Understanding your Abdominal Hysterectomy



The following information was provided by:
The Ottawa Hospital
Division of Gynecology Oncology
Author:
Lynne Jolicoeur RN, BScN, CON(c)
Gynecologic-Oncology Liaison Nurse
Sally Payette RN,
Reproductive Endocrinology/Menopause Liaison Nurse
Ginette Sumure RN,
8 West Team Leader
The Ottawa Hospital





What is a hysterectomy?

Hysterectomy is the surgical removal of the uterus. One or both of the fallopian tubes and/or ovaries may be included. There are different types of hysterectomies. Below you will find a description of each type.



Total hysterectomy:

If you have a total hysterectomy only your uterus is removed. This includes removal of the cervix. Because your ovaries are not removed, they continue to function and produce hormones. Your should not feel differently as only your menstruation will stop. Your menopause (change of life) will be as determined by your body. The average age of menopause (the last menstrual period), for a woman with a uterus is at age 50.

Because the blood supply to the ovaries is affected at the time of the hysterectomy, your menopause will probably occur one year earlier than expected. It is very important to know that a hysterectomy does not affect your hormones. You will not need to be on hormone replacement medication.



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Salpingo-oophorectomy:

In this surgery, one or both fallopian tubes and ovaries are removed. If only one ovary is removed, you should not have any menopause symptoms. If both ovaries are removed, you will start menopause (refer to the section on menopause below).

If the ovaries are removed but not the uterus, you may be subject to problems like abnormal bleeding or cancer of the uterus at the time of menopause (or after menopause). Your physician may therefore suggest that your uterus also be removed. This is called a total hysterectomy and bilateral salpingo-oopherectomy.

If you are already postmenopausal and have no symptoms, there may be very little change in how you fell after the operation.


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Sub-total hysterectomy:

This procedure includes removing the top of your uterus but it leaves the cervix (mouth of the womb) in place. Leaving the cervix behind means you must continue regular pap smears after surgery. However you will not have any menstrual periods. Please be aware that in patients with gynecological cancer, endometriosis or pelvic pain, the cervix is usually removed.

Pelvic lymphadenectomy:

In a pelvic lymphadenectomy or lymph node dissection, the pelvic lymph nodes are removed. Lymph nodes are found throughout the body. They produce and store cells that fight infection, filter bacteria and/or cancer cells out of your circulation. Pelvic lymph nodes are located on each side of the uterus. The lymph nodes are removed if cancer is suspected to see if the cancer has spread.


Omentectomy:

The omentectomy is an apron of fat that covers your organs. It has no specific function. Your surgeon will recommend that your omentum be removed if you have a pelvic mass, and ovarian cancer is suspected. Ovarian cancer cell often spread to the omentum.

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Pathology:

All organs removed during surgery will be sent to the Pathology lab. A pathologist (specialist) will examine the tissue under a microscope, to look for abnormalities in the organs or tissues. This pathologist then writes a complete description of the specimen and provides the diagnosis (e.g. : fibroids, ovarian cysts, endometriosis, inflammation, and most important he/she confirms if cancer is present and if if has spread). This process takes about 7-10 days.

Why do some women have an incision and some do not?
your physician has recommended an abdominal hysterectomy. Depending on the reasons for surgery, the physician may perform the hysterectomy through an incision on the abdomen or through the vagina. If you will be having a vaginal hysterectomy ask your nurse for that specific booklet.



Abdominal hysterectomy:

This procedure is used if the tubes and /or ovaries must be removed, if the uterus is quite large, or if there are other abdominal problems such as endometriosis, large fibroids, adhesions, or if cancer is suspected.

If you have an abdominal hysterectomy, your incision will be about 6" to 8" long. It will be either horizontal in your lower abdomen ("bikini" cut) or vertical. Although a horizontal incision is less noticeable, a vertical incision may be necessary in order to give the surgeon enough room to operate, and to thoroughly examine the abdomen.




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What can I expect after surgery?

You will have some pain around your incision as well as pelvic discomfort and heaviness. Pain medication will be ordered. Medication before or after a walking session can be helpful. Pain control is necessary for all surgeries. It is important to understand that it is very safe to take pain medication up to 1-2 weeks after your surgery. The better your pain control, the better you can move and return to your activities.

You may have a gauze dressing over the incision or a spray dressing. You may have stitches or staples. The stitches or staples will be removed about 5-7 days after your surgery in hospital, in clinic or by your family physician. After any type of surgery, there is a small risk of bleeding at the incision site. If this happens, the nurse and the physicians will observe you carefully. The incision at the top of the vagina will be closed with absorbable stitches that do not need to be removed. It takes 6-8 weeks for these stitches to be absorbed.

You will have a sanitary pad to absorb any blood that may have collected in the vagina during surgery. It is normal to have collected in the vagina during surgery. It is normal to have light bleeding for up to 2 weeks but you may have a discharge lasting you to 6 weeks while the stitches are absorbing. The discharge will become less, it will change from yellowish to white. Report any heavy bleeding or discharge with a bad odor to your physician.

A catheter will be in your bladder to drain the urine. This catheter will usually be removed the morning after surgery. Sometimes it can stay in the bladder a little longer.

You may have a small tube in your nose called a nasogastric tube. This goes to the stomach to prevent nausea and vomiting, The tube is not always needed. It will be removed when you start having bowel sounds and passing gas by your rectum.


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You may have gas pains on your second or third day after surgery. This is simply a sign that your bowels are returning to normal. Early and frequent walking is the best Cure.

The diagram shows how gas travels through the bowel from the right side of your body to the left side before it's expelled. Gas most often builds up at the bends in the bowel. It is in these areas you are most likely to feel pain.



A simple exercise to reduce gas buildup

To help keep gas moving from right to left and decrease the pain try this exercise: Lie on your back with your legs extended and a pillow under your knees. Slowly raise your right leg and move it toward your abdomen (belly), bending it at the knee and at the hip. Put your hands on your knee and pull your leg down onto your abdomen. Hold this position for a count of 10, then slowly lower your leg back onto the bed.

Now take two or three slow, deep breaths and repeat the exercise with your left leg. After you lower that leg onto the bed, take three or four more deep breaths. Perform these movements slowly and try to relax. When you feel the need to expel gas, do so: don't hold back.

Repeat this exercise three or four times with each leg, then rest awhile. You can perform it several times a day as needed. Walking and massaging your abdomen also helps move the gas.

As your bowels begin functioning, your diet will be increased slowly. You will start with a fluid diet. You will progress to solid foods when you are able to pass flatus/gas by your rectum.

You will need to do deep breathing and coughing exercise every hour. Ask your nurse for the booklet on "Coughing and breathing after surgery" or refer to this section in the "Before and after surgery" booklet.


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How to get out of bed without straining?

Roll on your side. Bring your knees up so your thighs are at right angles to your abdomen. Swing your feet over the side of the bed and push up with your elbow and forearm to sit up.

Early walking helps to improve blood circulation, muscle strength, breathing and passing gas and stool. On the night of the surgery, you will be helped to:

  1. sit up at the side of the bed for 5 -10 minutes;
  2. stand at the bedside briefly; or
  3. take a few steps.

The day after surgery you should be out of bed at least three times. Every day, you should be out of bed and walking frequently. When you are up, stand and walk as straight as possible. This may seem demanding, but it has been proven to decrease complications.


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Side Effects:

After your hysterectomy, you may develop some side effects. Below you will find tips on how to, prevent these side effects.

  • Infection at the incision site or opening of the incision.
    -To prevent infection it is important to keep this area clean and dry.
    Wash your incision with soap and water daily then dry thoroughly.
    -Signs of infection are: redness, bad odor, increased tenderness, drainage of the incision or fever (above 38°C199.4°F).
  • Urine infection (because of the catheter in your bladder after surgery).
    -To prevent a urine infection, drink about 8-10 glasses of liquid per day, once your are passing gas. Caution: start drinking slowly.
    -Signs of a urine infection are: urinating often or burning when urinating, foul smelling urine, blood in urine, pelvic pain or fever
  • Pneumonia (an infection in your lungs)
    -To prevent pneumonia, do deep breathing and coughing exercises (ask your nurse for the booklet on breathing exercises). If you smoke, you should try to stop smoking a week before your surgery.
    -People who smoke are at more risk of pneumonia.
  • Thrombosis is a blood clot in your leg, often caused by not moving your legs or walking. This is an uncommon side effect of surgery, however your risk is higher if you are elderly, obese, if you are having an extensive surgery or if you have cancer.
    -If you are taking hormonal medication like the birth control pill, hormone replacement therapy or the new medication Evista (for osteoporosis) they should be stopped one month before your surgery. Otherwise there is an increased risk of thrombosis.
    -To prevent a thrombosis, move your legs while you are in bed. Walking every day is very important. The nurses may give you a needle of Heparin, a medication to thin your blood.
    -Signs of thrombosis are: sharp pain, redness; swelling and/or an area hot to touch on your legs. The physicians and nurses will look at your legs regularly.

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Discharge Instructions

Discharge from hospital is usually 3-5 days after surgery. Expect to have a follow-up appointment 4-6 weeks after ".Y", your surgery .The nurse will inform you when to make the appointment or provide you with the appointment. The surgeon will discuss the results of the pathology during your appointment.


Activity
  • No heavy lifting or strenuous tasks for one month (e.g. washing floors, vacuuming).
  • Do not sit for longer than 30-45 minutes at a time, get up and walk around.
  • Increase your activities slowly. Pace yourself. Decrease your activity if you have pain.
  • It is common to tire easily for 4-6 weeks.
Driving
  • Do not drive until you are able to slam on the brakes suddenly with no pain or hesitation. You can test this in your driveway.
Diet
  • Drink 6 to 8 glasses (8 oz) of fluid daily (water/juice).
  • Limit your caffeine intake.
  • Follow the Canadian Food Guide. Eat food high in fiber.
  • You may initially require a stool softener if you are not having regular bowel movements. For example: Colace or a gentle laxative such as glycerin suppository or Metamucil.
  • If you are taking iron, remember that it increases constipation.
Incision
  • Wash your incision with soap and water daily and pat dry.
  • You may take a shower or bath.
  • Call your doctor or your visiting nurse if your incision is:
    - Red
    - Warm
    - Draining blood, greenish, or yellow fluid
    - Painful
    - Opened
Vaginal bleeding
  • It is common to have a small amount of vaginal bleeding (pink or dark red) or discharge (creamy white). This can last 4-6 weeks while the. stitches are dissolving.
  • Report any discharge with a foul odor to your doctor.
  • Vaginal bleeding may stop and then restart.
  • Call your doctor if you pass blood clots the size of a nickel or if you soak more than one full max-pad every hour. If you can't reach your doctor come to the emergency department.
  • Use sanitary pads only. DO NOT USE TAMPONS.
  • Change your sanitary pads frequently to prevent infection.
  • Do not use vaginal douches. It may increase the risk of vaginal infection.
  • Cotton underwear is preferable, because they keep less humidity therefore decrease your risk of infection.
Bladder
  • Notify your doctor if you have any of the following :
    -Burning when urinating
    - Foul smelling urine
    - Blood in urine
    - Pelvic pain
    - Fever
    (higher than 38°C or 100.9°F)
  • Always wipe yourself from front to back after going to the washroom
    Surgical menopause
  • Refer to Sexual activity link

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Sexual Activity:

Keep in mind that returning to your previous love-making, or making changes to fit with you or your partner's needs is possible with patience and care. It can take 1 to 3 months, or it may take more time depending on each person. If you or your partner have concerns, you are welcome to discuss them with your nurse or physician.

What changes will there be sexually?
This surgery will not change your ability to have satisfying sexual relations or change your level of interest in sex. You may notice the following changes:

  • The vagina may be shorter in its relaxed state, if the cervix has been removed. As the vagina is very stretchy, most people cannot tell the difference during lovemaking. In the aroused state the vagina naturally becomes longer. Using a position without deep penetration is recommended initially.
  • The operation will not affect ability to have an orgasm or sexual climax. However, a climax causes muscle contraction in the uterus as well as to other parts of the body. Since the uterus is no longer there, some women have said there is a slight difference in their orgasms.
  • If your surgery causes menopause, you may find that your vagina is dry or not as lubricated. It is a good idea to spend more time becoming aroused before lovemaking. It also helps to use a water soluble lubricant such as K-Y Jelly or Astro-Glide. A vaginal moisturizer "Replens" may be used as directed for ongoing vaginal dryness. Oil based lotions and Vaseline should not be used.

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Surgical Menopause:

If you are pre-menopausal and your ovaries must be removed, you will enter the menopause abruptly! This results in more severe symptomatology than naturally going into the menopause. Some of these symptoms may include:

  • Hot flashes/night sweats;
  • Vaginal dryness;
  • Mood swings;
  • Difficulty sleeping;
  • Urinary incontinence (leaking) ;
  • Decreased sex drive (especially if you are less than age 40).


If you notice these symptoms, call your surgeon or family physician. Do not wait for your return appointment.
The younger you are ( especially less than age 40) when entering menopause, the greater the risk of osteoporosis and cardiovascular disease. Ask your nurse or physician for information on osteoporosis and cardiovascular disease.