Your gynaecologist will explain how to prepare for your operation. 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 may be done under a general anaesthetic, in which case 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 gynaecologist’s advice. You may also be able to have the procedure done under epidural anaesthesia. This injection is given into the space that surrounds your spinal cord and completely blocks pain from your waist downward.
Your gynaecologist 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 be given antibiotics before the surgery.
A hysterectomy will usually only be recommended if other treatments, such as medicines or other surgery, are unsuitable or haven't worked for you. For example, if your gynaecologist thinks that you have a pelvic prolapse that isn’t very severe, you may not need surgery and will be referred to a physiotherapist. Treatment may involve exercises to strengthen your pelvic floor muscles. See our frequently asked questions for more information.
Alternative surgical techniques to a vaginal hysterectomy are as follows.
- Keyhole hysterectomy. This procedure is done through small cuts in your abdomen. This may be used to help with vaginal hysterectomy.
- Vaginal repair surgery that doesn't involve removing your womb.
- Abdominal hysterectomy. This involves removing your womb through a cut in your abdomen (tummy).
Ask your gynaecologist for advice about which surgery will be most suitable for you.
The operation usually takes about one to one and a half hours.
Your gynaecologist will make a cut in the top of your vagina and remove your cervix and womb. He or she will then close the top of your vagina using dissolvable stitches and may place a tampon-shaped dressing (known as a pack) in your vagina.
You will 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.
You will have a catheter after your operation – the length of time you need to keep this in will vary depending on what type of surgery you had. You may also need to keep it in for a few days if you have trouble passing urine after this time.
You may 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 and bloating. You may be offered a mild laxative to help ease this. Having a gentle walk around will also help once you feel able to get out of bed.
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. This will include exercises to strengthen your pelvic floor muscles.
The amount of time your dissolvable stitches will take to disappear depends on the type you have. It may be anything from a few days to a few weeks. The cut is done through your vagina so you won’t have any visible cuts or scars, unless you had keyhole surgery to help with the hysterectomy.
You will need to stay in hospital for one to two days. Before you go home, your nurse will give you advice about managing at home over the first few days and may arrange a date for a follow-up appointment.
The length of time it takes to recover after a vaginal hysterectomy will be different for every woman, and it can take up to a couple of months to get back to full health. Most women are able to return to work between two and six weeks after the operation but it will depend on the type of job you have and how physical it is.
You may have some pain in your lower abdomen after the procedure. How long this lasts varies for everyone but you should notice an improvement after a week or maybe sooner. 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.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards.
You will need to take it easy for a few days and you’re likely to feel more tired than usual. If a physiotherapist has given you exercises to do, try to do these regularly. You can lift light items, such as a kettle, but don't lift anything heavy for about four 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.
Try to start some gentle exercise such as walking once you’re back at home and steadily increase how much activity you do. You can go swimming about two to three weeks after your hysterectomy as long as you don’t have any vaginal bleeding or discharge. The only reason you will gain weight after a hysterectomy is if you eat too much and don’t do enough physical activity.
You will probably be able to drive two to four 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 gynaecologist's advice. It’s important that you can comfortably wear a seatbelt and do an emergency stop. 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.
It's usual 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. How much blood there is and how long it lasts will be different for everyone. If you have any concerns or you have a vaginal discharge that is bright red, heavy or smells unpleasant, contact your gynaecologist or hospital as you may have an infection.
You will need to wait until your scar has healed before you start to have sex again. This will take between four and six weeks. How comfortable you feel about sex after a hysterectomy and when you feel ready will vary for every woman. You may feel more sexual pleasure because the problem that meant you had to have a hysterectomy has now gone. However, some women feel a sense of loss after a hysterectomy and may find their libido (sex drive) is reduced.
It’s common to feel emotional or depressed after a hysterectomy and this may take some time to pass. You may find it helps to talk to your partner, a friend or family member about how you’re feeling, and you may also wish to talk to a counsellor.
As with every procedure, there are some risks associated with a vaginal hysterectomy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your gynaecologist to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of a vaginal hysterectomy include:
- abdominal pain
- vaginal bleeding
If your ovaries have been removed during the procedure, you will have menopausal symptoms such as hot flushes and vaginal dryness.
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Specific complications of a vaginal hysterectomy can include the following.
- Blood loss.
- Damage to other organs and tissues in your abdomen, particularly your bowel, bladder or ureters (tubes that carry urine from your kidneys to your bladder). This can cause incontinence or a need to urinate frequently.
- A wound or urinary infection. You may need antibiotics to treat this.
- Premature ovarian failure. There is a risk that if your ovaries aren’t removed, they may not work properly because they receive some of their blood supply through your womb.
- Prolapse of the vagina where it was cut.
- Nerve damage.
Will I need to take hormone replacement therapy (HRT) after my hysterectomy?
If your ovaries are removed, you may consider hormone replacement therapy (HRT) if you haven't already been through the menopause.
Your ovaries produce hormones, including oestrogen, so if they are removed, you will no longer produce these naturally. HRT replaces the oestrogen that your body has stopped making. If you have your ovaries removed in your hysterectomy operation and you haven't been through the menopause yet, you may be advised to start HRT soon after your operation. Otherwise you will go through the menopause early. The menopause causes symptoms such as hot flushes and night sweats – these can be treated with HRT.
HRT is available as skin patches, a skin gel or tablets. You may need to try different doses and forms of HRT before you find the one that suits you best.
HRT may cause some side-effects. These include tender breasts, headaches, nausea, bloating and fluid retention. The side-effects usually decrease over time and can often be relieved by lowering your dose of HRT.
Depending on your age and general health, HRT may increase your risk of certain conditions including stroke and certain types of cancer. If you have previously had breast cancer, heart disease, stroke or a blood clot, HRT may not be suitable for you. Make sure that your GP or gynaecologist knows if you have had any of these conditions in the past. This will help both of you to decide whether HRT is suitable for you.
If you need more information about using HRT after a hysterectomy, speak to your gynaecologist or GP.
Are there any advantages to having a vaginal hysterectomy rather than an abdominal hysterectomy?
Yes, there are some advantages to having a vaginal hysterectomy rather than an abdominal hysterectomy. The main advantage is that you’re likely to recover sooner. However, vaginal hysterectomy isn't appropriate for all conditions and is usually used to treat a pelvic prolapse.
A hysterectomy can either be done through your vagina – vaginal hysterectomy – or through a cut in your lower abdomen (tummy) – an abdominal hysterectomy. Your gynaecologist will discuss the advantages and disadvantages of each procedure and which will be most suitable for you.
If you have a vaginal hysterectomy, your recovery will be faster than it would be following an abdominal hysterectomy. This will mean a shorter stay in hospital and you may be able to return to work sooner. Another advantage of this type of hysterectomy is that it doesn't leave a visible scar.
A vaginal hysterectomy may also have fewer complications than an abdominal hysterectomy, but it isn’t suitable for treating all conditions. It’s most commonly used to treat a pelvic prolapse.
What do pelvic floor exercises involve?
You may see a physiotherapist after a vaginal hysterectomy who will explain some pelvic floor exercises that you should do to help your recovery. It’s important for you to get these muscles working properly after your operation.
Your pelvic floor muscles span the base of your pelvis. They help to keep your pelvic organs (including your bladder, bowel and vagina) in the correct position and help you control your bladder and bowel function, and prevent incontinence. They also help to improve sexual pleasure.
You can exercise your pelvic floor muscles by tightening them and then relaxing. Imagine you’re trying to stop passing urine and preventing yourself from passing wind at the same time to make sure you’re exercising the right muscles. Start with what is comfortable for you – for example by tightening them for a second – and then gradually increase the number of squeezes you do and for how long. Aim to get to about 10 seconds. It should feel as though your muscles are lifting and squeezing. Try to get into a routine of doing 10 long squeezes for up to 10 seconds each and follow these with 10 short squeezes. Do these exercises at least three times a day and try to breathe normally when you do them.
To begin with, you may find it more comfortable to do the exercises when you lie down or sit, but as your muscles get stronger, try to do them standing up. It’s important to tighten your pelvic floor muscles before you do anything that may put them under pressure (wherever possible), such as lifting, coughing or sneezing.
Try to make these exercises part of your daily routine to help keep your muscles strong. You might find it helpful to always do them at a certain point in your day, such as when you brush your teeth or when watching television.
If you have any difficulty doing the exercises or have any questions, ask your physiotherapist or GP for advice.
I’ve heard about ‘enhanced recovery’ for hysterectomy – what is this?
Enhanced recovery is a basic set of principles that aims to reduce the time it takes to recover from certain surgical procedures. It’s only appropriate for elective surgery – this means you have had time to think about the operation in advance and it isn’t being done as an emergency.
Enhanced recovery, also called ‘fast track’, ‘rapid’ or ‘accelerated recovery’, is designed to reduce how much you’re affected physically and emotionally by an operation. It has mainly been found to be effective for colorectal (bowel) surgery but there is some evidence that it may also be useful for improving how well you recover after a hysterectomy.
There are four key parts to the enhanced recovery programme, which means there are a number of differences compared with standard care when you have surgery. Enhanced recovery emphasises more specific planning and preparation before your operation. For example, you will be advised to get as fit and healthy as possible so that your body is able to deal with the operation as well as possible. Usually when you have an operation you won’t be able to eat or drink anything for about six hours beforehand, but enhanced recovery care recommends you can drink clear fluids, such as water or diluted cordial, until two hours before your operation.
With enhanced recovery you’re more likely to be offered a minimally invasive technique, such as keyhole surgery, or if this isn’t an option, your gynaecologist will make the cut as small as possible. If it’s possible, your gynaecologist will use an epidural or regional anaesthesia – this blocks pain from the area but you will stay awake – rather than general anaesthesia, which means you will be asleep during the operation.
A very important aspect of enhanced recovery is pain management. Treating any pain effectively will mean you’re able to get up and start moving around as soon as possible after your operation. This may be as early as the same day that you had it. This is known as early mobilisation and is another key area of this type of care. Moving around reduces your risk of a blood clot and prevents your muscles from losing too much strength.
You will be encouraged to drink something as soon as you feel able and to eat within 24 hours. This is different to traditional care in which you would probably only be able to take sips of drinks for a few days after your operation.
Enhanced recovery also involves having a clear plan for when you leave hospital, including what follow-up care you will have. This is particularly important for ensuring that the length of time you spend in hospital is as short as possible.
Enhanced recovery care isn’t available in all hospitals or for all procedures, and it isn’t suitable for everyone. Ask your gynaecologist for more information.
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