Vaginal Hysterectomy is the “removal of the uterus (body and cervix), through a surgical incision made in the upper part of the vagina. There is no cut made on the abdominal wall. It is sometimes described as having been undertaken “by suction”, although no suction device is actually used.
You may need removal of one or both ovaries (BSO), but this depends on the reason for your hysterectomy. This can be discussed with your surgeon. Under such circumstances a laparoscopic (keyhole) approach may be used. This involves making 3 -4 small 1cm long incisions on the abdomen for the instruments. The uterus is then removed vaginally (Laparoscopically Assisted Vaginal Hysterectomy – LAVH). In the case of Prolapse a vaginal repair may be necessary. This procedure may be undertaken at the same time as the Hysterectomy.
Following the operation you will no longer have periods, or any further pregnancies. The operation lasts less than one hour and is performed either using a General Anaesthetic, where you are asleep or alternatively you may choose an Epidural / Spinal Anaesthetic where you are awake, however you would not feel any pain at all and your recovery is quicker.
The after effects can last for up to six weeks and you may find that you feel tired and that it is difficult to concentrate for periods of time. These effects will wear off after time.
Preparation for Surgery
You can eat and drink as normal up until 12 midnight the night before surgery. No food or fluids may be taken after midnight. If your surgery is not scheduled until the afternoon, it may be appropriate that you be allowed to have a light breakfast before 07 a.m. You are also advised not to smoke on the day of surgery. Generally you should present to the Admissions department at a time advised to you by Dr. Kamal.
On Admission to ward:
On admission you will be greeted and admitted by a member of the Nursing team. There will be discussion of your surgery/care including any special needs or requirements you may have. Your medical / surgical history will be recorded and any relevant history relating to your admission. Please bring all medications with you, in their original containers i.e. as given to you by the pharmacy as these need to be documented.
An examination may be undertaken recording your temperature, pulse and blood pressure. A urine sample will be required for analysis. A blood sample may also be obtained. A small pubic shave is necessary (you may do this prior to admission if you wish). A gentle laxative may be necessary for some patients.
You will be admitted and consented for the procedure by Dr. Kamal (if not already undertaken). Routinely you will be seen by the anaesthetist prior to surgery, who will discuss the type of anaesthesia according to your medical / surgical history.
Preparation for Theatre
You will be asked to change into a hospital gown. You may be given a light sedative / premedication. You should have your dressing gown and slipper ready. On arrival, you will be greeted and checked-in by a member of the theatre Nursing staff. A Nurse will accompany you from the waiting room to the theatre where the anaesthetic is administered.
Recovery after Hysterectomy
Initially you will be closely observed in the recovery room. Once sufficiently recovered, you will go back to the ward to continue post-operative care. You will be assisted out of bed for a short walk the morning after surgery. This walk is very important to ensure the early return of normal circulation and is repeated 3-4 times the first day. An injection of Heparin is given daily to prevent deep vein thrombosis (DVT).
You will be catheterised during you operation, meaning that straight after the operation you do not have to worry about going to a toilet to pass urine, this is simply passed into a bag at your side and emptied regularly by the nurses. You will also have a vaginal pack, like a big tampon, at the end of your surgery. The catheter and the vaginal pack will be removed after the first 24 hours and is painless.
You will have an intravenous (IV) drip to help you re-hydrate for 24-48 hours. It is not unusual to feel sick for a day or two after the surgery. Should you experience nausea or vomiting, tell the nurse so that you can have medication to help it settle. To begin with, you can have small sips of water, then, slowly take more until you are eating normally.
A mild laxative may be necessary to help open your bowels and make you feel more comfortable. You might also have pain from trapped wind and indigestion due to lack of movement, this can be relieved by medication and/or by gentle exercise.
The vaginal stitches will dissolve in 10 to 14 days, without needing to be removed. You may experience slight vaginal bleeding for up to six weeks after surgery. If heavy you must inform Dr. Kamal.
It is normal during the first 24-36 hours after surgery to feel many aches and pains all over your body (backache, shoulder paid and a stiff neck as well as abdominal pain). A PCA (Patient Controlled Analgesia) device may be provided for your use, ensuring optimal, ongoing pain control. This allows you control your own pain relief. Alternatively, morphine by injection may be given until day 2-3 when oral pain relief should be sufficient. It will be necessary to continue taking oral pain relief to 2-3 weeks after your surgery. It is important to tell the nursing staff if you are having pain or if you feel your pain relief is not effective.
Once home you must make sure that you are taking things easy. The physiotherapist will give you some exercises to help you get back to full mobility. Gentle walking, a little further each day, helps your circulation. You should not lift anything heavy, such as shopping. If you live alone ask your nurse for the details of the local support network that can help.
You can usually begin to have sex again six weeks after surgery. You may wish to refer to the leaflet “Sexual Activity after Hysterectomy”.
Recovery rates differ from person to person. Rest is essential for a few weeks after the operation. A six week check-up will be arranged for you. It is normally at this time that women think about a return to work. However, it will depend on the type of work you do. Backache or discomfort in the abdomen is common for the first few weeks after surgery. A brown discharge should change to creamy white. A fresh blood or smelly discharge should be notified to your doctor immediately.