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Abdominal hysterectomy

Key points

  • An abdominal hysterectomy is surgery to remove your womb (uterus) through a cut in your abdomen (tummy).
  • There are different reasons why you may need to have a hysterectomy, including heavy menstrual bleeding, endometriosis and cancer.
  • There are several types of abdominal hysterectomy and it may be possible to have it done with keyhole surgery.
  • After a hysterectomy you will no longer have periods or be able to get pregnant.
  • The length of time it takes to recover from an abdominal hysterectomy varies for all women, and may take a couple of months.

Video: how abdominal hysterectomy is carried out

An abdominal hysterectomy is an operation to remove your womb (uterus) through a cut in your abdomen (tummy).

You will meet the gynaecologist (a doctor who specialises in women’s reproductive health) carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About abdominal hysterectomy

There are a number of reasons why you may be offered a hysterectomy, these may include the following. 

  • Irregular or heavy menstrual bleeding, but only if other treatments haven’t worked.
  • Endometriosis. A condition in which cells that usually line your womb grow elsewhere in your abdomen.
  • Adenomyosis. This is a benign condition in which cells that usually line your womb grow in the womb muscle causing painful, heavy periods.
  • Cancer of your womb, ovary, fallopian tube or cervix (neck of the womb).
  • Fibroids (non-cancerous growths of muscle and fibrous tissue in your womb) that are painful, cause bleeding or are very enlarged.
  • Pelvic organ prolapse. This is when your womb, rectum or bladder drops out of position into your vagina.

An abdominal hysterectomy involves removing your womb through a cut in your abdomen. There are different types of hysterectomy.

  • Total hysterectomy involves removing your entire womb and your cervix.
  • Subtotal (also known as partial or supracervical) hysterectomy in which the top part of your womb is removed but your cervix is left in place.
  • Total hysterectomy with oophorectomy is when your entire womb, cervix and one or both ovaries are removed.
  • Radical hysterectomy is when your womb, cervix, part of your vagina, surrounding ligaments and occasionally your lymph nodes are removed.

You may be able to have the operation done with keyhole surgery.

Your ovaries may or may not be left in place depending on why you’re having a hysterectomy. Your ovaries produce oestrogen so if you have them removed, you will immediately go through the menopause. There is some evidence to show that having your fallopian tubes removed during a hysterectomy may reduce your risk of ovarian cancer, even if your ovaries aren’t removed. It’s important to discuss this with your gynaecologist before the operation. See our frequently asked questions for more information.

After a hysterectomy you won't have any more periods or be able to become pregnant.

Illustration showing the location of the womb and surrounding structures

What are the alternatives to 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 you. For example, if you have fibroids or problem periods, you may be able to have other, less invasive treatments such as a uterine artery embolisation (blocking off the blood supply to your fibroids) or myomectomy (this involves removing tissue from the muscle in the wall of your womb). Speak to your gynaecologist for more information.

Alternative hysterectomy techniques to an abdominal hysterectomy are:

  • vaginal hysterectomy – the procedure is done through your vagina
  • keyhole hysterectomy – the procedure is done through small cuts in your abdomen and often in combination with vaginal hysterectomy

Ask your gynaecologist for advice about which surgery will be most suitable for you.

Preparing for an abdominal hysterectomy

Your gynaecologist 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, typically for about six hours beforehand. However, it’s important to follow your gynaecologist’s advice. It may be possible to have the operation done under epidural. This injection is given into the space that surrounds your spinal cord and numbs your body from the 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 also be given antibiotics before your surgery.

What happens during an abdominal hysterectomy?

The operation usually takes about an hour unless you’re having a radical hysterectomy, which takes about two hours. However, this may vary depending on why you’re having a hysterectomy as this will determine the complexity of the surgery.

Your gynaecologist will probably make a horizontal cut (between 10 and 16cm long) across your lower abdomen, just below your bikini line. It may be necessary for your gynaecologist to make a vertical cut from your belly button down to your bikini line instead, for example, if you have a particularly large womb or if you’re having the operation because you have or may have ovarian cancer. Your gynaecologist will discuss this with you before the operation.

Your gynaecologist 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 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.

You will have a catheter to drain urine for up to 24 hours after surgery. If you find it difficult to pass urine after this time, you may need to keep the catheter in for longer particularly if you had an epidural for pain relief.

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. 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.

You’re likely to be able to take off the dressing on your wound after about 24 hours. 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. However, dissolvable stitches are being used more often now as they don’t need to be removed and there is less risk of infection. The amount of time your dissolvable stitches will take to disappear depends on what type you have – it may be anything from a few days to a few weeks.

You will probably stay in hospital for up 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

The length of time it takes to recover after an abdominal hysterectomy will be different for every woman, and it can take up to a couple of months to recover fully. It's important to follow your gynaecologist'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 probably be able to return to your usual activities sooner than if you had open surgery. See our frequently asked questions for more information.

You may have some abdominal or back pain for a few weeks after your operation. 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 and you’re likely to feel more tired than usual. 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 in the first week or so. Gradually increase 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.

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.

You will probably 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 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 go abroad.

It's normal to have some bleeding from your vagina for up to three 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 is bright red, heavy or smells unpleasant, contact your gynaecologist or hospital as you may have an infection – see our frequently asked questions for more information.

Although you will stop having periods after a hysterectomy, you may notice monthly changes in your breasts, such as feeling lumpy or tender. These will continue until the age at which your periods would have stopped naturally. You may feel emotional or depressed, and this can take some time to improve. You may find it helps to talk to a friend or family member about how you’re feeling.

Wait until your scar has fully healed before you start having sex again. This will probably take between four and six weeks. See our frequently asked questions for more information.

As your wound heals you may be more aware of your lower abdomen and how it feels.

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 gynaecologist to explain how these risks apply to you. Your gynaecologist should be able to tell you his or her specific rates of side-effects and complications.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the operation. Side-effects of an abdominal hysterectomy include:

  • pain, swelling and bruising in your abdomen
  • bleeding or blood-stained vaginal discharge
  • numbness, tingling or a burning sensation around your scar

If your ovaries have been removed during the operation, you will have menopausal symptoms such as hot flushes, night sweats 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 time. This usually settles after about six to 12 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, this may include the following.

  • 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 bowel, bladder and ureters (the 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 will need to take antibiotics to treat this.
  • Premature ovarian failure. There is a risk that your ovaries won’t work properly because they receive some of their blood supply through the womb.
  • A blood clot. These develop most commonly in the leg

 

Reviewed by Polly Kerr, Bupa Health Information Team, August 2013.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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