Hysterectomy

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Preoperative Care

No matter which type of hysterectomy procedure is performed, hysterectomy requires hospitalization for one to five days.

Preparation for a hysterectomy typically involves several steps, including the following:

• Physical examination to determine overall health
  
• Pelvic exam
  
• Blood and urine tests
  
• Preoperative meeting with the surgeon to discuss the procedure and receive pre-surgery instructions
  
• Preoperative meeting with the anesthesiologist to discuss the type of anesthesia that will be used (general or local)
  

In many cases, patients are advised to quit smoking 2 to 6 weeks before surgery. Smoking may cause breathing problems during surgery and has been shown to delay healing.

If a pain reliever is needed in the week prior to surgery, acetaminophen is recommended over aspirin, ibuprofen, or naproxen, to reduce the risk for heavy bleeding during surgery.

In general, no food or drink is to be taken after midnight on the day of the procedure. In some cases, a laxative or enema is indicated to empty the bowels before surgery.

Postoperative Care

Immediately after surgery, the patient remains in the recovery room for a few hours. She is monitored for discomfort, and is given medications to prevent pain and infection.

Hysterectomy requires at least one overnight stay in the hospital, and may require hospitalization for as many as 5 days. After the first night, patients are up and walking. Sanitary pads are used to manage bleeding and discharge, which can last for several days.

Full recovery can take from 4 to 8 weeks for open abdominal hysterectomy, and from 1 to 2 weeks for vaginal and laparoscopic hysterectomies. During this time, patients should get plenty of rest. She should avoid heavy lifting and tub baths for a full 6 weeks.

Depending on the type of procedure used and on the patient's rate of recovery, light chores, some driving, and even returning to work during this period of time may be possible. In general, patients can resume sexual relations after six weeks.

Risks/Complications

Most women experience no complications during or following a hysterectomy. In fact, the relief of painful symptoms often results in a positive post-surgery experience. In some cases, the surgeon must change from a vaginal incision to an abdominal incision during surgery.

Risks associated with the procedure include the following:

• Blood clots
  
• Bowel or bladder injury
  
• Heavy blood loss requiring transfusion
  
• Infection
  
• Problems with anesthesia
  
• Wound pulling open after surgery
  

Following hysterectomy, long-term complications can include the following:

• Decrease in sexual desire (if both ovaries have been removed)
  
• Feelings of loss or diminished femininity
  
• Increased risk for osteoporosis in women under age 45
  
• Pain during sex (if vagina has been partially removed)
  
• Pelvic weakness
  
• Vaginal dryness (caused by low estrogen levels if ovaries are removed)
  

Follow-up

In most cases, patients follow up with their physician four to six weeks after the procedure. The following symptoms may indicate a medical emergency and should be reported to a health care provider as soon as possible:

• Bright red vaginal bleeding that soaks more than 2 pads in an hour
  
• Chest pain, cough, or difficulty breathing
  
• Difficulty with bowel movements, especially after 3-5 days or if accompanied by pain and swelling in the lower abdomen
  
• Fever over 100°F
  
• Hot flashes, sweating, flushing, or increased heart rate
  
• Large, painful blood clots
  
• Pain or tenderness and swelling in the legs, especially back of the calf
  
• Pain not relieved by medications
  
• Painful or burning urination, cloudy urine
  
• Pain, discomfort, or bleeding during sex
  

Hysterectomy, Preoperative Care, Prostoperative Care reprinted with permission from womenshealthchannel.com
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