Hysterectomy – an introduction

Up to 55,000 hysterectomy operations are carried out in the UK every year. It can and does help to ease many gynaecological complaints, including heavy and/or painful periods and endometriosis.

Hysterectomy is the surgical removal of the womb (uterus). It is one of the most common of all surgical procedures and can also involve the removal of the fallopian tubes, ovaries, cervix and part of the vagina to cure or help a number of gynaecological complaints. Following this operation you will no longer have periods, you will not be fertile and you will not be able to have any more children.

There are two main ways to perform a hysterectomy. The most common way is to remove the womb through a cut in the lower abdomen. The second, less common, way is to remove only the womb through a cut in the top of the vagina, the top of vagina is then stitched.

The reasons for having a hysterectomy may include heavy bleeding, fibroids, cancer, Endometriosis, prolapse of the womb, pelvic inflammatory disease.

There are many effects of having a hysterectomy and they may be physical, sexual and/or emotional. However, there are also a number of long-term health implications, which may include osteoporosis and heart disease.

If you have your ovaries removed you may be prescribed Hormone Replacement Therapy. As with any long term drug treatment there are implications that should be considered and these may include breast cancer and thrombosis. However, current research seems to indicate it may have beneficial effects on osteoporosis, heart disease, Alzheimer’s disease and of course menopausal symptoms.

Hormone Replacement Therapy comes in various forms, tablets, patches, implants and creams, gels or pessaries. The type you decide to take will be based on a number of factors including the one you are most comfortable using.

If you don’t want to take HRT, you may decide that you would like to try an alternative form of treatment that is not prescribed by doctors, this may include a progesterone cream, nutritional therapy to replace hormones or diet.

What to expect in the first few days after surgery – one patients experience

Day 1

  • It is normal during the first 24-36 hours after surgery to feel many aches and pains all over your body. It is usual to experience backache, shoulder pain and a stiff neck as well as abdominal pain. While you have been under the anaesthetic your body will have been handled by several medical personnel and have become quite stiff.
  • You may find you are attached to a PCA (Patient Controlled Analgesia), this is usually morphine. This means you will be in control of your own pain medication and you should receive information on this from the ward staff; if you don’t, then ask for it. You cannot give yourself too many pain killers, as there is a built-in timer. So if you feel pain at any time, do not hesitate to press your button, you do not have to wait hours between each dose and it is important you feel as comfortable as possible.
  • During your operation, you may well have been catheterised. It means that straight after the operation when you are at your most uncomfortable you do not have to worry about going to a toilet to pass urine; this will be simply passed into a bag at your side and emptied regularly by the nurses. It will be removed after the first 24 hours and is painless
  • Don’t plan any visits, except by those nearest to you. You will be drifting in and out of sleep and will not feel like talking much to anyone
  • You will be attached to a saline drip. This is because you will be dehydrated from having nil by mouth and the anaesthetic. Drink plenty of water, you can’t get enough. And the more you drink, the sooner your drip will be ready to come out.

Day 2

  • Ask for advice about suitable painkillers for your post-operative pain. I was told to immediately stop taking the strong pain medication that I had been regularly taking for abdominal pain prior to the hysterectomy and switch to a pill for surgical pain. But it can also work the other way round and you may need to take stronger painkillers than before.
  • You may have some slight vaginal bleeding; this is normal and should soon clear up.

Day 3

  • If you’ve not yet had one, a warm, gentle shower will do you the world of good. Do not be afraid of getting your wound wet but try not to get soap directly onto it. When you have finished, showering, simply pat the wound dry with a towel.
  • If you have not yet opened your bowels, ask for a mild and gentle laxative. I took Lactulose, which was very good. Once you have opened your bowels you should feel more comfortable. You may also experience slight pain from trapped wind and indigestion due to lack of movement; if so, do not hesitate to ask for something to help with this too.

Day 4

  • If it has not been done ask for a blood count. This is a simple and painless exercise. The tip of your finger will be pinpricked and a few drops of blood taken. It can be done on the spot. My count was below 10 and so I needed some iron tablet supplements.
  • At some point during your stay in hospital, you may feel low and quite weepy. This is perfectly normal and is nothing to be ashamed of you have been through a very traumatic event.

Day 5

  • If all has gone well and depending upon the policy of your hospital, you should be allowed to go home around this time. Make sure you have someone who can come and collect you and carry your bags. You should not lift anything heavy.

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