Women’s Health Care: Hysterectomy

The uterus is a hollow, round organ in your lower abdomen (belly). It is where your baby grows when you are pregnant. The cervix opens into your vagina and is the lowest part of the uterus. The fallopian (fu-low-p-un) tubes are attached to each side of your uterus. The ovaries are below and behind the fallopian tubes.

• What is a Hysterectomy?
• Preparation and Tests
• When to Arrive
• What You Need to Know
• After Surgery
• Patient Care Resources

What is a Hysterectomy?

There are three kinds of hysterectomy

1. A simple or total hysterectomy is a surgery that takes out your uterus and cervix.
2. A subtotal (supracervical) hysterectomy takes out your uterus, not your cervix.
3. Sometimes the ovaries and fallopian tubes are taken out in addition to the uterus and cervix. The removal of the ovaries and fallopian tubes is called a bilateral salpingo-oophorectomy.

Having a hysterectomy

This surgery can be done four different ways. You will want to discuss which surgery your doctor feels is best for you. They are:

1. Abdominal Hysterectomy: This surgery removes your uterus through an incision (cut) in your abdomen.
2. Vaginal Hysterectomy: This surgery removes your uterus through an incision (cut) in your vagina.
3. Laparoscopically Assisted Vaginal Hysterectomy (LAVH): Your doctor uses a laparoscope (lap-er-uh-skop) and other tools to make tiny incisions (cuts) into your abdomen. The laparoscope or “scope” is a long metal tube with a tiny magnifying glass and a light on the end. An incision is then made inside your vagina. The doctor will look through the scope in your abdomen as he or she removes your uterus through your vagina.
4. Da Vinci® Hysterectomy: If you are a candidate for this state-of-the-art procedure, a specially trained surgeon will use the da Vinci Surgical System to perform minimally invasive surgery. Drs. David Dhanraj and Michael Galloway are trained on the da Vinci system. You can read about this type of surgery by visiting our Da Vinci Hysterectomy web page.

Preparation and Tests

To prepare for this surgery, it is important that you know:

1. About the tests you will have before surgery;
2. What parts of your body will be removed during surgery;
3. How you should care for yourself after surgery.

This guide tells you the care you can expect before, during, and after your hospital stay. Since no one person is alike, this guide may be changed to fit your special needs. After reading it, please ask your nurse or doctor any questions, or share any feelings you may have about your surgery or medical condition.

Pre-admission testing:

Your doctor may order a variety of tests. These tests are usually done before your surgery. The tests will give the doctor information about your general health and they will also be used to compare with tests you may have after surgery.

Tests may include:

• Blood tests—To see if the different parts of your blood (white cells, red cells, etc.) are normal.
• X-rays, such as a chest x-ray—To see a picture of your lungs.
• EKG (Electrocardiogram)—To check the condition of your heart.
• Urinalysis—To check that your urinary tract and kidneys are working well.

If you are taking Aspirin, Coumadin, or other drugs that may thin your blood and affect clotting, they should be stopped three to seven days before your surgery. Your doctor may also tell you to stop taking medicines like Advil®, Motrin®, Aleve®, and Celebrex® two weeks before your surgery. Tell your doctor or nurse about any over-the-counter medicines you are taking such as vitamins, herbs, food supplements, or laxatives. Your doctor can find out if these medicines interact with medicines you may need during surgery. You should discuss any questions or concerns with your doctor or nurse.

You may be told to give yourself an enema to empty your bowel and a betadine douche to help clean the vaginal area.

Do not eat or drink anything after midnight on the night before your surgery. Ask your doctor before taking any medicine on the day of surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring a list of your medicines or the pill bottles with you to the hospital. Make sure you get a good night’s sleep.

When to Arrive

You should arrive at Miami Valley Hospital two hours before the time of your surgery.

What You Need to Know

Informed consent:

You have the right to understand your health. In words you can understand, you should be told what tests, treatments, or procedures may be done to treat your problem. Your doctor should also tell you about the risks and benefits of each treatment.

You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for you. (A consent form is a legal piece of paper that gives your doctor permission to do certain tests, treatments, or procedures.) This form should tell you exactly what will be done to you. Your doctor should tell you what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

While you are in pre-op holding (before your surgery):

An anesthesiologist (the doctor who will put you to sleep for your surgery) will stop by to talk with you. Anesthesia is medicine to make you comfortable during surgery. You may be awake or completely asleep. You and your doctor will decide which type of anesthesia is best for you.

The different types of anesthesia are:

• Spinal anesthesia: This is medicine put into your back through a shot. You are awake during surgery but numb below the waist. Feeling returns in about two hours.
• Epidural anesthesia: This is medicine put into your back through a tiny tube. The tube is left in place to give you more medicine later if needed. You are awake during surgery but numb below the waist. Feeling returns to your legs when the medicine wears off.
• General anesthesia: This is medicine given as a liquid in your IV. Or, it is given as a gas through a face mask or a tube placed in your mouth and throat. This tube is called an endotracheal (end-o-tra-kee-ull) tube or “ET tube.” Usually you are asleep before the tube is placed in your throat. The ET tube is usually removed before you wake up. You are completely asleep during surgery.

Also, you may be given medicine about 30 minutes before you go to surgery. It will help you relax and feel sleepy, and it may make your mouth dry. After you have been given your medicine, the side rails on your bed will be raised for your safety. If you need to get out of bed, please call your nurse for help.

You will also have a:

• Gown: A hospital gown is needed so that your doctors and nurses can easily check and treat you. They will show you how to put on your gown. You will not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.
• Heart monitor: This is also called an EKG or ECG, or electrocardiogram (e-lek-tro-KAR-d-o-gram). Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This allows the doctors and nurses to see a tracing of the electrical activity of your heart Your doctors and nurses will watch the tracing closely during your surgery. The heart monitor helps them make sure you are handling surgery well.
• IV: An IV is a tube placed in your vein for giving medicine or liquids.
• Pulse oximeter (oks-ih-mih-ter): This is a machine that tells how much oxygen is in your blood to see if you need more oxygen. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine.
• Vital signs check: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. It is attached to a machine which gives your blood pressure reading. Your doctor or nurse may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so the doctors and nurses can see how you are doing.

After Your Surgery (Same Day)

You will spend some time in the Recovery Room (PACU) before you go to your hospital room.

Later that day you will be given ice chips and something to drink if you are not sick to your stomach.

You will still have your IV.

You may have a tube (Foley catheter) in your bladder to drain your urine. It may be taken out the evening of surgery or the next morning. After the tube is taken out, your nurse will keep track of your urine each time you go to the bathroom.

Your nurse will often ask you about the amount of pain you may be feeling. The nurse will ask you to rate your pain on a scale of 1 to 10 with 10 being the worst. Rating your pain helps make sure that you are getting enough medicine to relieve your pain. This medicine may be given as a shot, by mouth, or through your IV or epidural catheter in your back. Tell your nurse if the pain does not go away or comes back. A special pump may be used that allows you to push a button and give yourself the medicine through your IV or the epidural catheter. This is called patient controlled analgesia (ah-null-g-z-uh) and is set up so you cannot accidentally give yourself too much medicine. You will receive only the amount of medicine you need for the day, as directed by your doctor.

If you have an upset stomach (nausea) you will be given medicine to lessen or stop your nausea.

It is important to keep your lungs healthy after surgery. When you lie in bed after surgery it can cause you to breathe shallow. Shallow breathing can make mucus collect in your lungs and can give you an infection. This is why it is so important to cough and deep breathe after your surgery. It will help keep your lungs clear and help keep you from getting pneumonia. It is best to cough and deep breathe at least every one to two hours. To help you do this, you will be given an incentive spirometer. A video showing how to use an incentive spirometer is shown three times a day on our Patient Education TV, Channel 5. If you put a blanket or pillow against your incision when you deep breathe and cough it will help lessen the pain.

Because smoking can cause lung problems, we encourage you not to smoke before your surgery and during your recovery. We also ask you not to go to the smoking area during your hospital stay. If you would like Nicotine Replacement Therapy, please ask your nurse or doctor.

To help prevent blood clots you will be shown how to do leg exercises. Making circles with your feet, pushing your legs into the bed and tightening and relaxing your leg muscles will also help blood flow. You may also wear stocking on your legs; these will also help to prevent blood clots.

Our staff will help you get out of bed the evening of your surgery.

The first day after your surgery:

You will begin to eat a regular diet.

Our staff will help you get out of bed and sit in a chair. You will also be encouraged to walk. Doing these activities several times a day will improve your blood flow and help keep blood clots from forming.

Your IV will be taken out and your pain medicine will be changed to pills that you will take by mouth.

The tube (Foley catheter) that drains the urine from your bladder will be taken out, if it was not taken out the night before.

You may be allowed to go home.

When you go home:

Your nurse will give you instructions on how to take care of your incision, if you have one; what activities you may do; and any medicines you will need to take.

Your doctor will give you a prescription for pain medicine. It is important that you get this from the drug store the day you go home.

Vaginal discharge is normal after surgery. It should slow down and stop in about two to four weeks.

When you get home and feel able, you may slowly increase your activity. But do not do anything hard such as housework, sweeping, or exercising. You may go up and down stairs. If you work outside of your home, your doctor will tell you at your follow-up appointment when you may go back to work.

Your follow-up appointment will be about 4 to 6 weeks after you are home. But, you will be seen sooner if needed.

Feelings you may have after your surgery:

Since you no longer have your uterus, you will no longer be able to have children. Also, you will no longer have monthly periods. If you do not have your ovaries removed then you will keep making female hormones and will have menopause (change of life) at your normal time. If your ovaries are removed you may feel symptoms of menopause, such as hot flashes, vaginal dryness or mood changes. Talk to your doctor about hormone medicines that will help you as you go through menopause.

Sexual feelings should not change because of this surgery. You should not have sex or douche vaginally until your doctor tells you that your body is healed. Also, talk to your doctor about any concerns you may have about sex.

Accepting that you have had a hysterectomy may be hard. You may have the following feelings; anger, fear, nervousness or anxiety, frustration or depression. These feelings are normal. It will help you to share these feelings with your loved ones, friends, nurse, and doctor. They can help you to deal with these feelings as you get well.

It is unusual to have problems after you go home, but you should call your doctor if you have any of the following:

• Have vaginal bleeding that makes you use more than one pad an hour.
• Have difficulty breathing.
• Have a fever higher than 100.4° or chills.
• Have more pain than you were told to expect.
• Have any redness, drainage, or swelling of your incision or if your incision comes open.
• Have vaginal discharge that has a bad odor.
• Are unable to pass gas.
• Have not had a bowel movement (BM) for two to three days.
• Have any other problems that concern you.

Your comfort and trust are very important to our staff at Miami Valley Hospital. We welcome your questions and hope that you will let us know if we can serve you further.

More information

If you would like more information on your surgery or health condition please call the Craig Memorial Library at Miami Valley Hospital (937) 208-2612. They will locate the information you are looking for and send it to you at no charge.