• Generally, it is used to treat the following conditions:
  • Fibroid or recurrent polyps.
  • Heavy & painful periods when other treatments have failed.
  • Cancer.
• Only suitable:
  
  • When you want a permanent solution to your fibroid problem.
  • You no longer want to have children or either near or pass menopause.
  • When the fibroids are large and cause heavy bleeding.
• Like all surgical procedure, hysterectomy carries short-term and long-term risks (see tables).
  
  

  Summary: Short-term Risks of Hysterectomy
  Serious Infection	Infection of the womb may necessitate you to return to the hospital for antibiotic treatment. Wound infection may also occur.
  Urinary problems	Kidney/bladder infection or urinary incontinence. The risk is higher for radical hysterectomy.
  Blood clots	Can happen in the veins in the leg (DVT) or pelvis. The risk is increased by smoking, inactivity, excess weight and oral contraceptives.
  Haemorrhage	Excessive blood loss during or after the operation which requires blood transfusion.
  Adverse reactions	Nausea/vomiting can occur due to anaesthetics.
  Adjacent organ perforation	This can happen to the bowels, bladder or urethra. If perforation occurs, you may have to undergo another operation to remove adhesions.

  
  
  

  Summary: Long-term Risks of Hysterectomy
  Urinary Incontinence	Small risk following damage to the pelvic nerves.
  Early menopause	Occurs when the ovaries are removed. This even happens when no removal of ovaries in women who were not yet menopausal prior to surgery due to decrease blood flow to the ovaries after hysterectomy.
  Lack of orgasm	Occurs when the cervix is removed.
  Prolapse	Intestines and bladder can descend towards the bottom which can lead to constipation and/or urinary incontinence/inability to control bladder and pain in sexual intercourse.
  Mood	Depression/sadness due to a feeling of loosing your femininity.

• If you are using oral contraceptives, you are required to stop OC 4-6 weeks before the operation and use condom instead.
• A few weeks before the operation, a pre-operative check is carried out to ensure that you are fit for the surgery and anaesthetics which include:
  - Pregnancy test.
  - Medical history including what medications you take regularly.
  - ECG for the heart fitness.
  - Blood test to check for haemoglobin level and "cross matching" in case you require blood transfusion either during or after the operation.
• You will normally come into the hospital the day before the operation.
• On the day of the operation, you will be seen by the gynaecologist who explains the procedure to you and also by the anaesthetist who ensures that you are healthy to receive anaesthetics and explains pain control programs during and after the surgery.
  The anaesthetist will go though the type of anaesthesia applicable for your case with you and ask questions on history of previous operation(s) if you had any and your family's.
  Also, he/she will give you warnings on possible side-effects (see Table). The risk of anaesthetic depends very much on your general health. A fit, healthy 20 year old person would be at far less risk than an 80 year old person would with some serious disease.
  Don't forget to mention any previous operation(s) you had and any side-effects. If you never had an operation under general anaesthesia, tell him/her about your family's operation(s).
  
  

  Possible risks of anaesthetic
  Nausea and Vomiting	Not always occur. May also be caused by the surgical procedure or pain relief medication. Medications and fluids may be required. This may be from a tube in the mouth or throat during anaesthetic. Cough lozenges, gargle, simple pain killer may help.
  Muscle weakness	Muscle pain may be from spasm around the wound or the use of certain anaesthetics. Pain killers and rest usually settle it.
  Blurred or Double vision	Usually settles down with rest.
  Post operative pain	This is due to cuts in your skin and tissues. Resolve with painkillers and anti-inflammatory.
  Allergic reactions	Your anaesthetist will avoid any known drugs that you know you are allergic to. In case of unexpected reaction, the team is well trained and qualified to deal with it.
  Damage to teeth	Once you are deeply asleep, tubes may be placed inside your mouth and throat. The shape of your mouth varies and different types of dental diseases, loose teeth, bridge and crowns may be present. The anaesthetic talks about possible damage to you before the operation. If damage occurs, you will be told about it afterward and repair is arranged.

  
  
• An hour before the actual operation, you will be taken to the anaesthetic room where you are given "pre-med" to relax and sedate you then you will be moved the operating theatre.

• Once in the operating theatre, the relevant anaesthetic program is started.
  Most hysterectomies, general anaesthetic is used. Occasionally, a spinal or epidural anaesthetic is used and you are also given sedative.
• What happens during the operation depends on the type of hysterectomy and your health.
  Generally speaking, the womb is removed by either one of three ways:
  
  

  Types of Hysterectomy Incision
  Description	How is it done?
  Abdominal	Hospital stay: several days The womb is removed through a 10 - 15 cm incision in the abdomen. The incision is either a horizontal line under the pubic hair line (also known as "bikini") or vertical between the pubis and the navel.
  Vaginal	Hospital stay: short Small incision in the rear of the vaginal is made and through which the uterus is removed.
  Vaginal with laparoscopy	Hospital stay: short. Small incisions (2 to 4) are made in the abdomen and a laparoscope is inserted. Using this instrument, the surgeon cuts the womb and removes it in the same way as in the vaginal hysterectomy.

  
  
  If you have an abdominal cut, your scar will look like either [a] or [b] in the diagram below:
  
  

  Types of Hysterectomy
  Type	What removed	What remain	Comments
  Sub-total (partial) hysterectomy	Uterus	cervix, vagina, fallopian tubes, ovaries	Must continue cervical smears afterwards.
  "Total hysterectomy	Uterus and cervix.	Fallopian tubes, vagina and ovaries.
  Total hysterectomy with salipingo-oophorecting	Uterus, cervix, fallopian tubes and ovary.	Vagina and 1 ovary if not Bilateral procedure in use (see note in the comments).	If both ovaries are removed, it is called bilateral.
  Radical hysterectomy (Wertheim's)	Uterus, cervix, top part of the vagina & supporting tissue, pelvic, lymphatic nodes.	Ovaries	This procedure is only carried out in the case of invasive gynaecological cancer.

  
  
  The diagram below shows what is removed in each type of hysterectomy as shaded areas:
  
  
• The time taken for the procedure varies depending on reasons and type of hysterectomy.
• When the operation is over, the anaesthetist will bring you back to consciousness.

What happens AFTER the procedure?

• You will be taken to the recovery room where you're given oxygen and monitored until you gain full consciousness from anaesthetics. You will continue to feel drowsy and weak for a little while.
  Specially trained nurses will care for you in the recovery room. When you are stable, you are then moved to the ward.
• When you wake up from the operation, you will notice that you have the followings:
  
  • An oxygen mask to help you breathe.
  • A drip in the arm to give fluids, blood, plasma.
  • A temporally bladder catheter.
  • A drain from the wound if you have open surgery.
  • A pain relieve pump:
    Either a PCA (patient controlled analgesia). You have a handheld device where you can press every time you want to give yourself a dose of the pain killer.
    Or an epidural pump which delivers the pain killer via your back.
  You will feel extremely tired and sleepy.
• For the next few days, you may be given anticoagulant injection to prevent DVT such as Clexane.
  The PCA for pain relief will be discontinued within 48 hours and you will be given oral pain killers (paracetamol, diclofenac, dihydrocodeine or morphine).
  If you do not open your bowels after 3 days, you will be given suppositories to help.
• The urinary catheter will be removed once you are able to make yourself to the toilet. The drain bottle from the wound is usually disconnected within 2 -3 days.
• For self-care in the hospital, you can follow the following guide.
  
  

  Self-care guide
  Time post-operation	What to do
  First day post-op	Start drinking small sips of water to kick starts your gut into working.
  	Sit up right, especially out of bed. This helps to prevent chest infection.
  	Start moving round. Wear your TED socks to help to prevent DVT.
  From second day to discharge time (5 to 6 days)	Try to move around more and become independent. Drink plenty of fluid & walk around to help your bowel working again.
  	Do pelvic floor exercise per instructions from the physiotherapist.

• The pinkish/brown vaginal discharge continues for 10-14 days post-op. This is normal as part of the healing process.
• Carry on with pelvic floor exercise per instruction from the physiotherapist.
• Most importantly, keep the wound (incision site) clean and dry. There is no need to put any dressing over it. Apply daily dry antiseptic spray such as Savlon Dry Antiseptic or Betadine Dry Spray (you can buy from pharmacy). The key objective here is to avoid infection for healing to take place.
• A DO and DON'T list is compiled for you as a guide, as always, use your common sense as well.
  

  DO and DON'T List
  Time post-op	DO	DON'T
  Week 1 to 2	- Use sanitary towels instead of tampons. - When you have a bath or shower, use only unscented bath/shower gel or soap around the wound area. - Pat dry your wound afterwards. - Avoid vaginal lubricant, gel or cream. - Start gentle walking around the house in week 1.	- DON'T lift anything heavier than a full kettle. - DON'T drive. - DON'T have sexual intercourse.
  Week 3 to 5	- Gently increase your physical activities. - Allow rest time throughout the day. - Start short walk in week 2.	- DON'T put anything inside your vagina. - DON'T drive. - DON'T have sexual intercourse.
  Week 6 Onwards	- Resume light work. - If you have no pain, you can start driving. If in doubt, see your GP. - You can start sexual intercourse if you have no pain or vaginal bleeding. If you experience pain or bleeding after sex, contact your GP for advice. - Start driving if you are confident to handle the car. - Return to heavier work and all activities without restrictions in week 10.

  
  
• Some women take up to 6 months for a full recovery.