Know What is Hysterectomy
A hysterectomy is a surgical procedure to remove the uterus. In some cases, the doctor will also remove the cervix, fallopian tubes, and ovaries. Hysterectomy is generally performed to treat conditions that can no longer be treated by other measures.
The uterus is an organ that plays an important role in the menstrual cycle and the fertile period. In addition, the uterus is also a place for the fetus to develop during pregnancy. If the uterus is removed, the menstrual cycle will stop and pregnancy will not occur. Early menopause can also occur if the ovaries are removed during a hysterectomy.
Types of Hysterectomy
Based on the part of the uterus that is removed, hysterectomy or surgical removal of the uterus is divided into several types. The type of hysterectomy that will be performed will be adjusted to the patient's condition. Here are some types of hysterectomy:
- Total hysterectomy
A total hysterectomy is a procedure that removes the uterus and cervix (cervix), but does not remove the ovaries. - Supracervical hysterectomy
A supracervical hysterectomy is a procedure that removes the upper part of the uterus, but does not remove the cervix. - Total hysterectomy with bilateral salpingo-oophorectomy
This procedure aims to remove the uterus, cervix, fallopian tubes and ovaries. - Radical hysterectomy with bilateral salpingo-oophorectomy
This procedure aims to remove the uterus, cervix, fallopian tubes, ovaries, upper part of the vagina, as well as some surrounding tissue and lymph nodes. This type of hysterectomy is performed when there is cancer in the area to be removed.
Indications for hysterectomy
A hysterectomy can be performed as a planned or emergency procedure. This procedure is performed to treat a number of conditions that cannot be treated by other methods. Some of these conditions are:- Menstruation with severe pain
- Heavy or abnormal vaginal bleeding
- Severe pelvic pain associated with uterine disorders
- Uterine prolapse or prolapse
- Disorders of the lining of the uterus, such as adenomyosis
- A benign tumor in the uterus, such as a myoma
- Endometriosis
- Uterine polyps
- uterine cancer
- Cervical cancer
- Ovarian cancer
- Endometrial cancer
Contraindications to Hysterectomy
There are several conditions that are not allowed or not recommended to undergo a vaginal hysterectomy, namely:
- Never given birth
- Undergoing pelvic radiotherapy
- Narrow vagina
- The uterus is very large
- Unmovable uterus
- Severe endometriosis
- Uterine adhesions
- Morbid obesity
Hysterectomy Warning
Before deciding to undergo a hysterectomy, consult with your doctor about the benefits and risks that may arise after undergoing a hysterectomy. In addition, the patient also needs to inform the doctor about the disease that is currently or has been suffered and the drugs that are being consumed
The way the doctor will perform a hysterectomy depends on the size, shape and position of the uterus, the patient's preferences, and the facilities available at the hospital.
Please note, patients who have undergone a hysterectomy cannot conceive and are no longer menstruating. Non-menopausal patients may also experience menopausal symptoms after having their fallopian tubes and ovaries removed.
Patients who have had a hysterectomy but have not had their cervix removed should undergo regular cervical cancer screening.
Before Hysterectomy
If the doctor declares the patient is ready to undergo a hysterectomy, there are several things that the patient must do first, namely:
Live a healthy lifestyle
Having a healthy body condition before undergoing surgery can speed up the recovery process and reduce the risk of complications. Therefore, the doctor will advise the patient to:
- Quit smoking
- Exercise regularly
- Eat a healthy and balanced diet
- Lose weight if you are overweight
Stop taking the drug
Consumption of certain drugs can also cause complications after surgery. Therefore, obey the doctor's advice regarding the consumption of drugs that may or should not be taken before surgery.
Generally, doctors will ask patients to stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, because these types of drugs can increase the risk of bleeding.
Undering inspection
Patients will also be asked to undergo pre-hysterectomy examinations, including:
- Blood tests and a thorough physical examination, to ensure the patient's condition is good enough for surgery
- Pelvic ultrasound, to see the size of myomas, polyps or cysts in the uterus or ovaries
- Cervical cytology (pap smear), to detect cancer or abnormal cells in the cervix
- Endometrial biopsy, to detect the presence of cancer or abnormal cells in the inner lining of the uterus
In addition to the things above, the doctor will also perform the following preoperative measures:
- Providing a special vaginal cleansing soap to reduce the risk of infection
- Ask the patient to fast from the night before the operation
- Cleaning the patient's vagina (douching) and rectum (enema)
- Give antibiotics intravenously to reduce the risk of infection
Hysterectomy Procedure
Before the hysterectomy is performed, the patient will be asked to change into a surgical gown. After that, the doctor will give anesthesia or anesthesia to the patient.
The anesthesia given can be in the form of general anesthesia so that the patient sleeps during the hysterectomy. Regional anesthesia can also be used to numb the patient's lower body, but keep the patient awake during the operation.
After the anesthetic has worked, the doctor will start a hysterectomy. This procedure can be done in three ways, namely:
1. Laparoscopic hysterectomy
This procedure is performed by first making several small incisions in the patient's abdominal and vaginal area. After that, the doctor will insert a small camera tube (laparoscope) through one incision, and insert surgical instruments through the other incision to remove the uterus.
2. Vaginal hysterectomy
In a vaginal hysterectomy, the doctor will make an incision in the upper part of the vagina. Next, a surgical instrument will be inserted through the vagina to release the uterus from the ligaments that hold it in place, then remove the uterus and cervix from the incision that has been made. After the uterus and cervix are removed, the doctor will sew up the incision.3. Abdominal hysterectomy
An abdominal hysterectomy is performed by first making an incision in the abdomen. The incision can be made vertically or horizontally, with a length of about 15-20 cm. Next, the doctor will remove the uterus through the incision. After the uterus is removed, the incision will be sutured. The length of the hysterectomy procedure depends on the type of hysterectomy performed and the size of the uterus to be removed. If the doctor also removes the fallopian tubes and ovaries, it will take longer. However, this procedure usually takes 1–3 hours.After Hysterectomy
After a hysterectomy, the patient will experience nausea or discomfort, but this is normal. To relieve these complaints, the doctor will prescribe pain relievers or anti-nausea drugs. The doctor will also provide other medical measures, such as:
- Put a bandage on the incision area
- Inserting an IV in the patient's arm as a route of administration of medication and fluid replacement
- Inserting a catheter as an outlet for urine from the bladder
- Inserting a tube in the abdomen of a patient undergoing an abdominal hysterectomy, to drain blood from the incision site
- Inserting gauze into the vagina of patients undergoing vaginal hysterectomy, to reduce the risk of bleeding
In some cases, patients who have undergone hysterectomy experience constipation and urinary tract infections. Therefore, the doctor will advise the patient to eat lots of fruits and foods rich in fiber, to help defecate. If needed, the doctor will prescribe laxatives.
To ensure that there is no bleeding, the doctor will monitor the patient's vital signs. The next day after surgery, the patient will be advised to walk to prevent blood clots in the legs or deep vein thrombosis.
Patients who undergo laparoscopic hysterectomy or vaginal hysterectomy can go home the same day or the next day after surgery. Meanwhile, in abdominal hysterectomy, the patient requires 2-3 days of hospitalization.
Please note, the patient's vagina will bleed for about 6 weeks after undergoing a hysterectomy. Therefore, patients are advised to wear sanitary napkins.After 5–7 days, the patient will be asked to check with the doctor at once to remove the stitches. Generally, patients need 6–8 weeks to fully recover after a hysterectomy.
Risks of Hysterectomy
Like any other surgical procedure, hysterectomy also has risks, including:
- Infection
- Heavy bleeding
- Allergic reactions to drugs
- Damage to the urinary tract, bladder, intestines, rectum, or pelvic tissues
- Blood clot
- Death, in rare cases
In addition to the above risks, hysterectomy can also lead to other risks, such as:
Early menopause
In patients who have had their ovaries removed, severe menopausal symptoms will generally appear after a hysterectomy, including:
- Anxious
- Disorders mood
- Heat sensation (hot flashes)
- Easy to sweat
To overcome these symptoms, the doctor will recommend hormone replacement therapy (hormone replacement therapy) in the form of implants, injections, or tablets.
Emotional disturbance
Some patients experience emotional disturbances after hysterectomy, such as not feeling like a full woman because they no longer have a uterus. In some cases, the patient may also experience depression.
Therefore, the doctor will advise the patient to consult a psychiatrist. If possible, patients can also share stories with other women who have had hysterectomies, to help overcome emotional disturbances.See a doctor immediately if you experience any of the following symptoms after a hysterectomy:
- Fever over 37°C
- Severe nausea or vomiting
- Blood discharge is bright red from the vagina
- Postoperative pain that gets worse
- Increased frequency of urination or difficulty urinating
- Pain when urinating
- The area of the incision is red, swollen and discharges fluid
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