Hysterectomy is a partial or complete removal of the uterus from the body. The uterus or womb is shaped like an inverted pear that is located between the bladder and rectum in a female body.
There are four main regions of the uterus:
- Fundus, an upper area that connects the fallopian tubes to the uterus;
- Body, which is the main part of the uterus;
- Isthmus, which is the lower and neck region of the uterus and
- Cervix, the lowest region that goes down from the isthmus to the opening of the vagina.
Types of Hysterectomy
- Partial hysterectomy: Removing of the body of the uterus and leaving the cervix intact is a partial removal. This is also called supra-cervical or sub-total.
- Complete hysterectomy: A complete removal involves removing the uterus body, fundus, and cervix of the uterus.
- Radical hysterectomy: This procedure is performed only when there is the presence of cancer. It involves removing of the uterus, the tissues on the sides of the uterus, and the top part of the vagina.
Diagnosis for Hysterectomy
Hysterectomy affects a woman’s hormonal balance and overall health for a lifetime. For this reason, an operation is normally resorted to only as the last remedy, when other treatments are unsuccessful, to treat certain conditions such as:
- Uterine fibroids: Benign lumps that grow in the uterus causing abnormal menstrual bleeding, urinary problems, difficult bowel movements, infertility, and other pregnancy complications.
- Endometriosis: A layering of tissue outside the uterus, this causes heavy periods, infertility, and abdominal pain.
- Chronic pelvic pain: Pain that occurs below the belly button and in between the hips that lasts longer than six months. The causes are varied and could be caused by endometriosis, musculoskeletal problems, irritable bowel syndrome interstitial cystitis, urinary tract infection, fibroids, and other cases.
- Adenomyosis: Like endometriosis, this occurs when the muscle tissue of the uterus is invaded by the cells that line the uterus. The symptoms include heavy periods, spotting during periods, painful periods, periods lasting longer than usual and, feeling of pressure in the rectum or bladder.
- Uterine prolapse: When the ligaments or muscles are no longer able to support the uterus because of weakening or stretching of the muscles, it causes prolapse in which the uterus slips down from its position to the vagina, outside of the vagina or birth canal. This causes vaginal bleeding, problems with sexual intercourse, increased discharge, recurrent bladder infections, constipation, and discomfort in the pelvis.
- Placenta praevia or placenta percreta: When there is a severe case of the placenta positioning itself near or over the cervical opening or, attaches itself abnormally to the uterine wall respectively. It is done postpartum and involves vaginal bleeding during pregnancy with or without pain.
- Cancer of the uterus, cervix or ovaries: Occurs when malignant, abnormal growth of cells are found in one of these areas causing vaginal bleeding, pelvic pain, abnormal discharge, pain during sex, urinary problems, etc.
Depending on nature, several tests are performed before the surgery.
- Ultrasound – either transabdominal or transvaginal ultrasound
- Pelvic examination
- Tests for anemia, pregnancy, and thyroid.
- PAP smear test
- CAT scan
- Endometrial biopsy
- Vaginal secretions culture
Surgical Techniques for Hysterectomy
Surgical techniques involve two approaches – traditional or open surgery or MIP – surgery using a minimally invasive procedure.
- Open Surgery Hysterectomy
- MIP- There are several approaches to this surgery:
- Vaginal hysterectomy
- Laparoscopic hysterectomy
- Laparoscopic-assisted vaginal hysterectomy
- Robotic-assisted Laparoscopic hysterectomy
As soon as you know you are getting a hysterectomy operation, you may be asked to do the following:
- Pre-assessment test like urine and blood tests, pregnancy tests, enema or other bowel preparation.
- X-Ray of abdomen and kidneys
- Pelvic ultrasound
- Dilation and curettage (D&C)
- The skin surrounding the abdominal and vaginal area is prepared with an antibacterial solution before surgery
- Stop smoking
- Eat a healthy, balanced diet
- Lose weight (if overweight)
- Fast or eat a light meal before midnight
Kindly ensure you share your medical history with your doctor.
General anesthesia is done through IVF either in the hand or arm. This blocks the pain and keeps the patient asleep during the operation. Antibiotics may also be given before the surgery. Since there are several techniques to the procedure, the operation may vary accordingly.
- Open Surgery Hysterectomy: Surgery is done on the lower abdominal area where the surgeon makes a vertical or horizontal 5-7 inch incision in the tissue to remove the uterus. The tissue is then sewn together, and the skin closed through stitches or staples. Hospital stay is at least 2 - 5 days. This usually leaves a scar mark.
- Vaginal hysterectomy: A cut is made through an incision in the vagina where the uterus is removed. This leaves no visible scar as the cut is then closed with dissolvable stitches.
- Laparoscopic hysterectomy: A tube with a lighted camera called Laparoscopy and surgical tools are inserted through small cuts in the stomach or one cut in the belly button. The operation can be viewed on a video screen performing the surgery from outside of the body.
- Laparoscopic-assisted vaginal hysterectomy: With Laparoscopic surgical tools, through an incision made in the vagina the uterus is removed.
- Robotic-assisted Laparoscopic hysterectomy: An advanced and sophisticated robotic system of surgical tools, the surgeon uses natural movement of the wrists and performs removal from outside the body while viewing the procedure on a three-dimensional screen. This procedure is helpful in difficult circumstance as dissection near the ureters, bladder, or blood vessels.
- Medication will be given to prevent infection, to relieve pain and discomfort. If you feel sick after anesthetic, medicine will be given for relief.
- Experience cramps and bloating, the need to empty your bowel.
- Have a drip in your arm.
- Have a catheter – a small bag that drains urine from your bladder. You will be able to pass urine normally after removal.
- If you had an abdominal hysterectomy, a drainage tube will be inserted in your abdomen to drain blood from the wound. The tubes usually stay for a day or two.
- For a vaginal hysterectomy, a gauze pack inserted into your vagina to reduce the risk of bleeding and stays for around 24 hours. Some women experience vaginal discharge that is brownish in color with a slight odor.
- After an operation, you may be encouraged to take a short walk to have a normal flow of blood and prevent any complications like blood clots in the leg.
- To develop mobility, a physiotherapist may show up to help you with pelvic muscle exercises.
- Any stitches during the procedure will be removed after five to seven days of operation.
- Avoid lifting any object that weighs more than 4 KGs/ 10 pounds.
Care at Home
- Follow the instructions given by your doctor
- Avoid lifting heavy objects and rest for at least two weeks
- Ask when you can use tampons and about Kegel exercise
- Wait six weeks to resume sexual activity
- Call your doctor if you experience any sign of infection, discharge/opening on the incision, excessive discharge or bleeding, fainting, shortness of breath, swelling or redness or pain in the leg, complications in urinating
Complications of Hysterectomy
Most women do not face any complications after the surgery. However, it is not devoid of difficulties. Complications could involve:
- Urinary tract infection or constipation
- Vaginal bleeding or discharge that is strong smelling or prolapse
- Surgical wound infections
- Early onset of menopause
- Excessive bleeding
- Loss of ovarian function
- Complications due to anesthetic
- Ureter damage
- Sexual dysfunction