What is Hysterectomy?

by Abbas Jahangir · June 15, 2024

Uterus; It is a female reproductive system organ that is in the shape of an upside down pear, has a cavity lined with a small amount of tissue that is renewed every month, and is located in the pelvic region of women. It is the place where the fetus develops and grows. Also known as uterus.

What is Hysterectomy?

Hysterectomy is surgery to remove the uterus. Hysterectomy surgery is the second most common surgery performed by women of reproductive age. After hysterectomy, the patient cannot get pregnant and does not menstruate. The type of surgery to be performed is determined according to which part or parts of the uterus will be removed during the surgery, why the surgery is performed, and whether other reproductive organs will be removed. There are 4 types of hysterectomy:

Total Hysterectomy: It is the most common type of hysterectomy. The entire uterus and cervix are removed. Ovaries are not removed.
Subtotal (Supracervical) Hysterectomy: In this type of hysterectomy, the uterus is removed, but the cervix is not removed.
Radical Hysterectomy: This is the type of hysterectomy that is mostly preferred in some cancer cases. The uterus, cervix, upper part of the vagina, tissues in the pelvic area around the cervix and, if necessary, pelvic lymph nodes are removed.
Hysterectomy with Bilateral Salpingo-oophorectomy: Removal of both ovaries and oviducts along with the uterus. It is the preferred type of hysterectomy if the patient is not of reproductive age.

Hysterectomy surgery can be performed open or closed (laparoscopic). The incisions made in closed surgery are much smaller than in open surgery. It is preferred because it is more advantageous than aesthetic surgery, but some conditions are restrictive for closed surgery. Open surgery can be performed in two ways. The uterus can be removed through an incision in the abdomen or through the vagina. When the vaginal route is preferred, no incision is made in the abdomen. In cases such as cancer and chocolate cyst, it may be preferred to remove the uterus through an incision made in the abdomen, and today, due to the development of laparoscopic methods, a door operation can also be performed. In case of uterine prolapse, it may be preferable to remove the uterus from the vagina and, if necessary, to add procedures to prevent prolapse of other intra-abdominal organs.

In what cases is the uterus removed?

There are many diseases and conditions that require hysterectomy. These can be listed as follows:

Chronic pelvic pain
Uncontrolled vaginal bleeding
Uterine cancer
Cervical cancer (cervix cancer)
Ovarian cancer (Ovarian cancer)
Fibroids (Myomas are benign tumors that form in the uterus.)
Pelvic inflammatory disease (Serious infection of the reproductive organs.)
Uterine prolapse (Uterine prolapse)
Chocolate cyst (Endometriosis)
uterine thickening

The most common conditions that cause hysterectomy are; fibroid tumors, chocolate cyst (endometriosis) and uterine prolapse.

How Many Hours Does Hysterectomy Surgery Take?

Hysterectomy surgery takes approximately 1 to 3 hours. This period may vary depending on the size of the uterus, whether the patient has had surgery before, and whether other reproductive organs will be removed along with the uterus.

Problems After Hysterectomy

The most common problems after hysterectomy are vaginal discharge and bleeding, and uncomfortable feelings, especially pain at the surgical incision site. Vaginal discharge and bleeding are not as heavy as bleeding during menstrual periods. It may take up to 6 weeks for recovery to occur. If there is excessive discharge or bleeding, accompanied by a strong bad odor and blood clots, a doctor should be consulted.

If the ovaries are removed along with the uterus, the patient may experience menopause-like symptoms such as hot flashes, vaginal dryness, loss of libido (decrease in sexual desire), difficulty sleeping (insomnia), anxiety and sweating. If menopause-like symptoms make the person’s daily life difficult, “Hormone Replacement Therapy (HRT)” can be given. Hormone Replacement Therapy begins to show its effect after a week. It should be noted that in order to reduce these complaints in patients who do not want to use HRT, consuming a low-fat plant diet and soybeans (and their products) may reduce the complaints. Exercise after the recovery period is also very useful in controlling menopause complaints.

It is known that some antidepressant drugs can be effective in reducing the effects of menopause complaints. There may be changes in the patient’s bowel habits after the operation. Some women may experience urinary tract infection or constipation after surgery. Both conditions can be easily treated. After the surgery, the patient may experience urinary incontinence. Women who have had a hysterectomy face a 60% increased risk of urinary incontinence throughout their lives compared to women who have not had surgery. This cannot always be prevented, however, if pre-operative examination detects existing incontinences that can be treated with surgery and the necessary procedures are added during the hysterectomy, this rate can be further reduced. One of the complications that may occur after the surgery is the cutting of the patient’s urinary tract (ureter) during the surgery. It is repaired during surgery. In most cases it does not cause any long-term problems.

How Long Does Pain Last After Hysterectomy?

This period may vary depending on the person’s age and the operation performed, but in general, simple pain and discomfort for up to 3 months after hysterectomy is considered normal. After the surgery, the patient is given painkillers. If the patient’s pain lasts longer than 3 months and has severe pain, he or she should consult a doctor.

Nutrition After Hysterectomy

Bladder and bowel habits may change after hysterectomy. The patient is recommended to consume plenty of water and fibrous food. The risk of encountering problems such as constipation increases after the surgery. If a person includes fibrous foods in his diet, he will reduce the possibility of constipation.

What Happens After Hysterectomy?

The length of hospital stay after surgery varies depending on the type of surgery performed. If the uterus is removed through an incision made in the abdomen (abdominal hysterectomy), the patient stays in the hospital for a longer time. It is normal to have pain and feel tired after the hysterectomy operation. The aim is to reduce the patient’s pain by giving painkillers.

The day after the surgery, the patient is recommended to take small walks. Thus, blood flow returns to normal and the patient is protected against complications such as clots in the legs (deep vein thrombosis). If there is a light red vaginal discharge after the surgery, if the patient has a fever of 38 oC or above, if there is severe nausea and vomiting, if there is difficulty in urinating or burning sensation while urinating. If there is severe pain, redness or discharge at the incision site, the patient should definitely consult a doctor.

Sexuality After Hysterectomy

After hysterectomy, patients are not recommended to have sexual intercourse until the scars heal and vaginal discharge stops. This may take approximately 4 to 6 weeks. If the ovaries are removed along with the uterus, the patient may have vaginal dryness. Due to vaginal dryness, water-based lubricants can be used or the patient can be given hormone replacement therapy. A decrease in sexual desire may be seen immediately after the operation. With recovery, the loss of libido will disappear. Apart from this, the patient’s sexual life will not be affected by the surgery after full recovery.

Will There Be Abdominal Swelling After Hysterectomy?

It is normal for the patient to have bloating and gas after hysterectomy surgery. It may take a few weeks for the abdominal swelling to subside. Some exercises may be recommended to reduce swelling. Bloating can be reduced by applying warm compression and paying attention to nutrition. Disruption of the intestinal flora due to antibiotics used during the surgery may also increase this swelling, and a high-fiber diet accelerates healing in this area.

Can I Gain Weight After Hysterectomy?

Some studies indicate that women have an increased risk of gaining weight after hysterectomy. However, there are many factors that affect this and it does not apply to every woman. It has been shown that women who were overweight before surgery, women whose ovaries were removed along with their uterus, women who took longer to recover and were not active during this time were more likely to gain weight.

What to Pay Attention to After Hysterectomy?

There are some situations that the patient should pay attention to after hysterectomy surgery:

The patient may have vaginal discharge for up to 6 weeks. It is recommended to use only sanitary pads for vaginal discharge.
Nothing should be inserted into the vagina and attention should be paid to genital area hygiene.
Heavy items should not be lifted for at least 4 to 6 weeks. It is especially recommended not to lift objects weighing more than 5 kg.
It is recommended not to have sexual intercourse for up to 6 weeks.
You can take a bath. The scar should be washed with soap and water. The stitches will dissolve spontaneously within 6 weeks. Therefore, the patient should not open the stitches.
The patient can return to the exercise routine within 4-6 weeks. Exercise is recommended for recovery. However, the exercises should not be challenging.
If the uterus was removed through an abdominal incision and narcotic painkillers are not taken, the patient can drive within 2 weeks. If the uterus was removed from the vagina or closed surgery was performed, the patient can drive within a few days.

The post-operative period is as important as the hysterectomy surgery. The patient must exercise due care. Follow the recommendations after hysterectomy, do not forget to go to the doctor for check-ups when necessary, and do not neglect your health!