A hysterectomy is the surgical removal of a woman’s uterus. It is a major procedure that involves removal of the uterus and sometimes other reproductive organs, including the cervix, ovaries, and fallopian tubes. A hysterectomy is considered major surgery because it requires general anesthesia, an incision in the abdomen, and a hospital stay.
What is a hysterectomy?
A hysterectomy is the surgical removal of a woman’s uterus, also known as the womb. There are three main types of hysterectomy:
- Partial hysterectomy – the uterus is removed but the cervix is left in place.
- Total hysterectomy – the whole uterus and cervix are removed.
- Radical hysterectomy – the uterus, cervix, the upper part of the vagina and surrounding tissues are removed.
The type performed depends on the reason for the hysterectomy. Sometimes the fallopian tubes and ovaries are also removed, called a salpingo-oophorectomy. This is done to decrease the risk of ovarian cancer.
Why do women get hysterectomies?
There are several medical reasons a doctor may recommend a hysterectomy:
- Uterine fibroids – noncancerous tumors that can cause heavy bleeding, pain, bladder pressure.
- Endometriosis – tissue that normally lines the uterus grows outside of it, causing pain and abnormal bleeding.
- Uterine prolapse – when weak pelvic muscles cause the uterus to slip down into the vagina.
- Cancer of the uterus, cervix, or ovaries.
- Chronic pelvic pain.
- Abnormal vaginal bleeding.
For some conditions, a hysterectomy may be elective and non-emergent. It should be considered only after other treatment options have failed.
How is a hysterectomy performed?
There are a few different techniques used to perform hysterectomies:
- Abdominal hysterectomy – An incision is made in the lower abdomen to remove the uterus through the abdomen. This is the most common approach.
- Vaginal hysterectomy – The uterus is removed through the vagina without any external incisions. Typically performed for prolapse.
- Laparoscopic hysterectomy – Small incisions are made and a tiny camera is used to guide the surgery. The uterus is removed in pieces through the incisions.
- Robotic hysterectomy – Similar to laparoscopic but uses a robotic surgical system controlled by the surgeon.
The method depends on the surgeon’s expertise and the reason for the hysterectomy. Abdominal and robotic approaches provide the best view of the pelvic organs. Vaginal and laparoscopic hysterectomies involve faster recovery times.
Why is a hysterectomy considered major surgery?
There are several reasons why a hysterectomy is considered a major surgical procedure:
- General anesthesia is required – The surgery involves cutting through skin, muscle, and internal tissues. This necessitates general anesthesia to keep the patient fully sedated and immobile.
- Invasive procedure – Most hysterectomies require an incision in the abdomen (either by scalpel or laparoscope). This allows access to remove internal reproductive organs.
- Significant blood loss risk – The uterus has a rich blood supply. Careful surgical technique is required to prevent hemorrhage.
- Long hospital stay – Patients typically stay 1-2 nights or longer in the hospital following a hysterectomy.
- Extended recovery time – Full recovery takes 4-6 weeks with restrictions on lifting and activities during that time.
- Risk of complications – With any major surgery, there are risks like infection, bleeding, blood clots, injury to other organs, adverse reactions to anesthesia, etc.
Due to these factors, a hysterectomy is considered a major, invasive surgery requiring skilled surgeons and an adequate recovery period. It is not a simple procedure.
What is the recovery like after a hysterectomy?
Recovering from a hysterectomy takes time. Here’s what to expect:
- Hospital stay – Patients usually stay 1-2 days or longer in the hospital after a hysterectomy. This allows close monitoring for any bleeding or complications.
- Pain management – Pain medication will be given, either orally or through an IV or epidural. Moving around in bed and walking will begin soon after surgery.
- Incision care – Incision sites will be monitored. Any dressing changes or washing will be done by a nurse initially.
- Preventing infection – Antibiotics may be given to prevent infection. Deep breathing and coughing helps prevent lung infections.
- Catheter – A catheter is inserted to drain urine for the first day or two after surgery.
- Bowel stimulation – Laxatives, diet and walking help restore regular bowel function.
- Gradual return to normal activities – Recovery takes about 4-6 weeks. Activity is gradually increased but lifting and driving is restricted initially.
- Physical therapy – Some women benefit from pelvic floor physical therapy after hysterectomy.
- Watch for complications – Report any signs of infection, bleeding, blood clots, or other issues to your doctor.
With time and follow up care, most women can return to their full activity level.
What are the risks associated with hysterectomy?
While hysterectomy is often a safe surgery, it does carry risks and possible complications. These include:
- Infection – Uncommon but possible at the incision site or internally in the pelvis.
- Bleeding – If a blood vessel is cut, hemorrhage may occur. Rarely, a blood transfusion is required.
- Damage to nearby organs – The intestines, bladder or ureters could be inadvertently injured.
- Bowel obstruction – Scarring can sometimes block the intestines.
- Blood clots – Clots may form in the veins of the leg and pelvis. These can break loose and cause pulmonary emboli.
- Negative sexual effects – Some women experience a change in libido and arousal after hysterectomy.
- Premature menopause – If ovaries are removed, this induces surgical menopause.
- Urinary incontinence – Weakened pelvic muscles can cause urinary leakage.
- Chronic pain or nerve problems – If nerves are cut, pain or numbness may result.
These complications are not extremely common. Choosing an experienced, high-volume surgeon performing the procedure at a reputable hospital can minimize risks.
What is the recovery timeline for hysterectomy?
Recovering after a hysterectomy occurs in phases:
Immediately After Surgery (hospital stay)
– 1-2 day hospital stay or longer if complications arise
– IV pain medications to manage pain
– Catheter in place to drain urine
– Getting in and out of bed with assistance
– Short walks in the hospital hallway
First Week Home
– Tenderness, pain and fatigue are still present
– Self-care and hygiene is difficult; require help
– Continue stool softeners and laxatives
– Walking short distances and climbing stairs slowly
– Showers allowed but no baths
– Mainly rest, take pain medication as needed
– Gradually increase standing, walking, climbing stairs
– Drive short distances if given the OK
– Perform light housework in short intervals
– Walk outside and perform leg exercises daily
– May return to sedentary desk job if allowed
– Avoid lifting anything over 10 pounds
– Energy levels improve
– Stop taking narcotic pain medication
– Return to regular bowel and bladder habits
– Drive longer distances and ride in a vehicle comfortably
– Resume light exercise (walking, swimming, stationary bike)
– See OB/GYN for follow up appointment
2-3 Months After Surgery
– Generally back to normal energy and activity
– No heavy lifting restrictions
– Core exercises can begin strengthening abdomen
– Resume all regular activities including exercise
– Some numbness or pain may still be present
Full recovery takes about 3 months for most women after an uncomplicated hysterectomy. Listen to your body and gradually increase activity. Avoiding complications helps speed the recovery.
In summary, a hysterectomy is the surgical removal of a woman’s uterus and is considered a major operation:
- It requires general anesthesia, an abdominal incision, and a hospital stay.
- There are risks of bleeding, infection, injury to other organs and other complications.
- The recovery period lasts for 4-6 weeks with activity restrictions.
- Follow up care and physical therapy may be needed during the recovery process.
- When performed by a skilled surgeon at a reputable hospital, hysterectomies are usually safe procedures.
- Many women can resume a full, active lifestyle after recovering from a hysterectomy.
While less invasive forms of hysterectomy have been developed, this surgery involves removal of major reproductive organs and still requires significant recovery. Considering the involved nature of the surgery, a hysterectomy remains a major operation for women.