Abdominal hysterectomy
About abdominal hysterectomy
A hysterectomy is a treatment option for a number of conditions that affect the reproductive system, including:
- irregular or heavy menstrual bleeding – but only if other treatments haven’t worked
- endometriosis – a condition in which cells that usually line the womb grow outside the womb in other parts of the body
- prolapse – where the womb drops into the vagina
- cancer of the uterus, ovary or cervix (neck of the womb)
- fibroids (non-cancerous growths of the womb) that are very enlarged
An abdominal hysterectomy is where your womb is removed through a cut in your abdomen. There are three types of hysterectomy, which are:
- total hysterectomy, where your womb and your cervix are removed
- subtotal hysterectomy, where your womb is removed but your cervix is left in place – this can often be done with keyhole surgery
- radical hysterectomy, where your cervix and surrounding tissues including your womb and part of your vagina are removed
Your ovaries may be left in place because they produce oestrogen – if you have these removed, you will immediately go through the menopause. It’s important to discuss this with your gynaecologist (a doctor who specialises in women’s reproductive health) before the operation.
After a hysterectomy you won't have any more periods or be able to become pregnant.
What are the alternatives to an abdominal hysterectomy?
A hysterectomy will usually only be recommended if other treatments, such as medicines or other surgery, are unsuitable or haven't worked. For example, if you have fibroids or problem periods you may be able to have treatments such as uterine artery embolisation, myomectomy, endometrial ablation or resection. Speak to your gynaecologist for more information.
Alternative hysterectomy techniques to an abdominal hysterectomy are:
- vaginal hysterectomy, where the procedure is done through your vagina
- keyhole hysterectomy, where the procedure is done through small cuts in your abdomen and often in combination with vaginal hysterectomy
Ask your surgeon for advice about which surgery will be most suitable for you.
Preparing for an abdominal hysterectomy
Your surgeon will explain how to prepare for your procedure. For example if you smoke, you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
The procedure is usually done under a general anaesthetic, so you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form. This process is usually done in the clinic prior to your admission.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as wearing compression stockings. Usually, you will also be given antibiotics before your surgery.
What happens during an abdominal hysterectomy?
The operation usually takes about an hour. This will depend on the complexity of the surgery, as a cancer operation may take much longer.
Your surgeon will make a cut (about 10cm long) across your lower abdomen, just below your bikini line. If you have large fibroids in your womb, he or she may need to make a cut from your belly button down to your bikini line instead. He or she will discuss this with you before the operation. In some cancer operations, the gynaecological oncologist (a specialist gynaecologist who concentrates on cancer surgery) may make an up and down cut (this is called a midline incision).
Your surgeon will take your womb out through the cut in your abdomen. Stitches (which may be dissolvable), metal clips or glue will be used to close the cut on your abdomen and the area will be covered with a dressing.
Animation - how abdominal hysterectomy is carried out
What to expect afterwards
You may need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
It's usual to feel some initial discomfort when you pass urine, but you should let your nurse or surgeon know if you are finding it difficult to pass urine or are having problems with bladder control. This should be temporary, but if it continues you may need to use a catheter for about two to three weeks.
You may also find that you don't have any bowel movements for a few days after the procedure and this can cause you to have painful wind. Taking laxatives will help you to avoid straining and stop you getting constipation.
Your nurse will give you advice about getting out of bed, bathing and your diet. You may see a physiotherapist who can explain some exercises that you can do to help your recovery.
The clips or stitches will usually be taken out by your practice nurse at your GP surgery about five to seven days after your operation. The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about two weeks.
Most women stay in hospital for two to four days. Before you go home, your nurse will advise you about caring for your wounds and may arrange a date for a follow-up appointment.
Recovering from an abdominal hysterectomy
It usually takes about four to 12 weeks to make a full recovery from an abdominal hysterectomy, but this varies between individuals, so it's important to follow your surgeon's advice. Most women are able to return to work between four and eight weeks after the operation but it will depend on the type of job you have and how physical it is. If you had a keyhole procedure, you will usually be able to return to your usual activities sooner than if you’ve had an open procedure.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
You will need to take it easy for a few days. If a physiotherapist has given you exercises to do, try to continue with these. You can lift light items, such as a kettle, but don't lift anything heavy. Plan your return to normal by increasing your activities over several weeks. If you live on your own, it may be helpful to ask a friend or relative to stay with you for the first few days while you recover.
You should be able to drive three to six weeks after the operation but if you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice. If you need to travel, consider how you feel and if you will be comfortable. Also bear in mind access to medical facilities if you need to go abroad. Discuss your plans with your surgeon or GP.
It's normal to have some bleeding from your vagina for about one to two weeks after the procedure. Use sanitary towels rather than tampons to help reduce the risk of infection. If you have any concerns or you have a vaginal discharge that’s bright red, heavy or smells unpleasant, contact your GP or your surgeon as you may have an infection.
You will need to wait around six weeks before having sex to allow your wound to heal.
What are the risks?
As with every procedure, there are some risks associated with an abdominal hysterectomy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of an abdominal hysterectomy include:
- pain, swelling and bruising in your abdomen
- blood-stained vaginal discharge
- numbness, tingling or a burning sensation around your scar
- feeling emotional
If your ovaries have been removed during the procedure, you will have menopausal symptoms such as hot flushes and vaginal dryness.
You will also have a permanently visible scar – this will be red and slightly raised to start with, but should soften and fade over the following months.
Complications
Complications are when problems occur during or after the procedure. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Specific complications of an abdominal hysterectomy include:
- blood loss – you may need further treatment, such as a second operation to stop the bleeding
- damage to other organs and tissues in your abdomen, particularly your bladder and ureters (the tubes that carry urine from your kidneys to your bladder) – this can cause incontinence or a frequent need to urinate
- damage to your bowel
- an infection, such as a urinary tract infection or an abscess in your pelvis
- premature ovarian failure – there is a chance your ovaries won’t function properly because they receive some of their blood supply through the uterus, which is removed during the operation
How can I tell if I’ve developed an infection after an abdominal hysterectomy?
Answer
If you’ve been making a good recovery after your operation but start to feel unwell and develop a fever, you may have an infection. Your wound may become red and inflamed and there may be discharge coming from it. If you have any of these symptoms, contact your GP or gynaecologist (a doctor who specialises in women’s reproductive health).
Explanation
You will have some pain and discomfort after an abdominal hysterectomy. Your gynaecologist will give you painkillers to help with this. You may need to take these for a few weeks, but as time goes on you should gradually feel less pain.
If the pain gets worse and you feel unwell or develop a fever, you may have an infection. It's important to contact your GP or surgeon if:
- your wound becomes red, tender and hot
- you have a heavy or unpleasant smelling discharge coming from your wound
- you have a burning feeling when you urinate, or feel like you need to urinate very often
Your GP or surgeon will ask about your symptoms and examine you. He or she will then be able to advise you about a suitable treatment.
How long will it be before I can return to work after I’ve had an abdominal hysterectomy?
Answer
Your surgeon will advise you when you can go back to your usual activities. Most women are able to return to work after four to eight weeks but this varies between individuals, so it's important to follow your surgeon's advice.
Explanation
The time it takes to recover from an abdominal hysterectomy will depend on your general health and whether you developed any complications as a result of the operation. Most women find that they are able to go back to work between four and eight weeks after their surgery, but it can take around 12 weeks to make a full recovery. It also depends on what kind of job you have. Although it's fine to carry out normal activities, don’t do any heavy lifting until around six weeks after your hysterectomy. Therefore, if your job involves any heavy manual work or lifting, you will probably have to wait longer before you're able to return to work.
Your GP or surgeon will be able to give you an idea of when you can go back to work. If your employer has an occupational health adviser, he or she may be able to advise you on how to gradually return to your normal duties at work.
Will having an abdominal hysterectomy bring on the menopause?
Answer
It depends on whether or not you have your ovaries removed during the procedure. If your ovaries are removed, you will have the symptoms of the menopause. You may be offered hormone replacement therapy (HRT) to reduce the symptoms. If you don't have your ovaries removed, your hysterectomy shouldn't bring on any menopausal symptoms.
Explanation
The menopause occurs when your ovaries naturally stop releasing eggs. This means you will stop having periods. Your ovaries will also stop producing the hormone oestrogen. This causes the symptoms of the menopause, including hot flushes, night sweats, vaginal dryness and trouble sleeping.
If you have a hysterectomy but don't have your ovaries removed, they should continue to work until you go through the menopause naturally. However, having a hysterectomy can sometimes make the menopause start sooner than it would naturally. This is called premature menopause and it sometimes happens if the blood supply to your ovaries changes as a result of the operation.
If your ovaries have been removed, your surgeon or GP may advise you to have HRT. This will replace the oestrogen that your ovaries are no longer producing and so reduce the symptoms of the menopause. HRT is available as tablets, skin patches, a skin gel or an implant. Ask your GP or surgeon for more information on HRT and whether it's suitable for you.
Will having a hysterectomy affect my sex life?
Answer
It's natural to worry that a hysterectomy might affect your sex life. This isn't necessarily the case and depends on a number of factors, including the exact type of operation you have.
Explanation
It takes time for your body to heal and recover from a hysterectomy. It’s best to wait about six weeks after your operation until you have sex, which will allow time for your scar to heal. It’s then safe to have sex as long as you feel comfortable. If you have any discomfort or dryness, you may find a vaginal lubricant helps – you can buy this from a pharmacy.
Having an abdominal hysterectomy can affect women in different ways. Some women feel more sexual pleasure after a hysterectomy because they don’t have the discomfort of the problem that led to them having the operation. Other women may notice a change in their sexual pleasure after a hysterectomy. As your womb is removed in the operation, womb contractions that may have been felt during orgasm will no longer occur and some of the nerves in the surrounding area can potentially be damaged in the operation.
Most women find that they are still able to have an orgasm, but the sensation may be different from before the operation. Pelvic-floor muscles span the base of your pelvis and exercises that work these muscles may help to improve your sexual satisfaction.
If you had your ovaries removed in the operation, this can potentially affect your sex life and result in an early menopause. Your ovaries produce several hormones that play a part in sexual pleasure. You may be given hormone replacement therapy (HRT) to help with menopausal symptoms that occur after a hysterectomy, which can include a loss of interest in sex.
If you have any sexual problems after your operation, ask your surgeon or GP for advice.