The Different Types of Hysterectomy
Women who undergo abdominal hysterectomy have their uterus removed through an incision in the lower abdomen. Usually a doctor will also remove one or both ovaries and the fallopian tubes during this procedure.
There are other types of hysterectomies that a doctor may use including laparoscopic assisted vaginal hysterectomy and vaginal hysterectomy.
Like an abdominal hysterectomy, a vaginal hysterectomy involves removal of the uterus. With vaginal hysterectomy the uterus is removed from the vagina instead of the abdomen. During a vaginal hysterectomy your doctor may decide to remove the ovaries and fallopian tubes as well as the uterus depending on your specific health condition.
Vaginal hysterectomy is usually a choice for women whose uterus is not enlarged or if any problems associated with the uterus are limited to the uterus and not the surrounding organs.
Vaginal hysterectomy has many advantages over abdominal hysterectomy including:
- Shorter hospital stay
- Fewer complications
- Faster recovery time
- No abdominal skin incision
- Less pain and discomfort
Laparoscopic assisted vaginal hysterectomy (LAVH) offers some patients an alternative to abdominal hysterectomy. It is possible to accomplish a vaginal hysterectomy with the assistance of the laparoscope when vaginal hysterectomy may have been contraindicated secondary to pelvic adhesions, thus avoiding the risks and pain of an abdominal incision. The laparoscopy can help your doctor remove any scar tissue that may exist on reproductive organs, facilitating removing the uterus through the vagina.
Sometimes while performing a laparoscopic assisted vaginal hysterectomy your doctor may find scar tissue that spans many areas. If this is the case, your doctor may decide that an abdominal hysterectomy makes more sense than a vaginal one. Your doctor may discover this after surgery has begun.
Before discussing the hysterectomy, it is important you understand how the female reproductive system works.
Biology of the Reproductive System
The most well-known organ of the reproductive system is the uterus. Often referred to as `pear shaped` the uterus resides in the pelvis or lower abdomen. The uterus is connected with the fallopian tubes toward the top of the uterus and to the ovaries by ligaments on the sides of the uterus. The cervix lives at the base of the uterus and protrudes into the top portion of the vagina.
During your reproductive years your ovaries release an egg every month. This egg passes through the fallopian tube and will fertilize if sperm is available. If the egg is fertilized it implants in the uterine lining and pregnancy results. If the egg is not fertilized however, the lining sheds and you start your menstrual period. The menstrual period is nothing more than blood and tissue that collects inside your uterus as your body prepares for fertilization and pregnancy.
The ovaries are not just egg laying machines. They also produce hormones including estrogen and progesterone, which help keep the body efficiently functioning during the reproductive years. During menopause, the ovaries stop producing hormones and eggs. Eventually your monthly menstrual period stops.
Reasons for Hysterectomy
Fibroids: Many women have fibroids, a condition where tumors form in the uterus. These tumors are not cancerous but can cause pain and dysfunctional uterine bleeding. Large fibroids can put pressure on your back, and give you a chronic lower back pain. Pressure on your bladder from large fibroids can give you a feeling of urgency and that you have to urinate all the time. Fibroids may cause pain with intercourse, called dyspareunia. Many hysterectomies are performed when chronic symptoms associated with fibroids become a problem.
Uterine bleeding: Some women have irregular and abnormal uterine bleeding that calls for a hysterectomy. Abnormal uterine bleeding or dysfunctional uterine bleeding is associated with irregular, heavy, or severe bleeding from the uterus. It can be caused by fibroids or changes in your hormonal production. Cancer of the uterus and an infection of the uterus can also cause abnormal uterine bleeding. Hysterectomy is an option for abnormal uterine bleeding if conservative measures do not help.
Pelvic relaxation: For some women the pelvic muscles and ligaments weaken over time resulting in prolapse of the pelvic organs, such as the bladder, uterus, rectum and intestines. The ligaments that support these structures become weakened with age, chronic cough, obesity or after childbirth. In severe cases you may see your uterus sticking out through the opening of the vagina. The symptoms of pelvic relaxation include a bearing down feeling, a pressure sensation or pelvic pain and problems with controlling your urine. A hysterectomy may be needed to correct the symptoms you are experiencing from pelvic support problems. At the time of hysterectomy many other surgical procedures can be performed to help improve your symptoms cause by pelvic relaxation.
Cervical abnormalities: Changes of the cervix that may lead to cancer found by a pap test can be treated successfully without a hysterectomy, but when the cervical changes become more serious such as invasive cancer a hysterectomy as well as radiation may be needed to control the disease. Hysterectomy may be the only way to stop the cancer from spreading into other organs.
Adnexal mass: This is a condition where a mass or tumor grows in the ovaries or fallopian tubes. If the tumor is just in the ovary a hysterectomy is not needed, but if the tumor involves endometriosis or adhesions as well as the ovary a hysterectomy may be necessary for definitive therapy.
Cancer: Cancer affecting the uterus or ovaries may call for a hysterectomy.
Chronic pain: Some women experience chronic pain in the uterus and pelvis. This may result from endometriosis, or scarring of pelvic organs. A hysterectomy may be performed to help relieve this pain.
Talking With Your Doctor about Hysterectomy
If you decide to undergo an abdominal hysterectomy it is vital you discuss the pros and cons with your doctor. You want to be clear about the risks and advantages of removing all or portions of the reproductive organs.
Oophorectomy: An oophorectomy is removal of both ovaries through surgery. Many women have this performed along with a hysterectomy. Your doctor may ask you if you want your ovaries intact or if you want them removed with your uterus. If you keep your ovaries, your body will still be able to produce natural estrogen and progesterone. Thus you may not need hormonal replacement therapy after the hysterectomy. If you have additional problems however that affect the ovaries, you may need to remove your ovaries regardless.
Most women have the ovaries removed if they are post menopausal, as the ovaries do not produce significant amounts of hormones anyway at this age.
Supracervical Hysterectomy: This procedure, sometimes called a subtotal hysterectomy allows a partial removal of the uterus. In this case the uterus but not the cervix is removed. There are many different reasons your doctor may leave the cervix. Some women feel that the cervix contributes to sexual satisfaction, thus prefer to leave it.
This procedure is also done sometimes when a hysterectomy is performed as an emergency to save a mother who is having a severe postpartum hemorrhage. It is important that women realize if the cervix remains intact their risk for cervical cancer remains higher than in a woman who has a complete hysterectomy.
Complications Associated With Hysterectomy
There are some complications with hysterectomy as there are with any surgery. The most common complications include:
- Excessive bleeding or hemorrhage: this occurs rarely and may result in a blood transfusion
- Infection: many women develop a fever after a hysterectomy. Sometimes this results from an infection that must be treated. Serious infections are a rare complication.
- Damage to surrounding organs: the organs surrounding the uterus may be damaged during a procedure. This includes the bladder or ureters.
- Urinary retention: some women are not able to pass urine after this procedure. Usually if this happens your doctor can insert a catheter to alleviate the problem. This problem is usually short-lived.
- Thromboembolism: this involves formation of a clot in a blood vessel. This is a risk with many surgeries. Usually this risk can be minimized with early ambulation after surgery or the use of low dose heparin.
Recovery from a Hysterectomy
Most women will stay in the hospital two to three days after a hysterectomy. It usually takes several weeks to fully recover from the surgery.
Your doctor may provide fluids and food shortly after surgery, though many women experience nausea or vomiting the first day after surgery. If this happens your doctor may recommend intravenous fluids to be continued until the nausea passes. There are many antiemetic medications that help with post operative vomiting.
Once you are discharged you can usually resume normal activities as soon as you are comfortable doing so. Your doctor will prescribe pain medications to help relieve pain you may experience at home.
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