A hysterectomy is a surgical procedure that removes the uterus (womb). After talking with your surgeon, you should be able to answer the following questions:
Why am I having a Hysterectomy?
A hysterectomy can be done for many different reasons.
A hysterectomy can be done to solve the problem of heavy continuous bleeding (for example, from adenomyosis or fibroids, or hormonal imbalances), if the bleeding hasn’t responded to other therapies.
A hysterectomy can also be offered to treat a prolapse of the uterus, in which case it may be combined with a vaginal wall repair. In some cases, the uterus can be stitched back up instead of being removed. A procedure that repairs the position of the uterus instead of removing the uterus is called a hysteropexy, or a Modified Manchester repair.
A hysterectomy may be suggested to treat cancer or if there is a high risk of cancer developing or spreading to the uterus or other pelvic organs. In such cases, the fallopian tubes and ovaries will also be removed.
A hysterectomy can also be done when there is severe chronic infection or inflammation, such as from Pelvic Inflammatory Disease (PID), or it may be done as a last resort for endometriosis or severe pelvic pain.
What kind of Hysterectomy am I having?
The uterus can be removed through a cut in the abdomen, or through a cut in the vagina.
Abdominal Hysterectomy
If you are having an abdominal hysterectomy, the surgeon will make an incision at the bikini line, in the same place as a caesarean. An abdominal procedure will be necessary if the uterus is bulky, or if the hysterectomy is being done for cancer, or if the surgeon needs access to the rest of the pelvis to do another procedure.
You can read more about abdominal hysterectomy here.
Vaginal Hysterectomy
In a vaginal hysterectomy, the uterus is removed through a cut inside at the top of the vagina. If a hysterectomy can be done this way you will have fewer complications, a shorter hospital stay, and a faster recovery once you are at home.
Sometimes the surgeon needs to remove scar tissue from around the uterus to make vaginal removal easier. In this case, they will make several short incisions in the lower belly (each just 1-2 cms long) so they can insert small instruments and a light source. This is called a Laparoscopic Assisted Vaginal Hysterectomy.
You can read more about vaginal hysterectomy here.
Abdominal and Vaginal Hysterectomies usually involve removal of the entire uterus and its cervix (the opening to the uterus). This may be referred to as a Total Hysterectomy. If the cervix is left behind, the procedure will be called a Subtotal Hysterectomy, and you will still need to have pap tests as normal. A Radical Hysterectomy, in which the tubes and ovaries are also removed, can only be done as an abdominal procedure. You will need to ask your doctor whether high vaginal swabs need to be done in place of pap tests.
What Can I Do to Prepare for a Hysterectomy?
1. Discuss the planned procedure with your doctor
Here are some good questions to ask:
- Is there an alternative non-surgical way of treating my condition? What is the name of the procedure you are recommending?
- Where will the incision/s be?
- What exactly will be removed? Will the entire uterus be removed or will you leave the cervix behind? Will the tubes be removed? Will the ovaries be taken too? Both of them?
- Will I need a catheter afterwards?
- Will I take antiobiotics afterwards?
- Will I need pain relief afterwards? What are the options? What are the side-effects?Will I need to take hormones afterwards? Will these hormones go in the vagina, or will I have an implant under the skin, will I swallow a tablet, or will I rub gel into my skin?
- Will I need to have pap tests or swabs afterwards?
- What are the potential risks or complications?
2. Find out what medical clearance you will need
Here are some more good questions to ask:
- Will I need any tests before the surgery? (For example, blood tests, an ECG, a chest X-ray).
- Will I need a consultation with another medical specialist to make sure I am healthy enough for the surgery? (This especially applies if you have other medical conditions)
3. Ask if you need to stop any of your other medications
Your doctor may advise you to stop taking medications such as blood thinners or nonsteroidal anti-inflammatory drugs before the surgery.
4. Arrange for transportation and help at home
After the procedure, you will need someone to drive you home and assist you with basic tasks like self-care and meal preparation for a few days. You may not be able to drive for up to 3 weeks.
5. Plan your recovery
You can expect to spend a few days in the hospital and then several weeks recovering at home. During this time, you will need help with daily tasks and you should have time off from work.
It is a good idea to have some ready-made meals in the freezer.
Get some help for washing and cleaning tasks or help with young children.
You will not be allowed to have a bath for at least 2 weeks- you must shower instead.
You will not be able to have sexual intercourse for at least 6 weeks.
It may take several months to get your normal energy levels back, and to feel like you can comfortably tolerate prolonged upright activities and moderately strenuous exercise.
6. Make lifestyle changes
Your doctor may advise you to stop smoking and limit your alcohol consumption so your tissues heal faster after the procedure. You may be advised to lose some weight beforehand.
Why See Your Pelvic Health Physiotherapist Before Your Hysterectomy?
It is generally a good idea to see your pelvic health physiotherapist once or twice BEFORE the surgery. It may be too late to find out what you should or shouldn’t have done 6 weeks down the track!
We think it is especially important to see us if your procedure is being done for prolapse or if you have risk factors for prolapse, or if you have had long-standing moderate to severe pain associated with your condition.
Here are some things you need to be aware of before your surgery:
1. Learn to Move Well
We can show you the safest way to move in bed, get up from the bed or a chair, and how to brace yourself if you need to cough, so that you don’t strain the surgical site. It is best to learn proper body mechanics such as how to transfer loads efficiently and how to have a balanced posture, before the surgery takes place.
After the surgery we can advise you on a safe and paced return to exercise. We can work with your exercise professional to suggest any modifications that you need to make to your current exercise program, or we can prescribe you a pelvic-floor safe home-based program if you want to start getting fitter and stronger.
2. Prepare Your Pelvic Floor Muscles
Some women get unpleasantly surprised to find that they leak urine after a hysterectomy. Some women can experience new-onset vaginal heaviness or bulge symptoms.
Removal of the uterus and pelvic connective tissue can change the way forces are distributed through the pelvis towards the bladder, bowel, and urethra (waterpipe). It is best to prepare your pelvic floor muscles for these changes before you go to hospital. This is especially important if you already have some urinary leakage when you cough or sneeze, or if you already have a vaginal prolapse.
For some women, particularly those that have had pain as part of their presentation, the pelvic floor muscles can become cramped and tense after surgery, and need help to release and lengthen.
3. Ensure Good Bowel Habits
It is common to have some constipation after a hysterectomy. This might be from pain relieving medications such as codeine or other narcotics which slow down gut transit, from the splinting effect that pain can have, or even from being in hospital and being unable to relax because its ‘not your toilet’. The nerves that supply rectal sensation and motility can sometimes be injured by the surgery.
Straining can increase the risk of other things going wrong, such as prolapse or anal fissures, or wound dehiscence (breakdown).
We can teach you how to prevent constipation in the first instance. We can teach you how to recognise and manage constipation if it starts to happen, before it causes a bigger problem.
4. Ensure Good Bladder Habits
You had the hysterectomy so you could have more freedom and get out and enjoy life without pain or pads. We don’t want you to have to stay home because your bladder needs to stay close to the toilet because you can’t hold on, and we don’t want you to feel uncomfortable when you are out because you are scared to drink fluids! We can teach you how to tame an overactive bladder.
One complication of a hysterectomy can actually the opposite problem- a bladder that doesn’t empty completely. This is known as ‘urinary retention’. It is caused by either the bladder not contracting strongly enough, or the waterpipe not opening wide enough. Nerve injury and/or local bruising and swelling can be the cause. This is usually managed by acute care nursing, but speak to your pelvic health physiotherapist if you are concerned after discharge. We will be able to do a pre/post void ultrasound to see if you are in fact retaining urine. Sometimes urinary frequency (passing small amounts often) happens because emptying isn’t ever complete
Here are some other ways your pelvic health physiotherapist can help after your surgery:
Your pelvic health physiotherapist can help you recover from a hysterectomy by providing individualized care that addresses your specific needs. Some of these might be:
1. Pain management
We can help manage pain through the use of manual therapy, pain-relieving exercises, dry needling or acupuncture, modifying or pacing of activities, and pain education where needed.
2. Scar management
We can provide guidance on scar management and massage to help reduce pain and improve tissue mobility. This applies to any abdominal scar, but also to the internal scar, which can sometimes adhere and cause vaginal stenosis (narrowing).
3. Sexual dysfunction
We can help address any sexual concerns related to your hysterectomy and provide exercises and techniques to improve sexual function.
Preparing for hysterectomy by seeing a pelvic health physiotherapist helps you manage the risks that come with this procedure and guide you to recovery. If you’re experiencing these conditions mentioned above, your physiotherapist can provide you with just the right support. Contact us today to get started!
