Preparation for a hysterectomy

Usually you will arrive at a decision about whether to have a hysterectomy gradually and after you’ve tried other treatments. This may have involved several appointments at a hospital clinic as well as visits to your GP. More rarely, the decision has to be made quickly with little time for adequate consideration.

Many women welcome the operation; others view it with fear and dismay. It is only natural to feel apprehensive. Having a major operation does not affect only you as an individual, it also has an impact on your partner, your family and your employer. The better informed and prepared you all are beforehand, the less anxious you will be and the inconvenience can then be kept to a minimum for all concerned.

What happens at the clinic?

The decision in favour of hysterectomy is usually made jointly and involves not only yourself but also your partner, your GP and the hospital gynaecologist. Above all, you must feel that this is the best solution for your particular problem and that you will have no regrets afterwards. Depending on the nature of the problem, this will usually mean that you have given medical therapy a fair try as well as one of the other options such as endometrial ablation(page xx), the progestogen-containing intrauterine system (page xx) or, if you have fibroids, embolisation (page xx).

As discussed on page xx, there are several different types of hysterectomy and it is important to understand what type of operation is proposed and for what reason. It is important that the gynaecologist informs you about the risks of the operation and also whether he or she recommends removal of your ovaries.

You should leave the hospital clinic feeling that you have been adequately informed or, if not, that you have been given someone to contact within the hospital for more information or access to reading material. You should be told how long you can expect to wait for the operation and about the arrangements that will be made regarding admission. You need to find out roughly how long you will be in hospital and how long it will be before you are fully recovered from the operation, so that you can prepare your family and employer well in advance.

How long will you be in hospital?

This will depend on the type of operation you are having, your state of health and your home circumstances. Most women are ready to leave hospital three or four days after an abdominal hysterectomy but the hospital stay will be shorter if you are having a vaginal or laparoscopically assisted hysterectomy. It will be longer if there are any complications or if you have any additional health problems. Also, if the hysterectomy is being done for cancer, the operation itself and the recovery process may be more complicated.

The hospital staff need to be made aware of your home circumstances, for example, if you live alone or have a dependent elderly relative or very young children. However, as far as possible you will be expected to make your own arrangements for additional help where necessary. Where circumstances are particularly difficult, your GP or the social services department may be able to offer advice.

Getting back to work

How long this takes differs from person to person and depends on the type of work you do and the operation itself. It is usual to recommend a minimum of six weeks off work. Some women who have had vaginal or laparoscopically assisted hysterectomies may be ready to return to work earlier, although after an abdominal hysterectomy it may take up to three months to recover fully. Recovery is discussed more fully on page xx.

Getting ready for the operation

If you are in good health, there are no special preparations to be made before surgery but try not to overdo it! Many women tire themselves out doing a lot extra, at home or at work, before coming in to hospital and this has an impact on how easily they recover afterwards.

If you are overweight, you should have been advised to lose weight before the operation. This is sensible advice because not only is the surgery more difficult if you are overweight, but there is also a greater risk of complications – both from the operation itself and from the anaesthetic.

You must also try hard to cut down on smoking (or preferably give up altogether) to reduce your risk of a chest infection after the operation. A smoker’s cough makes your wound more painful and puts more strain on the stitch line and on your pelvic floor. Remember that hospitals operate a no-smoking policy so you won’t be allowed to smoke during your hospital stay.

If you suffer from health problems, such as asthma, diabetes or high blood pressure, it is important that the hospital doctors know what medications you normally take so that any necessary adjustments can be made during and immediately after the operation. Most treatments that you are taking already should continue but, if in any doubt, do ask the hospital staff.

Admission arrangements

In some hospitals women are admitted to hospital on the day before the operation but most have a pre-admission clinic that you attend a week or so in advance and then you are admitted on the day of the operation. Either way, the purpose is to complete a certain amount of paper work relevant to your admission, carry out a routine health check and ensure that you are fully informed about the nature of your operation.

Routine investigations may include a chest X-ray, ECG (to check for any abnormality of your heart beat) and blood tests. This will include blood for cross-matching (in case you require a blood transfusion during or after the operation). You will be given a Consent Form to read through and sign. This gives the gynaecologist permission to carry out the operation and you must be sure that you understand the nature of the operation and what you are consenting to. This is an opportunity to ask questions and to seek further clarification about any issues of uncertainty, for example, whether or not your ovaries will be removed.

The anaesthetic

Hysterectomy may be carried out under a general or a regional (epidural or spinal) anaesthetic. The anaesthetist will visit you before the operation to discuss the anaesthetic, check up on your general health and find out what medication you may be taking. He or she will explain what will happen and will want to know if you have any particular concerns. You may be offered a ‘pre-med’ to help you relax which may make you drowsy. It is usually a tablet or capsule taken about an hour before you are brought along for the operation.

On the day of the operation you will not be allowed anything to eat or drink. This is to keep your stomach empty because, if you are sick while under the anaesthetic, there is a risk that you might inhale your stomach contents into your lungs. A nurse from the ward as well as a theatre nurse or orderly will go with you to the operating theatre.

When you arrive for the operation, you will be connected to several routine monitors. These are to measure your pulse, blood pressure and blood oxygen level during the operation. You will have a drip put into the back of your hand or at the bend of your arm so you can be given fluids during and after the operation when you are unable to drink. It is also used to give drugs or a blood transfusion if necessary.

Waking up

You will wake up in the recovery area. The nurses and the anaesthetist will check to make sure that you are breathing well and that you have had enough pain-killers. Oxygen treatment will continue for some time after the operation because anaesthetics and pain-killers tend to reduce the normal blood oxygen levels.

A catheter is placed in your bladder during the operation to keep it empty and this is usually left in afterwards in case you have difficulty passing urine yourself. It is connected through the tube into a bag at the side of the bed. Measuring the amount of urine in the bag is a good way of checking that things are going well after the operation.

A drain may be left in the wound, either through the abdomen or, in the case of a vaginal hysterectomy, through the vagina, so any blood loss after the operation can be measured and to prevent it collecting in the pelvis.

Antibiotics are usually given just before or during the operation to reduce the risk of infection. Some people are allergic to certain antibiotics so it is most important that you tell the doctor before hand of any allergies that you have to any medication.

KEY POINTS

• Medical treatments should be given a fair try and other surgical options considered before deciding on a hysterectomy

   

• Hysterectomies may be carried out under a general or regional (spinal or epidural) anaesthetic

   

• Preparation for hysterectomy includes a detailed explanation of the procedures to be undertaken and a general health check, including blood tests

   

• The consent form gives the gynaecologist permission to carry out the operation and women must be certain about the details of what they are signing

   

• It is important that the hospital staff, especially the anaesthetist, are fully informed about any health problems, medications and allergies