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Hysterectomy: Purpose, Procedure, Risks And Recovery

Hysterectomy is a simple surgical procedure to remove the uterus of the woman. While the doctor can remove other parts of the reproductive system as well, it certainly means that the women undergoing the procedure will no longer menstruate or conceive [1] . This procedure is usually done to a variety of medical reasons.

Why Is Hysterectomy Done

1. Uterine prolapse: In some cases such as a vaginal delivery, there are chances of the uterus shifting from its original position to the vaginal canal. [1] This can cause a lot of problems for a woman as its effects include uncontrollable bladder, constipation and even embarrassing sexual encounters.

2. Endometroisis: The condition occurs when the tissues inside the uterine walls are present on the outside of the womb as well [1] . This is a very painful experience for women, especially during menstruation. Most of the women with endometriosis are unable to have a normal sex life or have a hard time getting pregnant.

3. Uterine fibroids: These non-cancerous growths inside the uterus cause heavy periods, unbearable cramps, uncontrollable urge to urinate and even a painful sex life.

4. Uterine cancer: This form of cancer begins in the layer of cells that form the lining of the uterus. Symptoms include vaginal bleeding after menopause and bleeding between periods.

5. Cancer in the cervix [1] : Also known as cervical cancer, this form of cancer refers to the occurrence of a malignant tumour in the cervix (lowermost part of the uterus).

6. Adenomyosis: The condition where the inner lining of the uterus merges with the outer walls. This results in painful periods, menstrual cramps and abdominal bloating and pressure [1] .

All these conditions have a lot in common. Almost all of them are associated with painful periods and cramps, which can degrade the quality of life in a woman suffering from them. Therefore, hysterectomy serves as a means to get rid of the painful periods. However, a hysterectomy is usually the last diagnosis given by a doctor for non-cancerous reasons.

Types Of Hysterectomy

Based on the reasons for the procedure of hysterectomy, there are different types. While, some may include complete removal of the ovaries, fallopian tubes and the cervix as well, others only involve removing the uterus. What type of hysterectomy would you need, depends on your diagnosis. Here are a few types of hysterectomy.

1. Supracervical or subtotal hysterectomy: In this procedure, only the upper part of the uterus is removed. The cervix and the ovaries remain untouched. This procedure helps reduce the chances of problems in sex life, urinary problems and bowel problems. On the downside, women still have menstruation for at least a few years after the surgery. This form of hysterectomy is quick and much less damaging to the uterus than the others [2] .

2. Total hysterectomy: A total hysterectomy is performed when the complete uterus and the cervix is removed. This is the most common type of hysterectomy, the major side effect of which is a decreased sexual function [3] . This is mainly done on women suffering from painful periods, coupled with heavy bleeding and cramping. A woman completely seizes to menstruate after this procedure. Doctors usually recommend a total hysterectomy in cases of endometriosis, uterine fibroids or ovarian cancer.

3. Radical hysterectomy: The most extensive form of hysterectomy, radical hysterectomy involves the complete removal of reproductive organs, along with the surrounding tissues of the uterus and also the upper part of the vagina. This surgery is only recommended in extreme cases such as cancer as the procedure has a high risk of causing injury to the nearby parts of the body [4] .

Techniques Of Hysterectomy

The technique that your surgeon uses for the hysterectomy will determine your recovery time. You may discuss varies options for the hysterectomy and your doctor will recommend the best possible way ahead based on the reason for the procedure and your overall health.

There are possibly two techniques in which hysterectomy can be performed.

1. Open surgery hysterectomy: An open surgery hysterectomy is the most common one and is also referred to as an abdominal hysterectomy. In this procedure, the surgeon makes an incision across the abdomen in order to remove the uterus. This is quite similar to a Caesarean section. The open wound is then sutured. Just like a Caesarean, this procedure will give you a visible scar at the place of the incision. The recovery time of such a procedure is usually 2-3 days [5] .

2. MIP hysterectomy: It stands for Minimally Invasive Procedure hysterectomy. This type of hysterectomy is more sophisticated and does not leave a visible scar behind. This procedure can be done through a small incision in the vagina or using a laparoscope, which requires one or more small cuts near the belly button, thereby leaving no scars behind [6] .

Risks Of Hysterectomy

Regardless of the technique used to perform the hysterectomy, it is definitely a major surgery with a lot of complications. Some of them are as follows:

1. Vaginal prolapse [7] : This form of prolapse might occur after hysterectomy because it is the ligaments surrounding the uterus that provide support for the top of the vagina.

2. Vaginal fistula formation: After a hysterectomy, the removal of the uterus results in a barrier-free environment between the vagina and the bladder or rectum, which increase the chances of fistula occurrence in the vagina.

3. Gastrointestinal tract injury [7] : During the hysterectomy procedure, there have been cases where minor injuries to the small intestine and colon have occurred.

4. Abnormal bleeding after the surgery [7] : Mild vaginal bloody discharge is common after the surgery but in some cases there can be abnormal bleeding for several days.

5. Infections [7] : Operative site infection is the most common form of complication after the hysterectomy procedure.

Recovery After Hysterectomy

If undergoing an abdominal hysterectomy, you may have to abstain from carrying on your regular activities at least 6-8 weeks after the surgery [8] .

Doctors may also advice abstinence from sex during the recovery period. You may feel pain during the intercourse for the first time after the procedure, which will resolve eventually. Most of the women who have undergone a hysterectomy have reported going back to a normal sex life [9] .

Most of the women do report of having a better quality of life due to the absence of heavy and painful period. However, on the down side, you will experience menopause earlier than women who haven't undergone a hysterectomy [10] .

If you have had your ovaries removed during the procedure, you will immediately enter menopause. This may bring in vaginal dryness, loss of sex drive and also urinary incontinence [11] .

View Article References
  1. [1] Müller, A., Thiel, F. C., Renner, S. P., Winkler, M., Häberle, L., & Beckmann, M. W. (2010). Hysterectomy—A comparison of approaches.Deutsches Ärzteblatt International,107(20), 353.
  2. [2] Wilczyński, M., Cieślak, J., & Malinowski, A. (2014). Supracervical hysterectomy - the vaginal route.Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques,9(2), 207-212.
  3. [3] Goktas, S. B., Gun, I., Yildiz, T., Sakar, M. N., & Caglayan, S. (2015). The effect of total hysterectomy on sexual function and depression.Pakistan journal of medical sciences,31(3), 700-705.
  4. [4] Arispe, C., Pomares, A. I., Santiago, J. D., & Zapardiel, I. (2016). Evolution of radical hysterectomy for cervical cancer along the last two decades: single institution experience.Chinese journal of cancer research = Chung-kuo yen cheng yen chiu,28(2), 215-220.
  5. [5] Dutta, D. K., & Dutta, I. (2014). Abdominal hysterectomy: a new approach for conventional procedure.Journal of clinical and diagnostic research : JCDR,8(4), OC15-OC18.
  6. [6] Geller, E. J. (2014). Vaginal hysterectomy: the original minimally invasive surgery.Minerva ginecologica,66(1), 23-33.
  7. [7] McPherson, K., Metcalfe, M. A., Herbert, A., Maresh, M., Casbard, A., Hargreaves, J., ... & Clarke, A. (2004). Severe complications of hysterectomy: the VALUE study.BJOG: An International Journal of Obstetrics & Gynaecology,111(7), 688-694.
  8. [8] Müller, A., Thiel, F. C., Renner, S. P., Winkler, M., Häberle, L., & Beckmann, M. W. (2010). Hysterectomy-a comparison of approaches.Deutsches Arzteblatt international,107(20), 353-359.
  9. [9] Lonnée-Hoffmann, R., & Pinas, I. (2014). Effects of Hysterectomy on Sexual Function.Current sexual health reports,6(4), 244-251.
  10. [10] Read, M. D., Edey, K. A., Hapeshi, J., & Foy, C. (2010). The age of ovarian failure following premenopausal hysterectomy with ovarian conservation.Menopause international,16(2), 56-59.
  11. [11] Shuster, L. T., Rhodes, D. J., Gostout, B. S., Grossardt, B. R., & Rocca, W. A. (2009). Premature menopause or early menopause: long-term health consequences.Maturitas,65(2), 161-166.
Read more about: surgery uterus womb woman
Story first published: Wednesday, May 8, 2019, 10:30 [IST]
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