Hysterectomy – removal of the uterus

The hysterectomy is a surgical operation by which we carry out the removal of the uterusor matrix, either totally or partially. It is one of the most common interventions in women, according to the World Health Organization (WHO), with a very high success rate among patients. This operation will be performed under general anesthesia. Depending on the needs of each person and their diagnosis, there are different types of hysterectomy and techniques through which we can perform the intervention. The postoperative period is usually quite painful and requires specific treatment and a series of care that patients will have to comply with properly so that everything goes correctly. Recovery can take between 2 and 6 weeks depending on the type of hysterectomy, the technique that we are going to use and the patient in question who is going to undergo the intervention.

When is a hysterectomy necessary?

There are many different reasons why a woman may need a hysterectomy. When a patient has prolapses (the displacement of the organs, in this case, the womb sags and this causes pressure in the vagina and urinary incontinence ) or fibroids (benign gynecological tumor) it is likely that she needs to undergo this intervention. In the case of tumors, they are only operated on when their size is considerably large and the pain they cause us is very intense. In any case, the intention should always be to try to preserve the uterus and to remove only and exclusively the fibroids.

Another circumstance in which a hysterectomy might be necessary is when some bleeding complications occur after delivery . If the life of the patient is in danger, the surgeon must make the decision and take into account all the less invasive alternatives possible.

Before, the most common was to directly remove the uterus, but today doctors advise us to be more cautious and usually resort to less invasive operations. Currently, total excision is only used in the most serious cases, so that the quality of life of the patient is not affected. We always try to carry out the least aggressive surgery possible, or it is even possible that it is not necessary to completely remove the uterus, but only the affected parts.

In the event that the patient experiences excessive and prolonged bleeding during menstruation , removal of the uterus is the last resort. Today, there are treatments that help control the problem most of the time. Endometrial ablation may even be done through hysteroscopy. A less invasive surgery that involves the removal of the endometrium, the mucous membrane that lines the cavity of the uterus. The hysterectomy, in this case, would only be necessary when no treatment could stop that bleeding and this would cause some side effects such as anemia, frequent ways or low blood pressure, that is, some more serious complication.

A hysterectomy is usually necessary when we are diagnosed with cancer of the cervix or cancer of the uterus , and it is usually recommended when there is cancer of the ovaries . In these circumstances, hysterectomy is almost mandatory, although the reality is that most of the operations carried out are performed on women who do not have cancer.

Types of hysterectomy

Depending on the case, the ovaries and fallopian tubes may also be removed during the uterus operation. This decision will be made by the doctor based on the needs of each patient:

• Subtotal abdominal hysterectomy : this is called when only and exclusively the uterus is removed.
• Total abdominal hysterectomy : when the uterus is removed, also including the cervix.
• Radical abdominal hysterectomy : when the uterus, cervix, the highest part of the vagina and the set of lymph nodes and lymphatic ducts that surround it is performed. This type of hysterectomy is usually done to treat some cancers of the cervix.
• Total hysterectomy with double adnexectomy : when, in addition to all of the above, the fallopian tubes are removed.

Depending on the needs and conditions of the patient, hysterectomy can be carried out using different techniques. The most common is abdominal hysterectomy , although it is also the one that takes the longest recovery time. The surgeon works from an incision in the lower abdomen that is slow to heal and is quite painful. Another less invasive option is vaginal hysterectomy or laparoscopic hysterectomy . The surgeon will decide which technique to use during the operation, always taking into account the particular case of each woman.

Tips to keep in mind before the operation

Like any other operation, it is important to prepare the muscles that may be affected in advance to rule out any problems postoperatively. Some of those muscles that women who are going to undergo this intervention can work are, for example, the pelvic floor . With perineal exercises we will prevent a prolapse from occurring and we will reduce the probability of suffering other long-term problems. It is also important to strengthen the glutes to balance the stability of the pelvic floor. Women who are going to undergo a hysterectomy, will also have to work the spine and abdomen .

Postoperative and recovery

Hysterectomy is an operation that does not involve major risk, but it is usually accompanied by a painful postoperative period and, above all, uncomfortable for the woman, although it all depends on the type of hysterectomy that has been undergone. We also have to take into account that the recovery time can vary from one woman to another. As in all surgeries, we must follow the instructions of the doctor who knows our case, who will indicate to the patient a series of guidelines and minimum care so that everything goes correctly.

After the procedure, the patient will receive analgesics to alleviate the pain. You may also need a catheter to drain urine from your bladder. It is very important for the operated person to get up and walk around as soon as possible after surgery, to prevent blood clots from forming in the legs. Also, this can help speed up the recovery process.

The length of hospital stay will depend on the type of hysterectomy that has been performed. If the operation is carried out through a small cut in the vagina or through a laparoscope, the patient may be able to be discharged the day after the operation. If an incision is made in the abdomen, it may take another day or two in the hospital. In the event that the reason for which the operation is carried out is cancer, then the patient will probably have to remain hospitalized for a longer time so that she can receive other types of treatments.

Once out of the hospital, the woman has to rest, avoid going up and down stairs or gaining weight during the weeks following the operation. T Also excluded may have sex , not to douche or use tampons until your surgeon tells you to . You will not be able to drink alcoholic or carbonated beverages to avoid discomfort such as gas.

In addition, eating a diet rich in fiber and drinking plenty of water will help prevent constipation to avoid straining when going to the bathroom, something that could cause the surgical wound to open. Little by little, the patient will have to resume the activity of her daily life, she can even do the exercises mentioned above to strengthen the weakened muscles. In any case, it is important that women who have undergone this operation consult their doctor for specific recommendations for it. It is recommended that you consult a specialist if you have any of the following symptoms:

• Fever or chills , these symptoms could be caused by an infection and the patient would need to take antibiotics. Infections are more frequent when a vaginal hysterectomy has been performed, since when opening in that area, the bacteria that are there can contaminate the wound.
• Bleeding , which can occur within 24 hours after the intervention or up to ten days later. Some of the reasons why this bleeding can occur are poor healing of the surgical wound, necrosis of local tissues, reabsorption of suture threads, etc.
• Severe abdominal pain, cramps, or swelling .
• Swelling or redness at the incision area.

Life after a hysterectomy

The uterus is the hollow muscular organ in which the fetus develops during pregnancy. Therefore, its removal makes it impossible for the woman who has undergone this intervention to become pregnant, unless the ovaries have not been removed and it is done through surrogacy. This is the only way that currently exists for a woman without a uterus to become a mother after the operation.

Women who undergo this intervention may suffer an early menopause , although it all depends on the type of hysterectomy that has been performed. Not all hysterectomies necessarily entail an induced menopause , only if the ovaries are also removed. If only the uterus is removed and the ovaries are left intact, the patient does not have to suffer early menopause, in that case she would only stop having menstruation, but this would not alter hormonal levels.

The risk of having an early menopause due to a partial hysterectomy is low, although it can occur. Early menopause caused by a hysterectomy causes the same symptoms as regular menopause: hot flashes, fatigue, weight gain, loss of sex drive, insomnia , etc. In the event that the patient has not yet reached menopause, her doctor may prescribe hormone replacement therapy so that everything goes correctly. Women who have had a hysterectomy are usually only prescribed estrogens.

One of the concerns among patients is what their sexual life will be like after the intervention, whether or not they will lose sensitivity in the area. But in reality, not having a uterus does not have to affect sexual intercourse. In fact, it can generate great improvements, especially if we suffered prolonged bleeding or uterine pain during sex. If, in addition to that, a specialist believes it necessary for the patient to receive adequate hormonal treatment, this will help prevent vaginal dryness and loss of sexual desire, in the event that the patient suffers early menopause due to hysterectomy.

Another change that some women experience goes beyond the physical. It all depends on the person affected, but also on the reason for which he underwent this intervention. Many need psychological help , especially if they are young women with the desire to be mothers. Hysterectomy is an irreversible operation that makes it impossible for the intervened person to become pregnant. Some patients experience a sense of loss when their uterus is removed, a void that can affect us after the operation. It is advisable for the patient to express her emotions and feelings with her family and friends and, if necessary, seek the help of a professional to avoid any subsequent serious disorder.

Despite all the possible side effects of hysterectomy, this intervention has great benefits for women, as it relieves symptoms and problems before surgery, which can be really annoying and painful. We have to remember that today there are other less invasive alternatives that can replace this operation. Everything will depend on the person and their diagnosis. That is why it is important to go to a good specialist to study each case carefully and decide what is best for the patient.