E F Nigel Holland
Consultant Gynaecologist and Obstetrician
Menu Patient Leaflet 7 - Abdominal Hysterectomy - Back to List

This leaflet has been designed to help you prepare for your operation. It does not contain all the known facts about your operation or complaint. Some of the risks associated with your operation will depend on your medical condition and, as any operation can be life threatening, these risks will vary from person to person.

What is an Abdominal Hysterectomy?

A hysterectomy is an operation to remove the womb (uterus). The procedure is done through an incision on the abdomen which is usually in the bikini line (pfannensteil) but sometimes requires an up-and-down cut (midline). Having a hysterectomy means you will not be able to have any children and you will have no more periods.

There are two main types of abdominal hysterectomy:

Total abdominal hysterectomy involves the removal of the womb and cervix (neck of the womb). Because your cervix is removed cervical smears are no longer needed and there is no risk of cervical cancer developing.

Subtotal hysterectomy is a simpler operation which only involves removal of the womb. The risk of bladder injury is less. Occasionally a small part of the lining of the womb (endometrium) is left behind which can result in a light bleed at the time of a period. Controversially the cervix is thought by some to be responsible in part at least in orgasm which is a possible advantage of this procedure. Because your cervix remains you will need to continue to have regular cervical smears taken to ensure that any abnormal smear results can be treated as necessary.

Hysterectomy with a salpingo-oophorectomy. Sometimes one (unilateral) or both (bilateral) of your ovaries and fallopian tubes are removed at the same time as a hysterectomy. This is can be indicated for conditions such as cancer, endometriosis, premenstrual syndrome. Also when women are approaching the menopause as the ovaries start to decline in the function it is one of the ways of reducing the risk of ovarian cancer.

Why do I need a Hysterectomy?

You may be having one or more of the following symptoms:-
- Heavy and painful periods - not relieved by previous treatments
- Fibroids are benign (not cancer) growths in the muscle of the womb causing heavy and painful periods
- Endometriosis where the cells lining the womb grow outside the womb
- Pelvic inflammatory disease
- Cancer of the womb, cervix or ovaries

What are the benefits of Abdominal Hysterectomy?

It can help to cure or improve the problems associated with your condition

What are the risks of Abdominal Hysterectomy?

No operation is without risks. Those associated with hysterectomy are:-
- Wound or urine infection
- Difficulty passing urine
- Haemorrhage (difficulty in controlling bleeding)
- Damage to the internal organs surrounding the womb, especially the bowel, bladder and ureters (the tubes which lead from the kidneys to the bladder)

If any of the above occurs, further surgery or treatment may be needed to repair or investigate the problem.
- Clots (deep venous thrombosis DVT/pulmonary embolism PE)

Risks associated with a general anaesthetic

A general anaesthetic (you will be asleep) also carries a small risk. These risks are greater for women who smoke or are overweight. It is advisable, if either of these apply, to reduce or stop smoking and try to lose some weight. In addition there may be special risks for women with certain medical problems such as heart or lung disease.

You will be able to discuss any concerns you may have with your anaesthetist before your operation.

What happens before your operation?

You will have the opportunity to ask any questions you might have.
- You may be asked to shave the top inch of your pubic hair. This will help to stop any plasters/dressings sticking to the hair.
- You will be admitted to the ward on either the day before, or, the same day as your operation.
- If you have not attended a preoperative assessment clinic you may need to have some investigations done e.g. blood tests. These will be done on the day of your admission.
- It may be necessary for you to wear special stockings and/or have a series of small injections. These will help to lower the risk of blood clots forming.
- You may be seen by the physiotherapist.

What Happens during your operation?

Your operation is usually performed under a general anaesthetic and will take approximately one hour to complete. You will be away from the ward for approximately two to three hours depending on your recovery time.
- An incision (cut), is usually made just above your bikini line but sometimes a vertical cut (from your tummy button to your bikini line) is necessary.
- Your operation will be performed and, when completed, the wound will be closed with either sutures (stitches) or staples.
- It may be necessary to put a drain (a small plastic tube) into your wound and occasionally into your vagina. This helps to prevent a build up of fluid. They are usually removed after 24/48 hrs depending on your doctors' decision.
- You will normally have a catheter (a small tube) in your bladder. This drains the urine from your bladder. This is also removed approximately 24/48hrs after your operation if everything is satisfactory.
- You will have a drip (intra venous infusion, I.V.) usually in the back of your hand. This will help give you fluids or drugs until you are able to eat and drink normally.
- The drip also can provide pain relief with morphine which can be controlled safely by yourself (PCA - patient controlled analgesia)
- You will be given injection to reduce your risk of thrombosis.
- There will be a slight blood loss from your vagina and a sanitary pad will be in place.

Will I have any pain?

Any operation can produce pain. This can be mild in some patients and more severe in others. Always tell a member of staff if you are in pain, there is no need to suffer!

There are several methods of pain relief (analgesia) available. Before your operation the anaesthetist will discuss and explain to you which is the best method of analgesia for you. Some of these methods can include:-

- Epidural analgesia - an infusion (drip) around the spinal cord which numbs the surrounding nerves and helps to prevent pain.
- Patient Controlled Analgesia (PCA) - you control how much pain relief you need by pressing a hand held button attached to a pump (similar to a drip).
- Intra muscular analgesia - a pain killing injection usually given into the muscle of either your bottom or thigh.
- Suppository - this is for pain relief. It is given, with your permission, into your back passage (rectum)
- Tablets - taken by mouth when you feel able to drink.

It may be necessary to take some form of analgesia, usually tablets, when you go home.

Will I Feel Sick?

Some patients may feel sick from the effects of the anaesthetic or operation. Some of the drugs used for pain relief can also cause nausea and sickness. An anti sickness preparation can be given to help control this.

After the operation?

On your return to the ward the nurse will check your blood pressure, pulse and wound at regular intervals. If you are in pain please tell the nurse - there is no need for you to suffer.
- On the first day after your operation you will be encouraged to sit out of bed for short periods. You will be given help with your personal hygiene.
- On your second day you will be encouraged to move around more. Help with your hygiene will be given. Depending on how you are feeling you will be offered a bowl, bath or shower. Your drain and catheter will be checked and removed if satisfactory. Your dressing will be removed.
- After three days you should be moving around more and be able to have a bath or shower without assistance.
Your drip will be removed when you start to eat and drink.

Please remember not to compare your recovery rate with other patients. Not everyone will have had the same operation, and all patients are different.

Going Home

- You will feel tired when you go home. Try to arrange for someone to stay with you for the first few days.
- You may still have some bleeding or discharge from your vagina. This should be decreasing. To help prevent any infection please use sanitary towels, not tampons.
- After about 10-14 days you may find small pieces of suture material on your pad. Do not worry about this, the internal sutures are beginning to dissolve. When this occurs, bleeding from the vagina may increase slightly. If this becomes heavy or you are passing clots then you need to contact your doctor and rest.
- Continue to rest at home and do some form of gentle exercise each day e.g. short walk. Do not do any housework or lifting.
- Gradually increase your activities, remembering to rest when you feel tired. It is important to avoid any activity which puts a strain on the stomach muscles until after approximately 6-8 weeks. After this time you should be able to do most of the things you were doing before your operation except heavy lifting.
- The best advice you can have is to listen to your body. If you feel tired then rest.

Will I ben depressed?

It is normal to feel low and tearful after any major operation, not just a hysterectomy. However, if these feelings continue then see your doctor. Please remember that having any type of hysterectomy does not mean you will be less of a women. Your femininity will stay the same.

Will I have the menopasue?

If your ovaries are removed it may be necessary for you to have hormone replacement therapy (HRT). There are many ways in which this can be managed and the it will be discussed with you which type of HRT will be best for you.

Will I put on weight?

The operation itself will not cause you to put on weight - unless you eat more and exercise less. Your movement is limited after your operation so it is important that you continue with the exercises that you have been shown and eat a sensible diet.

How soon can i resume driving?

You need to be able to get in and out of the car easily, wear a seat belt with comfort and be able do an emergency stop and you may not have the strength to do this. It can also be painful. Please check the situation with your insurance company.

What about sex?

Sexual activity can normally be started after your check up which is usually about 6 weeks. After your operation please be sure that physically and mentally you feel ready to start having sexual intercourse.

When can i start sporting activities?

When you feel ready starting easily at first.

If there are any further questions you wish to ask please do not hesitate to ask.

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