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Published by Bupa's health information team, November 2009.
This factsheet is for women who are planning to have an abdominal hysterectomy, or who would like information about it.
An abdominal hysterectomy is an operation to remove the womb (uterus) through a cut in the abdomen (tummy). The ovaries can be removed at the same time if necessary - this is called an oophorectomy.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.
A hysterectomy is a treatment option for a number of conditions including:
- heavy and/or very painful periods
- endometriosis - a condition in which the lining of the womb grows somewhere else inside the abdomen, such as on the ovaries, behind the womb or on the bowels or bladder
- fibroids - non-cancerous growths of the womb
- prolapse - where the womb drops into the vagina
- cancer of the womb, cervix (neck of the womb) or ovaries
After a hysterectomy you won't have any more periods or be able to become pregnant.
Types of hysterectomy
There are three types of hysterectomy.
- Subtotal hysterectomy - the womb is removed but the cervix is left in place.
- Total hysterectomy - the womb and the cervix are removed.
- Radical hysterectomy - the womb, part of the vagina and the fallopian tubes are removed.
Your ovaries are usually left in place because they produce oestrogen - if they are removed, you will immediately go through the menopause.
There are also different surgical techniques, such as:
- vaginal hysterectomy - where the hysterectomy is done through the vagina
- keyhole hysterectomy, which is often done in combination with vaginal surgery - the surgery is done through small incisions in the abdomen
Ask your surgeon for advice on the best type of surgery for you.
The location of the womb and surrounding structures
What are the alternatives to a hysterectomy?
The operation is usually only recommended when other treatments are considered unsuitable or haven't been effective. There may be medicines you can try or alternative types of surgery. Your doctor or surgeon should have already discussed these options with you and offered them to you before recommending surgery.
Preparing for your operation
Your surgeon will explain how to prepare for your operation. For example if you smoke, you will be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
The operation is done under general anaesthetic, which means you will be asleep during the operation. You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand. Alternatively you may be given an epidural. This completely blocks feeling from the waist down and you will stay awake during the operation. If you have an epidural, you're likely to be given sedation - this relieves anxiety and helps you to relax.
Your surgeon and anaesthetist will usually visit you before the operation. This is a good time to ask any questions. If you have any particular concerns, write them down so that you don't forget them or contact your doctor about them before going into hospital. Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and give your permission for it to go ahead.
Your nurse will prepare you for theatre. 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, or instead of, wearing compression stockings.
You may be given antibiotics through a drip in your arm to help reduce the chance of getting an infection after surgery. These are usually given at the same time as the general anaesthetic.
What happens during an abdominal hysterectomy
The operation usually takes about an hour. Once the anaesthetic has taken effect, your surgeon will make a cut across your lower abdomen just below your bikini line. If you have large fibroids in your womb, your surgeon may need to make a cut from your belly button down to your bikini line instead. If this is likely to happen, your surgeon should discuss this with you before the operation.
Your womb will be taken out through the cut in your abdomen. Stitches (which may be dissolvable) or metal clips will be used to close the cut on your abdomen and the area will be covered with a dressing.
How abdominal hysterectomy is carried out
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What to expect afterwards
You will probably have a catheter (a thin tube) to drain urine from your bladder into a bag as most women have difficulty passing urine immediately after a hysterectomy.
A fine plastic tube (also known as a drain) may be left in your abdomen for up to 48 hours afterwards. This will allow any blood and fluids to drain into a bag and reduces the risk of infection.
You will be given pain relief to help with any discomfort as the anaesthetic wears off. You may be offered patient controlled analgesia (PCA). This is a pump connected to a drip in your arm that allows you to control how much pain medicine you receive.
The catheter and drain tubes will be removed as your recovery progresses and you become more mobile.
It's usual to feel some initial discomfort on passing urine but do tell your nurse or surgeon if you have any difficulty in passing urine or problems with bladder control. You may find that you don't have any bowel movements for a few days after the operation and this can cause painful wind.
Your nurse will give you advice about getting out of bed, bathing and your diet. You may be able to see a physiotherapist who can explain some exercises that you can do to help speed up your recovery.
The clips or stitches will usually be taken out before you go home. The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. They usually dissolve in around two to three weeks but it can take longer.
You will need to stay in hospital for up to five days, although some women are able to go home earlier than this. 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
At home you can usually 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. If you have seen a physiotherapist and been given exercises to do, try to continue with these. You can lift light items, such as a kettle, but don't lift anything heavy. If you have young children, you will need someone to help you with childcare.
You can usually drive a few weeks after the operation but always follow your surgeon's advice.
It's normal to have some blood-stained vaginal discharge for about six weeks after surgery. 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 GP as you may have an infection.
You will need to wait at least six weeks before having sexual intercourse so that the stitches placed at the top of your vagina when the cervix is removed aren't disturbed. It's natural to worry that a hysterectomy might affect your sex life. This isn't necessarily the case and depends on a number of factors, including the exact type of operation you have - ask your surgeon for more advice.
Your surgeon will advise you when you can go back to your usual activities. A full recovery can take up to 12 weeks, but you may recover faster than this.
What are the risks?
Abdominal hysterectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Common side-effects include:
- pain, swelling and bruising in your abdomen - this usually clears up within a few days
- a permanently visible scar - although this will be red and slightly raised to start with, it should soften and fade over the following months
- menopausal symptoms such as hot flushes and vaginal dryness if your ovaries are removed - you may need to have hormone replacement therapy (HRT) and your surgeon or GP can give you advice about this
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection.
Specific complications of hysterectomy are uncommon but can include:
- blood loss - you may need further treatment, such as a second operation to stop bleeding or to repair a damaged organ or a blood transfusion to replace lost blood
- damage to other organs and tissues in the abdomen, particularly the bladder and ureters (tubes that carry urine from the kidneys to the bladder)
The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.
The Hysterectomy Association
- Hysterectomy. GP Notebook. www.gpnotebook.co.uk, accessed 30 April 2009
- Abdominal hysterectomy for heavy periods. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, accessed 30 April 2009
- 2007 Annual evidence update on endometriosis - surgical management. NHS Evidence. www.library.nhs.uk, accessed 30 April 2009
- Hirst A, Dutton S, Wu O, et al. A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL study. Health Technol Assess 2008; 12(5):1-248. www.ncchta.org
- Sacrocolpopexy with hysterectomy using mesh for uterine prolapse repair. National Institute for Health and Clinical Excellence (NICE), 2009. www.nice.org.uk
- West C. Understanding hysterectomy and menstrual disorders: London. Family Doctor Publications and the British Medical Association, 2007
- Abdominal hysterectomy. NHS Dumfries and Galloway. www.nhsdg.scot.nhs.uk, accessed 1 May 2009
- Abdominal hysterectomy. Birmingham Women's Health Care NHS Trust. www.bham.ac.uk, accessed 1 May 2009
- Having a hysterectomy. Macmillan Cancer Support. www.macmillan.org.uk/Home.aspx, accessed 1 May 2009
- Menopause. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 1 May 2009
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: November 2009