A hysterectomy refers to removal of the uterus (or womb). This can be done with or without removal of the cervix (the opening to the uterus) or the adnexa (tubes and ovaries). There are a variety of reasons why you might be considering undergoing a hysterectomy. Just a few include problems with abnormal bleeding, fibroids (benign growth on the uterus), endometriosis, uterine or pelvic organ prolapse, or precancerous or cancerous cells. For many of these conditions, your doctor will likely recommend less invasive treatments first, and if these do not succeed, may suggest that you consider a hysterectomy.
Traditionally, this type of surgery was either performed through a side to side (bikini) or vertical incision on your abdomen or through the vagina. However, there are many more choices today and your doctor will individualize his/her recommendations based on your specific circumstances. In addition to the aforementioned options, your doctor may recommend using laparoscopy to assist with a vaginal hysterectomy, a fully-laparoscopic hysterectomy, or a robotic hysterectomy. It is important to know that all of these choices have pros and cons and that when we make recommendations, they are based on your specific needs.
When we perform a hysterectomy, we usually bring you in to the hospital on the morning of the surgery, and after you have been seen by your doctor, you are taken to the operating room where you are given medication to put you to sleep. Typically, you will have any necessary tests either several days before the procedure or on the day of surgery. Once the surgery is completed, you are usually watched in the recovery area briefly, and then moved to a private room where you will be closely monitored. For many types of hysterectomy, you may only spend one night in the hospital. Prior to leaving the hospital, we will make sure that you are on your way to a speedy and healthy recovery and that you know when to come back to the office and how to contact your doctor, should the need arise.
Hysteroscopy is a procedure in which a tiny camera is inserted through the vagina and cervix without any incisions on the abdomen and used to see inside the uterus. It is also referred to as minimally invasive surgery. It can be performed in the office, surgery center or hospital using local anesthesia, spinal anesthesia (numb from the waist down) or general anesthesia (going to sleep) depending on your specific situation. It may be performed at the same time as laparoscopy for some women.
There are many reasons your doctor may recommend this type of procedure. For example, if you have had certain types of abnormal uterine bleeding your doctor may recommend this type of procedure either to further evaluate or treat your condition. This type of surgery can be performed at the same time as a D&C (scraping of the uterus), removal of polyps or fibroids, ablation (burning the uterine lining to treat heavy periods), tying tubes to prevent pregnancy, or for evaluation of infertility. It is usually an outpatient procedure, which means you most likely will go home afterwards.
If you have any questions or concerns about your specific condition, your doctor will be happy to discuss whether this procedure is appropriate for you.
Laparoscopic surgery refers to surgery done through one or more small incisions, usually about one-half to one inch long. This is also called minimally invasive surgery. Many problems which are traditionally treated with surgery through side to side (bikini) incisions or up and down (vertical) incisions can now be done in a way that offers less pain, a faster recovery and a more cosmetic scar.
When we perform this type of surgery, we usually bring you in to the hospital or surgery center on the morning of the procedure, and after you have had any necessary lab work and been seen by your doctor, you are taken to the operating room where you are given medication to put you to sleep. Then we make one or more small incisions in your abdomen, fill your belly up with carbon dioxide gas and insert small instruments inside to perform the procedure, all while watching closely with a camera.
This type of surgery can be used to treat pelvic pain, infertility, endometriosis, ovarian cysts, scar tissue, fibroids, or even to perform a hysterectomy. Depending on exactly what is done, you will most likely be able to go home the same day or the next and will be back on your feet much faster than with traditional surgery. Your doctor will discuss with you if this is a good option for your specific circumstances.
Minimally Invasive Surgery (MIS)
If you are concerned that you may need surgery for either an ongoing medical problem or a new one, you may be wondering what kind of options are available. It is important to know that many surgical procedures that were once only possible though large side-to-side (bikini) or vertical incisions are now frequently done through small incisions or no incision at all. Common procedures like treatment for fibroids, endometriosis, ovarian cysts, dropping (prolapsing) organs and bladder leakage are routinely done through laparoscopic, vaginal, hysteroscopic or robotic techniques. All of these options comprise minimally invasive surgery. For details about what is involved, please see our other patient information summaries. Nationally and internationally, there are numerous professional societies devoted to advancing these methods, and many of our physicians are active participants in these organizations.
The following links are to the American College of Obstetrics and Gynecology's Web site.
- D & C
- Endometrial ablation
- Preparing for Surgery
- Sterilization by Laparoscopy
Post Operative Care
It will take some time to feel completely normal, depending on the specific procedure that you had. Recovery is a gradual process, and each day should improve. It is very important to understand that your body uses a great deal of energy to heal, and as a result it is normal to feel more tired than usual and crucial that you get enough rest. Strenuous activity, such as exercise and heavy lifting, should be avoided in the immediate time after surgery.
Walking is the best exercise, and when you go home it is good to be up for several hours a day; we suggest that you be up for awhile, take a rest and repeat. Being up for very long stretches of time will probably cause you to feel worse, not better. Go easy on stair climbing, and limit it to only what is necessary in your home. You should not drive a car until you are off prescription pain medication and able to wear a seat belt without discomfort. Your doctor will tell you when you need to come back to the office.
Care of Your Incision
When you go home, your incision(s) will most likely have the edges glued or taped together, but not yet be healed over. Your doctor will tell you what you need to do care for it. In general, shower every day, using a mild soap over the incision(s) to keep the skin clean. Pat dry and be gentle. It is OK to cover your incision(s) loosely for your comfort. Unless your doctor recommends it, there is no need to use antibiotic ointment. There is no need to “pick at” any crust or scab that forms; this is a normal process, and picking may cause it to become infected. If you have a bigger incision, you may wear an abdominal binder or band for additional support.
After certain types of surgery, including a hysterectomy, it is very normal to have either vaginal bleeding or vaginal discharge. If there is a foul, pus-like smell or if you have a temperature greater than 100.4º, you need to contact your doctor. If you are on birth control, your doctor will tell you when to take it. If you are soaking a pad in an hour or less, for more than a couple of hours, please contact your doctor. Do not use tampons unless specifically approved by your doctor; stick to pads or liners. Typically, light bleeding or discharge will resolve within 1-3 weeks. Absolutely no douching unless you have been instructed to do so.
By the time you go home, your pain should be fairly well controlled with oral pain medication. You still may require a prescription, which your doctor will give you. You can also use a heating pad on low or take warm showers (not baths). As you feel better and better, you may transition to over-the-counter pain medication. If you have had a vaginal procedure and there is external discomfort, you may use Tucks® hemorrhoid pads on the outside of your vagina and/or do sitz baths (3-4 inches of warm water in the tub, flowing, for 10-15 minutes) at home. You may wash your hair at any time. Again, do not take tub baths unless approved by your doctor.
If you had to do a bowel prep (clean out) before surgery, it is very common for it to take 2-3 days before you need to go again. Also, if you are taking any narcotic pain medication (like Lortab® or Percocet®) it may slow down your bowels and you may add a stool softener like Colace®. Drink lots of water, try and eat foods with fiber, and don’t try to force it. If you are able to eat without nausea and vomiting, and you are passing gas from below, you will eventually have a bowel movement. If nothing has happened in 4-5 days, please contact your doctor for instructions. Do not use any type of rectal suppository or enema unless your doctor has okayed it, but it is OK to use a mild laxative like Miralax or Milk of Magnesia.
Do not have sex until after your first post-operative visit, unless your doctor has specified otherwise.
Please call if you are having a temperature greater than 100.4º, severe chills, persistent burning with urination or frequent urination, heavy vaginal bleeding, dizziness or fainting, redness, swelling or pus from your incision(s), or any other concerns.