taken effect, your surgeon will make a cut across your lower abdomen just below your 'bikini line'. If you have fibroids in your womb your surgeon may need to make a cut from your belly button down to your 'bikini line' instead. Your womb is taken out through the cut in your abdomen. Your surgeon will sew up the top of the vagina. Stitches (which may be dissolvable) or metal clips are used to close the cut on your abdomen and the area is covered with a dressing. A urinary catheter (a thin tube) is usually put into the bladder to help drain urine into a bag beside your bed. This is because most women have difficulty passing urine immediately after a hysterectomy. Fine plastic tubes may be left in the abdomen for up to 48 hours afterwards. These allow blood and fluids to drain into a bag. What to expect afterwardsYou will need pain relief as the general anaesthetic wears off. Controlling pain after an operation is very important because pain can interfere with your recovery. You may be offered patient controlled analgesia (PCA). This is a pump connected to your cannula that allows you to control how much pain medicine you have. When you no longer need intravenous medicines and are able to drink enough fluids, the cannula and drip will be removed. You will be wearing a sanitary towel to absorb any vaginal bleeding, which is usually similar to a light period. The catheter is usually taken out in the first day or two. It is usual to feel some initial discomfort on passing urine but this normally improves within 24 hours. Please tell your nurse or surgeon if you have any difficulty in passing urine or problems with bladder control. You may find that you don't open your bowels for a few days after the operation. However, you should try not to strain too much when you go to the toilet as this can stretch the healing wound. Mild laxatives can help with this. Your nurse will give you advice about getting out of bed, bathing and diet. A physiotherapist will explain some exercises that you can do to help speed up your recovery. The clips or stitches will be taken out after five days. Dissolvable stitches will disappear on their own in seven to 10 days. Before you go home, your nurse will advise you about caring for the healing wounds and will arrange a date for a follow-up visit. Recovering from your hysterectomyAt home, if you need them, you can usually take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. You will need to take it easy for a few days but continue doing the exercises recommended by your physiotherapist and try to go for a daily 10 minute walk. Lifting light items such as a kettle will not harm you, but you shouldn't lift anything heavy. If you have young children you will need someone to help you with childcare. You must follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort. This is usually about four to six weeks after the operation. It is normal to have some blood stained vaginal discharge for about six weeks after surgery. Use sanitary towels rather than tampons to help reduce the risk of infection. If you have any concerns or you have a vaginal discharge that is bright red, heavy or smells unpleasant, contact your GP as you may have an infection. Your surgeon will advise you when you can resume your normal activities and sexual intercourse. A full recovery can take up to 12 weeks, but some women recover faster. What are the risks?A hysterectomy is a commonly performed and generally safe surgical procedure. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications. Side-effectsThese are the unwanted, but mostly temporary effects of a successful procedure, for example, feeling sick as a result of the general anaesthetic. After surgery, you will have some pain, swelling and bruising in the abdomen area. These side-effects usually clear up within a few days. You will have a permanently visible scar. Although this will be red and slightly raised to start with, it should soften and fade over the following months. It is natural to worry that a hysterectomy might affect your sex life. This is not necessarily the case and depends on a number of factors, including the exact type of operation you have. Talk to your surgeon if you are worried about your sex life after the operation. If your ovaries are removed, you may get menopausal symptoms such as hot flushes and vaginal dryness. You may need to have hormone replacement therapy (HRT). You should ask your GP for advice about HRT. If sexual intercourse becomes painful because your vagina is dry, lubricants (available from most chemists) can help. ComplicationsThis is when problems occur during or after the operation. Most women are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding, infection or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Specific complications of hysterectomy are uncommon but can include damage to other organs and tissues in the abdomen, particularly the bladder and ureters (tubes that carry urine from the kidneys to the bladder). Further treatment such as returning to theatre to stop bleeding or to repair a damaged organ, antibiotics to treat an infection, or a blood transfusion to replace lost blood may be needed. The exact risks will differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you. Further information
Sources
Related topics
This information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by consultant gynaecologist Mr Andrew Hextall, and The Hysterectomy Association and BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: September 2007. Expected review date: July 2009.
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