Preparing for a hysterectomy?Â It’s not only about theÂ consultationsÂ and the decision to undergo aÂ hysterectomy. Preparing for a hysterectomy also includesÂ deciding which technique yourÂ surgeon will use, making sure your costs are covered and what you will need to do during the aftercareÂ procedure. Also importantÂ when preparing for a hysterectomyÂ is knowing what you need to do pre-op, the day you arrive for your stay in hospital and how much time you will need to take for home recovery,Â so you can prepare your family and book time off work.
Here’s what you need to know.
What Hysterectomy consultations will you need?
Generally, a woman is referred to a qualified gynecologist or a general surgeon by her family doctor because she has dysfunctional uterine bleeding (DUB) or pre-cancer (endometrial hyperplasia). Most often, the woman has experienced longstanding menstrual problems that have not responded to birth control pills, synthetic progestins (ProveraÂ® or MegaceÂ®), iron supplements, or tranexamic acid (CyklokapronÂ®). An ultrasound may or may not reveal the cause of the dysfunctional bleeding; 20% of cases have no known cause.
Hysterectomy is the last resort. The gynecologist will investigate your complaint with more detailed and possibly more invasive tests than the family doctor did, then make a recommendation for treatment. Hysterectomy is a permanent and irreversible treatment option.
Usually, a surgeon will not consider elective hysterectomy until a woman has reached 30 years old and she is certain of not wanting more children. This consideration is waived if cancer is diagnosed. You are not obliged to accept the recommended hysterectomy. Remember that you can always ask for time in which to get a second opinion.Â You can also ask the gynecologist to discuss alternative treatments that spare the uterus, such as endometrial ablation, myomectomy or uterine fibroid embolization and natural progesterone use. Not all doctors are aware of the benefits of usingÂ natural progesteroneÂ creams so if they don’t bring up the subject then you should!
If you decide to accept the hysterectomy, your gynecologistâ€™s will give you a â€˜pre-op packageâ€™ up to three months before the surgery. The package includes requisitions for bloodwork, urinalysis, a chest x-ray, and pelvic ultrasound. It contains consent forms, directions for aftercare and a schedule for follow-up. An appointment with the anesthetist will be scheduled, so that you can be evaluated for any problems that might arise with the anesthetic. If you smoke, take over- the-counter or prescription medication, herbs or vitamin supplements, tell the anesthetist because these could affect your reaction to the anesthetic. Bring the containers with you to your appointment.
You may also be booked in for a nursing consult. Your nurse will teach you about aftercare and danger signs, and this teaching will be repeated again after surgery to ensure you understand and retain it. Nurses realize that you are under considerable stress and your grasp of the material may not be as good as it might be under ideal circumstances.
Choice of technique for HysterectomyÂ
Most women who decide to accept hysterectomy opt for general anesthetic (complete unconsciousness), but sedation with a local anesthetic can also be used. It takes about one to threeÂ hours for an abdominal hysterectomy. The complication rate for abdominal hysterectomy is 9.3%. It takes about one or two hours for a vaginal hysterectomy, but this technique requires more skill than an abdominal approach. The complication rate for a vaginal hysterectomy is 5.3%. Most general surgeons can easily perform an abdominal hysterectomy with a vertical incision, but it requires an experienced gynecologist to perform a vaginal hysterectomy. It is more difficult for the surgeon to see the internal organs.
If your fibroid tumors are large or the uterus enlarged you may not be given the option of a vaginal hysterectomy, because it is not physically possible to remove the distended uterus through the vagina. Did you know that fibroids can reach the size of a large grapefruit?
It is very difficult to remove the ovaries through the vagina. An expertly skilled gynecologist may perform a laparoscopically-assisted vaginal hysterectomy (LAVH). The gynecologist makes tiny holes in the abdomen for a small camera and lights. The gynecologist removes the suspensory ligaments, pedicles, and ties off the arteries feeding the uterus through the tiny holes, and pulls the uterus out through a cut at the top of the vagina. The complication rate for an LAVH is 3.6%. Hospital time is reduced to one day and recovery time is only two weeks. However, LAVH is a fairly new technique and not every hospital has the equipment, nor every surgeon the skill to use it. LAVH takes about 120 minutes. Remember that if your surgeon experiences problems during an LAVH, he/she may abandon that approach and revert to a standard abdominal incision (10 cm to 15 cm).
The Cost of having a Hysterectomy
The price for a hysterectomy in Australia ranges from $2000 to $5,000 for a total abdominal hysterectomy, and from $1,700 to $5,100 for an LAVH. The high cost of disposables used in LAVH is off-set by the shorter hospital stay. You will require blood tests while in the hospital to monitor you for blood loss leading to anemia, infection, and hormonal fluctuations. Laboratory tests, pharmaceuticals and medical imaging are separate costs.
Costs are considerably higher in the United States and vary depending upon medical insurance coverage. It is highly recommended to find out the likely costs of the procedure prior to making a final decision.
Preparing for your absence
Hysterectomy is always performed at a hospital on an in-patient basis because it is major surgery; an out-patient procedure at a clinic is not an option. You must make provisions for dependent children for at least one week if you have an abdominal operation and for at least three days if you have a vaginal operation. You need to book a taxi or arrange for somebody to drive you home from the hospital.
You will convalesce at home for at least four more weeks, and possibly eight weeks in the case of an abdominal approach. During that time, you will not be able to perform motions that pressurize the sutures and pull muscles, such as vacuuming or lifting objects weighing more than five pounds. Explain to your family or house-mates that they must shoulder your household tasks while you recuperate to ensure a good outcome.
You must stop smoking two weeks before surgery. You cannot take Vitamin E, herbs, aspirin, and anti-inflammatories for two weeks before the surgery because these increase bleeding.
Also, ask your doctor if you must stop taking birth control pills, hormones, or CyklokaperonÂ® before the surgery because they could cause clotting.
Packing for your hospital stay
Bring one overnight bag. Pack a notebook and pen so you can jot down any instructions. Take along a package of sanitary napkins,
several pairs of cotton underwear, three nightshirts, a robe, and a pair of slippers. Bring a toothbrush and toothpaste, shampoo and conditioner, lip balm, deodorant, and moisturizer. You will need a hairbrush and ponytail holder (if you have long hair). Keep a phone- calling card and an emergency contact list. Remember that cell phones can interfere with patientsâ€™ telemetry, so you may be forbidden to use a cell within the hospital.
You may want a long pregnancy support pillow and a â€˜swelly belly bandâ€™ for comfort after your surgery. Bring your glasses, as you will not be allowed to wear contact lenses for the surgery. Wear low-heeled, slip-on shoes without laces so that your pelvis is stable and you do not have to bend to put them on. You may want to bring an anti-nausea pill, paper towels and a basin for the ride home.
Check-in at the hospital
When you arrive at the hospitalâ€™s Admitting Department, the clerk will register you, take your insurance information, give you an identification bracelet, and give you directions to the gynecology unit. The clerk will explain the hospitalâ€™s visiting and payment policies. It is best not to bring large sums of cash or jewelry, but the Admitting clerk can lock your valuables in a safe. Ask the clerk how much it will cost to get a copy of your chart, and where and when you can pick it up from Medical Records.
When you arrive on the in-patient floor, your nurse will record your vital signs (temperature, pulse, respiration, and blood pressure), height and weight. Your nurse will check your pre-op bloodwork, urinalysis, and medical imaging results. If there are any abnormalities or missing information, then the tests must be repeated. Your nurse ensures that Blood Bank has at least two units of suitable blood on hand for transfusion, in the event that you bleed excessively. If you have a temperature, heart arrhythmia, breathing difficulties, or high blood pressure, then your nurse notifies your surgeon and your surgery may be cancelled or postponed while you get appropriate treatment.
A physiotherapist or nurse-educator may teach you rehabilitative exercises to restore the tone of your abdomen and bladder after surgery. You can start isometric stomach muscle tightening about four weeks post-op. You should start leg lifts and sit-ups with knees bent about six weeks after your surgery, providing you will not have had a bladder suspension with the hysterectomy. If the surgeon works on your bladder or bowel during the hysterectomy, then you must wait 12 weeks before exercising.
The night before surgery, your nurse places your belongings in a bag labeled with your name. You must shower. A nursing assistant will shave your abdomen and groin. You will get a light dinner and then the nurse will place a sign over your bed reading â€˜NPOâ€™, which means you are to have nothing to eat or drink â€˜ not even waterÂ â€™ after midnight.
The nurse wants to ensure that your stomach remains empty to minimize the chance that you will inhale (aspirate) your own vomit during surgery. You may receive an enema and/ or stool softeners to clear out your bowel. If you wear dentures or glasses, your nurse will keep them in a safe place.
Feel free to ask your nurse questions about the upcoming surgery and aftercare, such as pain management and correct body mechanics to reduce pressure on your incision. Your nurse can arrange for you to see the hospital chaplain if you need spiritual reassurance.
What about post-hysterectomy aftercare?
Preparing for a hysterectomy also means preparing for what happens afterwards. Your nurse or physiotherapist will encourage you to get up and walk soon after the surgery to prevent pooling of body fluids and pneumonia. You can take a shower two days after your surgery. Barring complications, you probably can return to work in one or two months. You must return to have your surgeon remove your sutures in one or two weeks. Most women can resume exercising in six weeks.
Expect to have constipation for a week after the surgery. Keep the following supplies available at home: A thermometer; loose clothing; heating pads or hot water bottles; enough menstrual pads for one month; several pillows; a basin for vomiting; prune juice; MetamucilÂ® or another fiber laxative; ice chips and a water jug; pain- killers prescribed by your doctor; a multi-vitamin and mineral pill recommended by your doctor or pharmacist.
You may benefit from the extra support of an elastic pressure bandage or surgical garment for six weeks. You must wear it day and night for two weeks to reduce swelling and help prevent skin sagging. Then for the next four weeks, just wear it at night. Massage the area daily to prevent contour irregularities from developing. The final shape of your abdomen following the hysterectomy will not appear for three months to one year. Expect some weight gain.
You will require a follow-up examination six weeks after surgery.
Surgery always produces bruising, swelling and scarring to some degree. Hence, you may be disappointed if you expected an immediate flattening of your abdomen. Your abdomen may be numbed or you may have diminished sensation for up to a year because nerves are severed. You must wear absorbent dressings for the first 24 hours after surgery, because your wounds will drain a combination of blood and injection fluid. Expect to bandage your wounds for two weeks thereafter.
You may desire skin removal for cosmetic reasons, if your abdomen was very enlarged, to prevent sagging after the hysterectomy. This cosmetic procedure will present an additional cost and will likely be done as a separate follow-up procedure, rather than at the time of the hysterectomy. If you had a vertical incision, the red, raised scar will gradually fade and flatten over the next six months.
Wear silicone sheet over the scar for two months and avoid sun exposure for six months so the scar will not become darkly pigmented.
Avoid lifting more than five pounds during your recovery period. You cannot perform duties like vacuuming that will strain your incision.
Avoid stair-climbing, driving, and standing for prolonged periods. Avoid taking aspirin and alcohol with your prescription pain-killers. If you spike a temperature of 100.6Â°F or 38.1Â°C, or experience severe pain, redness, drainage, swelling, or bleeding at the incision site, then call your doctor.
When can I resume sexual relations?
Generally, you can resume penetrative sex after your six-week check-up. If you have stopped bleeding after four weeks, then you can have non-penetrative sex. Do not be surprised if your desire (libido) is low after major surgery with a rapid hormonal drop, especially if the ovaries are removed. Your libido can be enhanced with a testosterone cream likeÂ AndroFeme, providing your doctor approves.
71%Â of women are greatly relieved after a hysterectomy because their debilitating symptoms, such as heavy menstrual bleeding and fatigue, disappear.
Some women develop sexual dysfunction after hysterectomy.
If the vagina is shortened to remove cancer, penetration by a penis or even a finger can be uncomfortable or painful. If your cervix is removed, you may find it difficult to reach orgasm because you miss cervical tapping by a penis or finger. If your ovaries are removed, you may find it impossible to produce enough estrogens for natural lubrication, and may need to use a water-soluble lubricant for the first time.
Your sex partner needs to be educated about different positions, angle of penetration, and alternative methods of stimulation, in case you find penetration difficult. Also diminished levels of the hormone testosterone can radically affect sexual desire and lower libido.
Some women develop psychological issues surrounding hysterectomy. They feel unfeminine and mourn their loss of childbearing ability.
Speaking to a licensed psychologist or accredited sex therapist who is experienced with hysterectomy can help. Most medical insurance plans do not provide reimbursement for sex therapy, even though the sexual dysfunction resulted from surgery.
Sex therapy costs up to $300 per session, so ensure your sex therapist has proper credentials:
- In Australia, sex therapists are certified by theÂ Australian Society of Sex Educators, Researchers and Therapists National (ASSERT)
- In the U.K., sex therapists are accredited by theÂ British Association for Sexual and Relationship Therapy (BASRT)
- In the U.S.A. and Canada, sex therapists are certified by either theÂ American Association of Sex Educators, Counselors and Therapists
Verify with the appropriate governing body that your sex therapist is a member in good standing before your treatment begins.
Understand more on Hysterectomy:
The information in this article has been taken with permission from the official Lawley booklet onÂ Understanding Hysterectomy.