After the operation

The first 24 hours

Recovering from an operation is a different experience for everyone. At least you can feel relief that it is all over. Initially you will most probably have a drip in your arm, a catheter in your bladder and possibly a wound drain. If you had an epidural anaesthetic, the epidural tube may still be in place in your back. All these tubes will gradually be removed as your recovery progresses and you become more mobile.

Pain relief

Pain relief depends on what type of operation you had; an abdominal hysterectomy involves an incision that is more painful than a vaginal hysterectomy. Initially you are given strong pain-killers such as morphine (known as opiates). This is often given by a method known as “patient controlled analgesia” which enables you to give yourself small extra doses whenever you need to by pressing a button on a small machine that controls the flow of pain-killing drug through the drip in your arm. Additional pain-killers may be given if required.

You must try to move around too, even though it hurts, because this helps to prevent complications such as blood clots or chest infections. Try to take an occasional deep breath and cough if you feel like it. If you have had a spinal or epidural anaesthetic you will have no pain until the anaesthetic wears off. You will have to tell the nurses as soon as you feel any discomfort as the pain may build up quite quickly.

When you no longer need powerful pain-killers and are able to move around, you’ll be given milder and less frequent pain-killers instead. Taking these regularly is more effective than waiting until the pain gets too bad. Nausea and vomiting can be a problem, particularly if you are prone to travel sickness or have had the same problem with previous anaesthetics. Modern treatments are much better than older drugs so sickness should not be a big problem for most people.

The next 24 to 48 hours

You are not usually allowed to drink or eat on the day of the operation. You should be able to drink fluids on the day after the operation and to eat by the second day. Following surgery, the bowel tends to become rather sluggish, and this can cause nausea, flatulence and constipation. Painful passage of wind plagues many women after hysterectomy but fortunately this is a very temporary problem. Passing urine may feel strange initially and this is normal, but you should let the nurse know if it feels sore or if you have a frequent urge to pass small amounts of urine as this may be a symptom of a urinary tract infection.

On the first day after the operation you will be allowed up to sit in a chair. You will be taken to the bathroom for a shower on your second day. If you have had a vaginal or laparoscopically assisted hysterectomy, you will be able to get up sooner. Movement is important after an operation because it helps to relieve pain and stiffness and also helps to prevent deep vein thrombosis (blood clots in the legs). As there is a risk of this after a hysterectomy, you may have to wear strong supporting tights or stockings, and some women are given injections of an anti-clotting drug called heparin. At this stage, you will still require pain-killers and you should take them regularly in order to prevent a sudden build-up of pain as the effects wear off.

The staff team

A team of nursing staff will look after you during your stay in the ward, liaise with your relatives and help you to plan your discharge home. Take every opportunity to ask questions; the staff are there to help. There is also a team of doctors, headed by a consultant, and one of them will visit you every day to assess your progress and answer any questions that you might have. The gynaecologist who performed your operation will give you information about the operation itself. Make sure that you are clear about whether you still have your ovaries and, if not, whether and when you should start hormone replacement therapy. The physiotherapist will come and give you advice about mobility and a routine of gentle exercises which you should do regularly to assist your recovery.

The pathology report

The uterus and any other organs that have been removed are examined by a pathologist as a matter of routine and the report is filed in your case notes. Unless an urgent report is requested, it takes seven to 10 days for it to be completed, by which time you will have gone home. However, your GP is usually informed of the result in the discharge letter that is routinely sent out, summarising your hospital stay. If you want to know the results as soon as possible, you can arrange to contact a member of the hospital staff at the appropriate time.

Going home

Minor complications are common after hysterectomy (see page xx). Most are easily treated and should not unduly prolong your stay in hospital. Most hospitals have a very flexible policy about when you can go home. If you have good home support you will be allowed home as soon as you feel well enough. After a laparoscopically assisted or vaginal hysterectomy this may be as early as the first or second post-operative day, but is usually three or four days after an abdominal hysterectomy. If there are abdominal sutures or staples to be removed, arrangements can be made for this to be done as an outpatient or by the district nurse. Often dissolving sutures are used which do not require removal.

The early recovery period

It is usual to feel very tired and rather ‘low’ in the early days and even weeks; an operation is very stressful both physically and emotionally and you will need plenty of rest. You probably won’t feel up to anything more than light reading, listening to music and watching television, and you should avoid taking on household or family responsibilities until you feel able to cope. There may also be times during the recovery period when you feel rather depressed or emotional, which is a perfectly natural reaction that will pass.

Return to normal activities

When it comes to physical activities, take it slowly, but you should be able to bath, shower, walk up and down stairs, and make drinks and light snacks by the end of the first week. Make a real effort to do the exercises prescribed by the physiotherapist on a regular basis. By the second or third week you can go out for short walks, go shopping (but don’t carry heavy bags or push a trolley) and make light meals.

You can start to swim and drive by the fourth or fifth week and do light housework. Within six to eight weeks you should be getting back to all your normal activities, including work and sport. You can start to resume your sex life if you feel ready but take it slowly. Your partner is likely to feel equally apprehensive!

If you are still experiencing bleeding or any abnormal discharge six weeks after the operation, it is best to delay having full intercourse until you have seen your doctor. Similarly, if you experience bleeding or unusual discomfort when you first start having intercourse, this might be a sign of infection or delayed healing and you should contact your doctor in order to arrange an internal examination.

Common problems

Problems can arise after discharge from hospital. Pain and discomfort are inevitable after an operation and you should have been prescribed some pain-killers, which you’ll probably need to take for up to two weeks after the operation.

Your pain should gradually lessen during this time but there will be times when you are aware of it, for example, when you are tired or have been more active than before. If your pain worsens for no obvious reason and you feel unwell and develop a fever, you should contact your doctor as this may be a sign of infection.

Urinary problems may occur. If you have any difficulty passing urine you must contact your doctor. Symptoms such as burning and a desire to pass urine very frequently may mean that you have developed an infection; you should drink plenty of fluids and arrange to have a sample of urine tested. Bowel problems are extremely common and are in part related to the operation itself and also to the upset in your normal diet and routine. They will gradually settle as you return to normal.

Muscle tone is temporarily reduced following an operation, for example you may notice that your tummy bulges out. Similarly the muscles of the pelvic floor become rather slack, hence the importance of doing the regular pelvic floor and abdominal wall exercises shown to you by the physiotherapist.

Emotional symptoms may occur in addition to the physical problems described above. These are usually just a short-lived reaction to the stress of the operation. It’s normal to feel tired and lethargic for some time after surgery. Emotional symptoms following removal of the ovaries and other symptoms of the menopause can be treated with HRT.

Problems with the scar

An abdominal scar may cause problems such as discomfort, lumpiness, bruising and slight stickiness or discharge. It is normal for the skin area above the scar to feel numb because some of the nerves supplying the skin were cut. Nerves are extremely slow to heal so the numbness will persist for many months. Odd skin sensations and even sharp pains around the scar are common during the healing process.

If the wound becomes very red, tender and hot, this is usually the result of a wound infection and you should contact your GP as you will need antibiotics. After a wound infection there may be a heavy discoloured or offensive discharge from the wound and you will need help from the district or practice nurse. Minor wound discharge does not require any special attention other than a clean dressing.

There is also likely to be some dark-brown discharge from the stitch line at the top of the vagina and this can last for two to three weeks. If it becomes heavy, offensive or bright red this may be a sign of infection and you should contact your doctor. It’s better to use sanitary pads rather than tampons during this time, to reduce the risk of infection.

The postoperative check

It used to be recommended that women were seen back at the hospital six weeks after a hysterectomy for a check-up and internal examination. This no longer takes place routinely but, if the hospital does not arrange an appointment, you will be advised to see your general practitioner after six weeks for a check-up. This will give you the opportunity to discuss any concerns.

By six weeks after the operation you should be well on your way to full recovery, and the abdominal scar and the scar at the top of the vagina should have healed completely. Any bleeding or discharge should have settled. If you are still experiencing any bleeding or abnormal discharge you should tell your doctor.

He or she will carry out an internal examination to check for signs of infection and to inspect the vaginal scar. Sometimes, so-called ‘granulation tissue’ may form. This is a minor complication of the healing process and is easily treated. It may also cause bleeding and discomfort on intercourse, so do not panic if you experience these problems; there is usually a simple explanation.

If you have had your ovaries removed and have started HRT, the doctor will want to find out if you are experiencing any problems with it. If you have not yet started HRT, this will be an opportunity to discuss whether and when you should start it and which preparation would be most suitable for you. Your doctor will have a written summary of your operation and your stay in hospital and the result of the pathologist’s examination of your uterus, and should be able to answer any questions that you may have. You will also need to discuss your plans for return to work.

KEY POINTS

Nausea, vomiting and pain are common early on, but medication will be given to relieve these problems
Movement is particularly important after an operation because it helps to prevent stiffness, pain and venous thrombosis
An abdominal hysterectomy involves on average three to five days in hospital, varying according to general health and individual circumstances
Most women can drive a car after three to four weeks, and return to work after six to twelve weeks, depending on their speed of recovery and the nature of their work
Women can expect to return to a normal sex life after a hysterectomy