First, what is Total Abdominal Hysterectomy?
The most common type of hysterectomy. During a total abdominal hysterectomy, the uterus and the cervix are removed. Cancer of the ovaries and uterus, endometriosis, and large uterine fibroids are treated with total abdominal hysterectomy.
Other types of Hysterectomies
A partial, subtotal, or supra-cervical hysterectomy removes just the upper part of the uterus. The cervix is left in place.
A Radical Hysterectomy removes the entire uterus, the tissue on both sides of the cervix, and the upper part of the vagina.
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Why is it done?
According to WebMD, you may need a hysterectomy to treat:
- Gynecologic cancer. If you have gynecologic cancer — such as cancer of the uterus or cervix — a hysterectomy may be your best treatment option. Depending on the specific cancer you have and how advanced it is, your other options might include radiation or chemotherapy.
- A hysterectomy is the only certain, permanent solution for fibroids — benign uterine tumors that often cause persistent bleeding, anemia, pelvic pain or bladder pressure. Nonsurgical treatments of fibroids are a possibility, depending on your discomfort level and tumor size. Many women with fibroids have minimal symptoms and require no treatment.
- In endometriosis, the tissue lining the inside of your uterus (endometrium) grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative surgery doesn’t improve endometriosis, you might need a hysterectomy along with the removal of your ovaries and fallopian tubes (bilateral salpingo-oophorectomy).
- Uterine Prolapse. The descent of the uterus into your vagina can happen when supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. A hysterectomy may be necessary to treat these conditions.
- Abnormal vaginal bleeding. If your periods are heavy, irregular or prolonged each cycle, or if you experience abnormal bleeding after periods, a hysterectomy may bring relief when the bleeding can’t be controlled by other methods.
- Chronic pelvic pain. Occasionally, surgery is a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, a hysterectomy provides no relief from many forms of pelvic pain, and an unnecessary hysterectomy may create new problems. Seek careful evaluation before proceeding with such major surgery.
A hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, ask your doctor about alternatives to this surgery. In the case of cancer, a hysterectomy might be the only option. But for other conditions — including fibroids, endometriosis, and uterine prolapse — you may be able to try less invasive treatments first.
During hysterectomy surgery, your surgeon might also perform a related procedure that removes both of your ovaries and your fallopian tubes (bilateral salpingo-oophorectomy). You and your doctor should discuss ahead of time whether you need this procedure, which results in what’s known as surgical menopause.
With surgical menopause, menopause symptoms often begin suddenly for women after having the procedure done. Depending on how much these symptoms affect your quality of life, you may need short-term treatment with hormones.
How to prepare
To fully prepare for a hysterectomy, we suggest doing the following:
- Gather all of the necessary information
- Be sure to follow all instructions regarding medication
- Ask what type of anesthesia will be administered
- Arrange for help with a driver to bring you to your procedure and to pick you up afterward.
What are the risks?
As with any major surgery, there are risks for complications. Some of those risks may include the following:
- Blood clots
- Excessive bleeding
- Adverse reaction to anesthesia
- Early onset of menopause
- Damage to the urinary tract, bladder, rectum or other pelvic structures during the procedure.
What to Expect Before, During and After the Procedure
Before the procedure, you may be required to have one of the following tests:
- A cervical cytology (Pap test): helps detect the presence of abnormal cervical cells or cervical cancer.
- Endometrial biopsy: detects abnormal cells in the uterine lining or endometrial cancer.
- Pelvic ultrasound: may show the size of uterine fibroids, endometrial polyps or ovarian cysts.
A hysterectomy typically is performed under general anesthesia, so you won’t be awake during the surgery. The procedure itself generally lasts about one to two hours, although you’ll spend some time beforehand getting ready to go into the operating room.
To begin the procedure, a member of your surgical team passes a urinary catheter through your urethra to empty your bladder. The catheter remains in place during surgery and for a short time afterward. Your abdomen and vagina are cleaned with a sterile solution before surgery.
To perform the hysterectomy, your surgeon makes a cut (incision) in your lower abdomen, using one of two approaches:
- A vertical incision, which starts in the middle of your abdomen and extends from just below your navel to just above your pubic bone
- A horizontal bikini-line incision, which lies about an inch above your pubic bone
After the procedure, you will be monitored for signs of pain, given medicine to prevent any kind of infection and post-procedure activity instructions. You will need to use sanitary napkins for vaginal bleeding and discharge. It is quite normal to have bleeding or discharge up to a couple weeks after this type of procedure. If you experience menstrual-like bleeding (heavy) or persistent bleeding, contact your surgeon for follow-up.
Scars…let’s chat briefly about the scarring.
The type of incision depends on many factors, including the reason for your hysterectomy, the need to explore the upper abdomen, the size of your uterus and the presence of any scars from prior abdominal surgeries. For instance, hysterectomies performed for endometriosis, large fibroids, and gynecologic cancers are done mainly through a vertical incision. If it’s an abdominal incision as opposed to a laparoscopic procedure, you will have a scar that will heal gradually over time.
It takes about 6 weeks for most women to get back to their usual self with an abdominal hysterectomy. The recovery time may be less if a laparoscopic single site incision hysterectomy was done.
DOs and DON’Ts:
- Get lots of rest
- Stay active but don’t do strenuous physical activities for 6 weeks
- Wait 6 weeks before any sexual activity
- Follow doctor recommendations about returning to your normal activities
Life After a Hysterectomy
Some things may be permanently altered or fully changed after a hysterectomy.
Some examples include:
- No more periods…YAY!
- You can no longer get pregnant
- Having the ovaries removed will cause premenopausal women to begin menopause
- You will experience menopause at a younger age if you have a hysterectomy but keep your ovaries
- You can still get cervical cancer if you have a partial hysterectomy and keep your cervix. Regular pap smear tests will be needed to screen for it
- Symptoms that originally made the surgery necessary will no longer be present
Things to remember…
- Your quality of life is more than likely going to be enhanced due to the relief of symptoms. A better outlook on life and of well-being are also possibilities.
- A good sex life prior to a hysterectomy will most likely be maintained after the procedure. Woohoo!