Why is Uterus Removal Surgery Required?
Uterus removal surgery is performed for different medical reasons such as vaginal bleeding, severe abdominal pain and cramps, and also the severe symptoms of menopause.
Following are some of the medical conditions for which doctors recommend undergoing uterus removal surgery:
- Uterine Fibroids: Fibroids are the fibrous muscular outgrowths on the uterine walls. These outgrowths may grow in size and number if not attended timely. Though the exact reason for uterine fibroids is unknown, several risk factors include an unhealthy diet, a sedentary lifestyle, genetic factors, and hormonal changes. A woman may deal with uterine fibroids at any stage, even after menopause. At times, the symptoms, such as irregular painful periods, spotting, and infertility issues, keep worsening, and uterus removal is the only permanent treatment.
- Endometriosis: It is a chronic condition in which the cells of the inner lining of the uterus (endometrium) grow outside the uterus. Usually, endometriosis is a non-cancerous condition where endometrial tissues also appear in the ovaries and abdomen when not treated in time. Endometriosis causes excruciating, heavy, and irregular periods and may even increase the chances of uterine cancer in some cases.
- Uterine prolapse: When the tissues, ligaments, and various muscles that hold the uterus in place weaken due to pregnancy, childbirth, hormonal changes, or aging, the uterus drops into the vaginal canal. This condition is called uterine prolapse or prolapsed uterus. When the disease reaches the last stage, where the uterus is outside the vagina, doctors often resort to uterus removal surgery.
Preoperative Preparation
- Discussion With the Doctor: Have a detailed conversation with your gynecologist regarding the severity of your condition, medical history, and which technique of uterus removal is safest for you. Make sure you learn about the advantages and disadvantages of removing the uterus to move ahead with clarity and have no regrets after the surgery. Also, tell the gynecologist about your ongoing medication, if there is any.
- Screening Tests and Medication: A gynecologist advises several screening tests before surgical removal of the uterus. X-Ray, pelvic ultrasound, CT scan, MRI scan, blood and urine tests, endometrial biopsy, and dilation and curettage are the necessary screening tests to ensure that you are an ideal candidate for uterus removal operation. If needed, the doctor will recommend a course of oral medication before the surgery.
Day Before Surgery
Generally, doctors recommend that the patient gets admitted one day before the uterus removal operation day to ensure that the patient feels comfortable. It also helps start the treatment at the pre-decided time, without any delays. The patient must not drink or eat anything at least 7-8 hours before the surgery. This prevents the risk of vomiting and urinary/fecal incontinence under the effect of general anesthesia administered before surgery. The doctor prescribes antacids to deal with stomach acids and laxatives to ensure easy egestion.
Procedure Day
On the day of the uterus removal operation, the patient must be well prepared in advance. Before the surgery, the female is asked to change into the hospital's clean surgical gown. Then, the doctor administers general anesthesia into a vein in the form of nasal fumes to be inhaled. In an abdominal hysterectomy, the region is cleaned using an antiseptic solution. Vitals like blood pressure, pulse, respiratory rate, body temperature, etc., are also noted before surgery.
Methods/Techniques of Uterus Removal Surgery
- Abdominal Hysterectomy: In this technique of uterus removal, the surgeon carries out an open incision in the lower abdomen to manually remove the uterus. It is a conventional and invasive approach known as open surgery for uterus removal. The primary abdominal incision is stitched with a dissolvable suture. It takes about 5-6 weeks to recover from abdominal uterus removal surgery.
- Vaginal Hysterectomy: This method is mainly preferred in cases where a hysterectomy is necessary because of a prolapsed uterus. The gynecological surgeon removes the prolapsed uterus through the vagina during the procedure. The process is less invasive than abdominal hysterectomy and involves only minor vaginal incisions. The significant recovery occurs within 1-3 weeks following vaginal hysterectomy.
- Total Laparoscopic Hysterectomy (TLH): This is an advanced laparoscopic surgery for uterus removal, which is minimally invasive and offers speedy recovery to the patient. The doctor uses a surgical tool called a laparoscope (a thin tube-like device with a camera and light mounted on one end). During the procedure, the surgeon makes 4-5 keyhole incisions (0.5-1 inch in size) in the lower abdomen to insert a laparoscope and other surgical devices. The laparoscopic technique lets the doctor clearly visualize the internal organ and precisely remove the uterus without causing damage to the surrounding tissues and blood vessels. The uterus is removed through the vaginal passage. The minor incisions are closed off with self-dissolving sutures, and the patient can expect a smooth recovery in 1-2 weeks.
Post Procedure
One has to follow proper precautions after removal of the uterus to have a smooth and faster recovery. Following are the phases of post-surgery care and healing:
- Hospital Care: As the uterus removal operation is performed under general anesthesia, the patient remains asleep. When surgery completes, the patient is shifted to their ward. As they become conscious again, the doctor performs a general physical exam and ensures that the functional area is appropriately packed, clean, and dry. However, the patient remains more sleepy for the first 24 hours following surgery than usual. They are administered glucose or saline through an intravenous line until their bowel movements become normal. Also, in most cases, the hospital stay after the uterus removal operation is 1-2 days; however, it may stretch based on the patient's recovery and stability.
- Home Care: After getting discharged from the hospital, the doctor advises proper bed rest for 1-2 weeks. The patient has to ensure that their stitches are clean and dry and the dressing is changed per the doctor's instructions. The patient should also refrain from exerting pressure on the abdomen to avoid scarring, bleeding stitches at the incision site, or any other complication. Also, during the first two weeks of recovery, a light fluid and fiber-rich diet helps the body recover smoothly from the surgery. However, if the patient experiences sudden excruciating pain or bleeding, it is best to seek immediate consultation with the doctor.
- Physical Activity: The complete recovery may take 4-6 weeks, during which one has to be careful with their physical movements. Do not lift any object during the first two weeks following uterus removal surgery. Walking around the house helps in regaining physical balance and stamina. However, high-intensity workouts, stretching, running, climbing stairs, traveling long distances, or sexual intercourse must be avoided for at least four weeks post-surgery
- Medications: Doctors prescribe medication for pain management and speedy recovery from uterus removal surgery. Usually, the remedies include Tylenol and nonsteroidal anti-inflammatory drugs (NSAIDs) for 15-21 days, depending upon the patient's condition.
- Follow-up: After undergoing surgical removal of the uterus, regular visits to the doctor are necessary to keep track of recovery. This also helps prevent post-surgery complications and ensures that the patient follows all the post-surgery care tips.
Risks and Complications
Uterus removal surgery is a safe procedure that only trained gynecological surgeons should perform. With new interventions such as laparoscopy, surgery has become safer. However, if an untrained professional performs surgery or the patient does not observe precautionary measures during recovery, it makes them prone to risks and complications. Following are the possible risks and complications of uterus removal operation (in different scenarios).
During surgery:
- Heavy bleeding due to injury to a blood vessel
- Trauma to surrounding tissues or organs of the pelvis
- Anesthesia-related complications
Post-surgery:
- Infection
- Damaged nerve endings in the operated region
- Damaged urinary tract
- Obstruction in the bowel movements
