Hysterectomy

What is a hysterectomy?

The female reproductive organs are made up of a womb, vagina, Fallopian tubes and ovaries. The womb is about the size of a pear. It is made of specialised muscle and lies in the pelvis between the bladder and the bowel. A Hysterectomy is the removal of the womb by an operation.

A hysterectomy can treat a number of conditions that affect the reproductive system including irregular or heavy menstrual bleeding, endometriosis, prolapse or fibroids.

A hysterectomy can be performed by one of the following ways:

• An abdominal hysterectomy, where your womb is removed through a cut in your abdomen
• And a laparoscopic (keyhole) hysterectomy, a procedure done through small cuts in your abdomen which can also be used to assist with vaginal hysterectomy.

There are different types of surgeries which may be available depending on your condition: 

• Supracervical hysterectomy: removal of the uterus only
• Total hysterectomy: removal of the uterus and cervix (the opening of the uterus leading to the vagina)
• Radical hysterectomy: removal of the uterus, ovaries, fallopian tubes, upper part of the vagina, and the pelvic lymph nodes
• Salpingo-oophorectomy: removal of the ovaries and fallopian tubes (may be combined with any of the above procedures)

Usually your ovaries are usually left in place because they produce oestrogen – otherwise you would immediately go through the menopause. After a hysterectomy, you will no longer have periods or be able to become pregnant.

Why would I have a hysterectomy?

You may have a hysterectomy if your uterus is causing health problems that cannot be treated by other means. 

Possible reasons include the following: 

• Heavy or very painful periods. In some women, day-to-day life is made difficult because of heavy periods. Sometimes the heavy bleeding can cause anaemia. There are various other treatment options for heavy periods, including tablets and an intrauterine system (Mirena® coil). If they do not help to improve the problem, hysterectomy is an option for treatment. See separate leaflet called 'Heavy Periods (Menorrhagia)' for further information.
• Fibroids. These are swellings of abnormal muscle that grow in the womb. Fibroids are common and often do not cause any symptoms. However, in some women they can cause heavy or painful periods. Some fibroids are quite large and can press on the bladder to cause urinary symptoms.
• Prolapse. This is where the uterus or parts of the vaginal wall drop down. This may happen after the menopause when the tissues which support the uterus tend to become thinner and weaker.
• Endometriosis. This is a condition where the cells which line the uterus are found outside the uterus in the pelvis. This can cause scarring around the uterus, and may cause the bladder or rectum to stick to the uterus or Fallopian tubes. Endometriosis may cause only mild symptoms, but some women develop painful periods, abdominal pain or have pain during sex.
• Cancer. Hysterectomy may be advised if you develop cancer of the cervix, uterus, Fallopian tubes or ovaries. 

What is a vaginal hysterectomy?

Vaginal hysterectomy usually takes about an hour, during which your surgeon will pass specially designed instruments through your vagina to remove your cervix and womb. The surgeon will then close the top of your vagina using dissolvable stitches and may place a tampon-shaped dressing in your vagina. With a vaginal hysterectomy you won’t have any visible cuts or scars.

What is an abdominal hysterectomy?

There are a number of reasons why many women consider having abdominal hysterectomy surgery, these may include the following: 

• Irregular or heavy menstrual bleeding, but only if other treatments haven’t worked.
• Endometriosis. A condition in which cells that usually line your womb grow elsewhere in your abdomen.
• Adenomyosis. This is a benign condition in which cells that usually line your womb grow in the womb muscle causing painful, heavy periods.
• Cancer of your womb, ovary, fallopian tube or cervix (neck of the womb).
• Fibroids (non-cancerous growths of muscle and fibrous tissue in your womb) that are painful, cause bleeding or are very enlarged.
• Pelvic organ prolapse. This is when your womb, rectum or bladder drops out of position into your vagina.

An abdominal hysterectomy involves removing your womb through a cut in your abdomen. There are different types of hysterectomy: 

• Total hysterectomy involves removing your entire womb and your cervix.
• Subtotal (also known as partial or supracervical) hysterectomy in which the top part of your womb is removed but your cervix is left in place.
• Total hysterectomy with oophorectomy is when your entire womb, cervix and one or both ovaries are removed.
• Radical hysterectomy is when your womb, cervix, part of your vagina, surrounding ligaments and occasionally your lymph nodes are removed.

You may be able to have the operation done with keyhole surgery.

What are the alternatives to abdominal hysterectomy?

A hysterectomy procedure at Kingsbridge Private Hospital Belfast will usually be recommended if other treatments, such as medicines or other surgery, are unsuitable or haven't worked.

Alternative hysterectomy techniques to an abdominal hysterectomy are: 

• vaginal hysterectomy – the procedure is done through your vagina
• keyhole hysterectomy – the procedure is done through small cuts in your abdomen and often in combination with vaginal hysterectomy

Ask your gynaecologist for advice about which surgery will be most suitable for you.

Preparing for an abdominal hysterectomy

Your gynaecologist will explain how to prepare for your procedure. For example if you smoke, you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

The procedure is usually done under a general anaesthetic at Kingsbridge Private Hospital. You will be asked to follow fasting instructions which means not eating for about six hours before surgery.

It may be possible to have the operation done under epidural. This is an injection into the space surrounding your spinal cord and numbs your body from the waist downward.

What happens during an abdominal hysterectomy?

The operation at Kingsbridge Private Hospital usually takes about an hour. However, this may vary depending on why you’re having a hysterectomy as this will determine the complexity of the surgery.

Your gynaecologist will probably make a horizontal cut (between 10 and 16cm long) across your lower abdomen, just below your bikini line. In some cases it may be necessary for your gynaecologist to make a vertical cut from your belly button down to your bikini line instead. The womb is then removed and stitched. Our experts will discuss this with you before the operation so you are reassured and informed.

How long does recovery take after a hysterectomy?

You will need to rest until the effects of the anaesthetic have passed after your surgery at Kingsbridge Private Hospital. Pain relief may be required to help with any discomfort.

Recovery time will depend on the type of hysterectomy treatment you've received.

With a vaginal hysterectomy, you will need to stay in hospital for one to two days, whereas with an abdominal hysterectomy most women will stay in hospital for two to four days depending on recovery.

Following surgery at Kingsbridge Private Hospital Belfast, it will usually take about four to six weeks to make a full recovery from a vaginal hysterectomy and most women are able to return to work between two and six weeks after the procedure.

An abdominal hysterectomy normally takes about 4 to 12 weeks to make a full recovery from. Most women find they are able to return to work between 4 and 8 weeks after the operation. During the recovery period you can lift light items, such as a kettle, but nothing heavy. Following surgery, we recommend that a friend or relative to stay with you for the first few days after your treatment.

The dressing on your wound normal can be removed after 24 hours. Clips or stitches will be taken out at an appointment five to seven days after your operation but dissolvable stitches may be used instead. Dissolvable stitches can take a few days to a few weeks to disappear depending on the type used.

You will probably stay in hospital for up to four days. Before you go home, our nurses will advise you about caring for your wounds and a follow-up appointment may be arranged.

Recovering from an abdominal hysterectomy

The length of time it takes to recover will be different for every woman. It can take a couple of months to recover fully. Most women find they are able to return to work between four and eight weeks after the operation.

If you had a keyhole procedure, you will probably be able to return to your usual activities sooner than if you had open surgery. The type of surgery will depend on individual circumstances which will be discussed in full at your consultation. 

You may have some abdominal or back pain for a few weeks after your operation. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Following surgery you should take it easy for a few days. It is common to feel more tired than usual so rest is recommended. Our physiotherapists may have given you exercises to do, try to continue with these. Do not lift any heavy items but lighter items can be lifted i.e. a kettle.  We recommend that a friend or relative stay with you for the first few days while you recover.

What are the risks?

As with every type of surgical procedure, there are some risks associated with an abdominal hysterectomy. Risks are specific to you and will be discussed at your consultation.

Side-effects

Side-effects of an abdominal hysterectomy include: 

• pain, swelling and bruising in your abdomen
• bleeding or blood-stained vaginal discharge
• numbness, tingling or a burning sensation around your scar 

If your ovaries have been removed during the operation, you will have menopausal symptoms such as hot flushes, night sweats and vaginal dryness. Your Consultant will discuss this with you and help offer advice.

You will also have a permanently visible scar – this will be red and slightly raised to start with, but should soften and fade over time. This will usually settle down after about six to 12 months.

Complications

Complications are rare but possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of an abdominal hysterectomy may include: 

• Blood loss. You may need further treatment, such as a second operation, to stop the bleeding.
• Damage to other organs and tissues in your abdomen, particularly your bowel, bladder and ureters (the tubes that carry urine from your kidneys to your bladder). This can cause incontinence or a need to urinate frequently.
• A wound or urinary infection. You will need to take antibiotics to treat this.
• Premature ovarian failure. There is a risk that your ovaries won’t work properly because they receive some of their blood supply through the womb.
• A blood clot. These develop most commonly in the leg