I have often found when a woman is faced with the prospect of having a hysterectomy there is a mixture of shock, disbelief,
and anger. However equally often there is absolute relief that their problem/problems will be taken away.
A hysterectomy is the surgical removal of the uterus (womb). Most hysterectomies are performed for non-cancerous problems such as heavy bleeding, pain, and discomfort.
The most common reasons we would do a hysterectomy are:
- Uterine fibroids. These are benign growths of the muscle of the uterus. These can cause pain, bleeding, pressure on the bladder or bowel, and an abdominal mass.
- Prolapse of the uterus. Weakness of the pelvic floor muscles can cause the uterus and the walls of the vagina to prolapsed or come out through the vagina.
- Heavy or irregular bleeding. Often this is unexplained and fits into the group of conditions called Dysfunctional Uterine Bleeding or D.U.B.
- Adenomyosis or endometriosis of the uterus. This is when the lining of the uterus migrates into the uterine muscle and may cause:
– Abdominal pain
– Heavy bleeding
– Painful intercourse
-Very painful periods
– Uterine tenderness.
What kinds of Hysterectomies are there?
- Total Hysterectomy: This is when the uterus and the cervix (lower part of the uterus) are removed.
- Total Hysterectomy plus unilateral (one) or bilateral salpingo-oophorectomy (both). What this means is the total hysterectomy plus one or both ovaries and fallopian tubes.
- Subtotal hysterectomy with or without ovaries and tubes. This is when the uterus is removed but not the cervix.
- Radical Hysterectomy. This is usually done for cancer and is when the uterus, top of the vagina and the tissue around the cervix is removed. The ovaries and fallopian tubes may or may not be removed.
There are different ways to perform this operation which your surgeon will discuss with you. Your choice will depend on the reason for the surgery and what your surgeon is most comfortable doing.
There are three groups of procedures:
- Abdominal Hysterectomy; an incision is made into the tummy and the operation is done through an abdominal wound.
- Vaginal Hysterectomy: The operation is done through the vagina.
- Laparoscopic Hysterectomy; This is when the operation is done through a telescope and is referred to as minimally invasive surgery. Always remember that although the skin incisions are small the internal surgery is the same major surgery.
All the operations have pros and cons and it is really up to you and your surgeon as to which type of hysterectomy is most appropriate for you.
The Subtotal Hysterectomy
This is when the tummy is opened or it can be done laparoscopically but not vaginally. The uterus is removed but the cervix is left untouched meaning that the vagina does not need to be opened.
This is the most common type of surgery I perform and one which many women are requesting. This type of surgery is particular for benign conditions such as fibroids which is my special interest.
Many women feel that their cervix is an integral part of their sexual fulfillment and would prefer the vagina not to be opened from above and have it disturbed. I have also found less postoperative bleeding and less post-operative complications related to this surgery. The recovery time seems to be quicker, the problem is resolved and as much of the anatomy is left intact. Hospital stay is also usually reduced.
Of course, the smears should be normal and it is very important to remember that you should continue to have ongoing smear tests as you normally would.
The hospital stay for hysterectomy is about 3 to 5 days depending on the person, type of operation and whether there have been any complications. The off work period is usually 4–6 weeks.
Please always remember that a hysterectomy is a major surgery and as with any surgery there can always be complications. This needs to be discussed with your doctor and explained to you in detail.