Abdominal Hysterectomy

What is a hysterectomy?

A hysterectomy is a surgical procedure to remove a woman's uterus, or womb.   The uterus is where a baby grows when a woman is pregnant.   In some cases, the ovaries and fallopian tubes are also removed.

The Uterus and Ovaries

The uterus protects and nourishes a fetus from conception to birth, and it aids in the delivery of the baby. It also produces the monthly menstrual flow, or period.

The ovaries have two major functions. One is the production of eggs, which permits childbearing. The second is the production of hormones or chemicals which regulate menstruation and other aspects of health and well-being, including sexual well-being.

If the egg that is released during a woman's normal monthly cycle is not fertilized, the lining of the uterus is shed by bleeding, or menstruation.

After a hysterectomy, a woman can no longer have children and menstruation stops. The ovaries generally continue to produce hormones, although in some cases they may have reduced activity.

Some hysterectomies also include removal of the ovaries, so the supply of essential female hormones is greatly reduced and menopause occurs.

What is an Abdominal Hysterectomy?

About 75% of hysterectomies performed in the United States are abdominal hysterectomies. The surgeon makes a four to six inch incision either horizontally across the pubic hair line from hip bone to hip bone or vertically from navel to pubic bone. Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity. The blood vessels, fallopian tubes, and ligaments are cut away from the uterus, which is lifted out.

During a total abdominal hysterectomy, the surgeon removes the uterus, including the cervix. The scar may be horizontal or vertical, depending on the reason the procedure is performed, and the size of the area being treated.   Cancers of the ovary or uterus, endometriosis, and large uterine fibroids are usually treated with total abdominal hysterectomy.   Total abdominal hysterectomy may also be done in some unusual cases of very severe pelvic pain, after a very thorough evaluation to identify the cause of the pain, and only after several attempts at non-surgical treatments.   Clearly a woman cannot bear children herself after this procedure, so it is not performed on women of childbearing age unless there is a serious condition, such as cancer.   An abdominal hysterectomy allows the whole abdomen and pelvis to be examined, which is an advantage in women with cancer.  Abdominal hysterectomies take from one to three hours. The hospital stay is two to four days, and it takes four to six weeks to return to normal activities.

The advantages of an abdominal hysterectomy are that the uterus can be removed even if a woman has internal scarring (adhesions) from previous surgery or her fibroids are large. The surgeon has a good view of the abdominal cavity and more room to work. Also, surgeons have the most experience with this type of hysterectomy. However, the abdominal incision is more painful than with vaginal hysterectomy and the recovery period is longer.

When an Abdominal Hysterectomy is Recommended

In most cases, a hysterectomy is only performed for serious medical conditions, and after all nonsurgical options have been explored.   Some of the most common reasons for an abdominal hysterectomy are the following:

• Fibroids - common non-cancerous (benign) tumors of the uterus and they are the most frequent reason for recommending a hysterectomy.  They are made up of muscle and fibrous tissue, and grow from the muscular wall of the uterus.   Many women have fibroids and are unaware of it because they have no symptoms.
  In some women, however, the fibroids may cause heavy bleeding, pelvic discomfort and pain and sometimes pressure on other organs.
• Endometriosis - another common reason for undergoing a hysterectomy.  It is a noncancerous medical problem in which cells from the uterine lining grow in the body but outside of the uterus. These growths can occur on the ovaries, fallopian tubes, bladder, bowel and other pelvic structures, including the uterine wall.  These cells may cause pain and discomfort at the time of menstruation. Endometriosis may also cause scarring, adhesions and infertility.
• Prolapse - sometimes occurs as a woman ages, when the vaginal supports begin to lose their tone and sag downward or prolapse.  When this happens, the bladder or rectum may also be pulled downward.  If the prolapse worsens, some women experience a bulge protruding from the vagina, problems in controlling bladder or bowel functions, and other difficult symptoms. 
• Pelvic adhesions - scarring that can result from endometriosis, infections or injury.  Symptoms may include severe pain, infertility, and bladder or bowel problems.
• Cancer – Hysterectomy is usually recommended as part of the treatment for cancer of the uterus, cervix, or ovaries.
• Persistent vaginal bleeding – A hysterectomy is sometimes recommended for women whose periods are extremely heavy, irregular or last for many days each cycle, and cannot be controlled by nonsurgical methods. 

Risks of Hysterectomy

An abdominal hysterectomy is a major operation, so the risks are the same as for any major surgery. 
Bladder and wound infections sometimes occur, both of which can usually be treated with antibiotics.  Less often, women may require a blood transfusion before surgery because of anemia or during surgery for blood loss.   Complications related to anesthesia might also occur, especially for women who smoke, are obese, or have serious heart or lung disease.

As with any major abdominal or pelvic operation, serious complications such as blood clots, severe infection, adhesions, postoperative hemorrhage, bowel obstruction or injury to the urinary tract can happen. Rarely, even death can occur.

In addition to surgical risks, there may be longer-term physical and psychological effects, potentially including depression and loss of sexual pleasure.  If the ovaries are removed along with the uterus prior to menopause, there is an increased risk of osteoporosis and heart disease as well.
In making a decision, you should also consider that a hysterectomy is not reversible. After a hysterectomy, you will no longer be able to bear children and you will no longer menstruate. You need to think about the impact these changes would have on you.

Recovery

Recovery after a hysterectomy takes time.   Immediately after a hysterectomy, you will stay in the hospital from 1 to 3 days for postsurgery care. 

At home, you may resume your normal diet, and bathe or shower normally.  The incision should be kept clean with soap and water, but it is not necessary to keep it bandaged.  You may use lotion on the skin around the incision to relieve itching.

Follow your physician’s recommendations regarding resuming your normal activities.  In general, guidelines are:

• Avoid lifting more than 20 pounds for at least four weeks
• Do not douche or have sexual intercourse for at least four weeks.
• Light swimming may be permitted at two weeks after surgery
• Resume your exercise routine in 4 to 6 weeks
• You can usually drive and go back to work after 4 to 6 weeks

Aftereffects

Each woman reacts differently, both emotionally and physically.  For example, many women report an increase in enjoyment of sex, especially if they had a lot of bleeding and pain before surgery.   Some women feel more relaxed because they don’t have to worry about getting pregnant. On the other hand, if the ovaries were removed prior to natural menopause, the loss of hormones can cause vaginal dryness and make sexual relations uncomfortable.  There are several options available to treat this condition, such as hormone replacement therapy or using a vaginal lubricant.  

Some women report having a strong negative emotional reaction after a hysterectomy. Most feel better after a few weeks, but some women do feel depressed for a long time.   Other women experience a feeling of relief after a hysterectomy.Losing the ability to bear children can cause emotional problems for some women. Some women feel they have suffered a loss, and may grieve and go through depression.   Talking things over with your physician, your partner, a friend or a counselor often helps.   It may help to talk with a friend or another woman who has had a hysterectomy before and after your operation.

Remember

Abdominal hysterectomy is a major surgical procedure.  You should be aware of all of your options, as well as the risks, benefits and possible effects of the surgery before scheduling the procedure.