Abdominal hysterectomy

For an abdominal hysterectomy, the uterus is removed through an incision in the lower abdomen. This incision is either horizontally just above the pubic bone (around the top of a bikini brief) or vertically from just below the umbilicus (belly button) down to the pubic bone.

The operation routinely lasts about an hour. It is usually performed under general anaesthetic, which means you will be asleep during the procedure. If you would like more information about general anaesthesia, please see a separate leaflet.

Once at the hospital, you may be asked about your medical history and any previous experience of hospital treatment. Your answers will help them in planning your care whilst you are in hospital.

Before you come into hospital for your hysterectomy, you will also be asked to:

• Have a bath or shower on the day of your admission
• Remove any rings, make-up or nail varnish. Rings and earrings that you would prefer not to remove can usually be covered with adhesive tape
• Go without food for six hours before the operation. You can usually take sips of water until two hours before. More specific advice will be given in your admission confirmation letter

When you arrive at the hospital, a nurse will explain how you will be cared for during your stay. The surgeon and anaesthetist will also visit you. This is a good time to ask any outstanding questions about your treatment.

The nurse will help you prepare for theatre. You may be asked to put on support stockings to help maintain the blood flow in the veins of your legs. These will feel tight, but they do help prevent blood clots.

Consent
Before going to theatre you will be given a consent form to sign. By doing this, you confirm that you understand what the procedure involves, including the benefits and risks, and give your permission for it to go ahead.

Hysterectomy is a commonly performed procedure. For most people, the benefits in terms of improved symptoms are greater than the disadvantages. However, all surgery does carry some element of risk. This can be divided into the risk of side-effects and the risk of complications.

Side-effects
These are the unwanted but mostly temporary effects of a successful treatment. Common side-effects of hysterectomy include some pain and discomfort. There may also be some bruising around the lower abdomen. Feeling or being sick as a result of the anaesthetic or painkillers is also quite common, although medicines are available to help avoid this.

In the longer term, a hysterectomy may decrease your sex drive, especially if your ovaries are removed. Its worth discussing this with your doctor so that you know what to expect and get advice about possible treatments, including hormone replacement therapy.

Complications
This is when problems occur during or after the operation. They are much rarer than most side-effects.

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). The complications specific to a hysterectomy are excessive bleeding during or soon after the operation, infection, and damage to other organs and tissues in the abdomen. These complications may require further treatment such as returning to theatre to stop bleeding or antibiotics to deal with an infection.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. You should ask your surgeon to explain how these risks apply to you.

You will be taken from the operating theatre to a recovery room, where you will come round from the anaesthetic under close supervision.

After this, you will return to your room, where a nurse will make you comfortable. She will assess the operation site and monitor your blood pressure and pulse at regular intervals. You will be wearing a sanitary towel to absorb any vaginal bleeding, which is usually similar to a light period.

You will have a catheter in place after surgery as most women experience temporary difficulty passing urine after this procedure. The catheter drains urine out of the bladder and into a bag beside your bed. After abdominal hysterectomy, you may also have tubes running from under the skin in the area of the operation. These drain any fluid out of the operation site into another bag or jar. You will also find a drip in your arm to keep you hydrated. This will be removed when you have started drinking enough fluid.

Recovery
You will need to rest until the effects of the general anaesthetic have passed. Your surgeon will visit you to answer any questions you have about the operation.

The anaesthetist will prescribe painkillers for the first few days after the operation. Suffering from pain could slow down your recovery, so please discuss any discomfort you have with your doctors or nurses.

When you feel ready, you can begin to drink and eat, starting with clear fluids such as water or apple juice.

The catheter will usually be removed within 48 hours. You may experience some discomfort to begin with, such as the constant urge to urinate and some dribbling. This should pass within 24 hours.

You may find that you do not open your bowels for up to five days after the operation, but should avoid straining when you go to the toilet. If you need them, laxatives can be provided. Your nurse will advise you about getting out of bed, bathing, diet and gentle exercises.

The clips or stitches that seal the incision on your lower abdomen will be removed on around the fifth day following the operation.

Physiotherapy
If required, a physiotherapist will visit you in the first few days after your operation to discuss gentle exercises that you can do at home. These will help speed up your recovery. The physiotherapist will provide further information materials for you to take home.

Going home
On discharge, the nurse will advise you on caring for the stitches, hygiene and bathing.

You will be given a contact telephone number for the hospital and a date for a follow-up appointment with your surgeon. This will be about six weeks later.

After you return home
You will need to take it easy and should expect to tire easily to begin with. Avoid strenuous exercise and lifting. You should not drive until you feel confident that you could perform an emergency stop without discomfort – probably no less than three weeks after your operation.

At your follow-up appointment, your surgeon will advise you when you can resume your other normal activities, including sport and sexual intercourse. A full recovery can take up to twelve weeks.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

The information on this page, and any information on third party websites referred to on this page, is provided as a guide only. It should not be relied upon as a substitute for professional medical advice, nor is it intended to be used for medical diagnosis or treatment. Bupa (Asia) Limited is not liable for any loss or damage you suffer arising out of the use of, or reliance on, the information.

Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites.

National Womens Health Information CenterWebMD
- http://my.webmd.com/encyclopedia/article/1840.52431

American College of Surgeons
- http://www.facs.org/public_info/operation/hysterectomy.pdf

Hysterectomy Educational Resources and Services (HERS)
- http://www.hersfoundation.com/