What is Uterus?
Uterus is a hollow muscular and inverted pear shaped structure. It lies in the pelvic cavity between the urinary bladder and the rectum. It is attached by ligaments to the pelvic wall. The uterus consists of a body called corpus a narrow uterine cavity called internal Os and the lower cylindrical structure called cervix.
The hormonally imbalanced state can give rise to abnormal uterine bleeding (Hyper-estrogenic state/unopposed estrogen action, hyper progestogenic state/ abnormal progesterone-estrogen ratio). In severe cases removal of uterus is recommended by doctors.
Surgically removing the uterus through a hysterectomy is an option that is exercised whenever infection, cancer, or structural damage assails the female reproductive system. Such adverse developments in the female reproductive system may cause intense pain, inflammation, and bleeding. A hysterectomy gives permanent relief from such life-threatening symptoms. The surgery may involve the elimination of the uterus completely or partially, and post-surgery, the patient ceases to menstruate and loses her childbearing capacity.
During a hysterectomy, the ovaries, fallopian tubes, and cervix are usually left undisturbed. The uterus’s supporting musculature, blood supply, and nervous tissue are also navigated carefully to prevent collateral damage.
Precautions necessary prior to hysterectomy
The Pap smear or Papanikolaou test
The cervix is the connecting corridor between the uterus and the vagina. The Pap smear is a milestone test that screens the cervix for the presence of cancer. Cells extracted from the cervical lining are examined under a microscope to detect cancerous growths.The Pap smear test involves scraping and brushing the cells from the cervix which will be examined for abnormalities. Pap test is used to detect abnormal cells in the cervix which include cancer cells as well as cell changes that could increase risk for cervical cancer.
Here, the surgeon uses a pipette to extract a sample of the endometrium or inner uterine lining for cytological evaluation to detect tissue abnormalities or cancerous growths.
Unlike the Pap smear and endometrial biopsy, this is a non-invasive technique that uses ultrasound to ascertain the size and shape of abdominal organs and each part of the reproductive system. The technique enables the surgeon to identify the source of pelvic pain, excessive menstrual bleeding, and abnormal growths that may require a hysterectomy as corrective surgery.
Body cleansing using medicated soap
In preparation for the surgery, the patient will be asked to bathe her body using medicated soap specially provided for the purpose.
A bottled solution that usually combines water and vinegar is sprayed into the vagina to cleanse the vaginal passage and provide a clean and sterile environment before surgery.
Fluids are pumped into the rectum through the anal opening to flush the rectum of waste matter so that feces are not voided during and after surgery.
Hysterectomy – the whys and hows of the surgical procedure
Usually, the surgery takes about two to three hours with an additional hour for pre and post-operative treatments. The use of general anesthesia ensures that the patient remains asleep and does not feel any pain throughout the entire procedure.
- A disinfecting solution is used to wash the pelvic area and vagina.
- Excess urine is drained away from the urinary bladder using a catheter that physically connects the bladder and the urethral opening.
- A top to bottom incision is made below the belly button to the area above the pelvic bone.
- Another cut is made along the bikini line intersecting the vertical incision.
- The incision is made in the upper wall of the vaginal passage to enable the removal of the uterus, a procedure aided by ultrasound.
- Smaller openings are made in the abdomen; one central incision for pulling out the uterus, and two bilateral openings for manipulating the laparoscope and other surgical instruments.
Each surgical option is determined by the seriousness of the underlying problem. In cases of endometriosis, enlarged uterine fibroids, and uterine cancer, the surgeon would prefer abdominal surgery. In other instances, laparoscopic surgery or vaginal incisions are preferred. Post-surgical recovery is longest (two-day hospitalization) in abdominal surgery and shortest (same day discharge) in laparoscopic surgery, and vaginal incisions leave no external scars.
Types of Hysterectomy
Hysterectomies are of several different types:
In a partial hysterectomy, only a portion of the uterus is removed, leaving the cervix intact. It is also known as subtotal hysterectomy.
Total hysterectomy removes the entire uterus and the cervix.
Hysterectomy and Salpingo-Oophorectomy
Here the uterus along with one or both of your ovaries and fallopian tubes are removed. Hormone replacement therapy is advised for those whose both ovaries are removed.
Post-surgical care and medication
After the hysterectomy, the patient is placed under medical supervision for an hour or two to observe for and tackle any possible unforeseen complications like bleeding and abdominal pain. Painkillers and antibiotics are administered on discharge.
The patient will be advised to avoid any strenuous activity, heavy lifting, or exercise that could strain the abdomen, and also to abstain from vaginal sex for at least a month and a half post-surgery.
Women above 40 who have undergone hysterectomy are advised to include soya bean (about 50gm) in their diet. Those who do not prefer hormone replacement therapy can include food rich in phytoestrogens such as carrot, papaya, tomato, watermelon.
Hysterectomy is a major surgery, no matter how it is done. You will have some pain and may need to stay in the hospital for a few days. After leaving the hospital, you need to take rest and take care of yourself, taking off for sometime from your job or household works. Because of the stitches in your vagina, you might experience some sorts of vaginal discharge or bleeding. Abstain from sex for few weeks after the surgery. Do not douche or put anything, such as tampon, into your vagina during this time. Contact you doctor if you have any of the following;
- Fever or chills
- Heavy bleeding or vaginal discharge
- Severe pain
- Redness or discharge from the abdominal cuts
- Problem with urination or bowel movements
- Shortness of breath or chest pain