Hysterectomy | Women’s Health Concern

Hysterectomy means the surgical removal of the uterus (womb) and is still one of the most common operation. For some women, especially those who suffer from heavy periods, having a hysterectomy comes as a welcome relief. For others, being told they need the operation is a major shock. Usually other treatment options for your heavy periods will have been tried before a hysterectomy is suggested.

Reasons for having a hysterectomy

There are many different reasons why hysterectomy may be necessary. These include:

• Painful, heavy or frequent periods which are not improved with medical treatments
• Fibroids – Swellings of abnormal muscle that grow in the uterus, which can cause painful, heavy periods or pressure on other pelvic organs
• A prolapsed womb, which is caused by the dropping of the uterus.
• Endometriosis, a condition where tissue segments from the womb attach and grow in the wrong place, causing pain
• Adenomyosis – the same problem as endometriosis, but affecting the muscle of the womb
• Severe, recurrent or untreatable pelvic infection
• Cancer or precancerous changes in the vagina, cervix, uterus, fallopian tubes or ovaries

Very rarely, hysterectomy is performed as an emergency procedure, such as if bleeding becomes uncontrollable during childbirth. Usually though, the operation is planned.

Kinds of hysterectomy

There are several different types of operations. A total abdominal hysterectomy, is when both the body of the uterus and and cervix (neck of the uterus) is removed. A subtotal hysterectomy removes the body of the uterus but not the cervix. . In cases of cancer, an extended or radical hysterectomy may be performed. This involves removal of the womb, fallopian tubes and ovaries, and the upper part of the vagina. A vaginal hysterectomy is where the hysterectomy is performed through the vagina instead of through an abdominal incision. When the uterus is prolapsed it is often removed through the vagina by means of a vaginal hysterectomy, which leaves no abdominal scar. Some surgeons prefer to do a vaginal hysterectomy even in the absence of prolapse. Laparoscopic hysterectomy is known as keyhole surgery and the uterus (and sometimes the tubes and ovaries) is removed though four small incisions or cuts on the abdomen.

Whichever way the operation is done, if the ovaries are removed as well as the womb, a woman no longer produces the female sex hormone oestrogen and Hormone Replacement Therapy (HRT) should be considered, especially for women under the age of 50.

Effects

• After the operation you will no longer have periods or be able to get pregnant.
• Menopausal symptoms may not occur until later, unless the ovaries have been removed. The menopause, which normally occurs at about the age of 50, may arrive a little earlier following a hysterectomy.

Common Myths

Before the operation friends may warn that you might get fat, grow facial hair, become depressed, and nd it dif cult to make love properly again.

These common myths about hysterectomy are simply not true. However, women sometimes feel a sense of loss when their womb is removed. A proper understanding of why the hysterectomy is necessary may help.

Don’t be afraid to ask about alternatives to hysterectomy for heavy bleeding, such as endometrial ablation or a Mirena coil and don’t agree to the operation until you understand why it is necessary.

How will I feel after the operation?

After the operation you may have an intravenous drip for uids or occasionally blood. You may also have a catheter to drain urine.

If your operation is performed through an abdominal incision, the wound will be held together with clips or stitches. There will still be some stitches with laparoscopic surgery. The internal stitches used in vaginal hysterectomy will dissolve naturally. The wound will heal in a week or so but internal surgery will take longer. This is why the recovery period can take up to twelve weeks.

Recovery

The day after your hysterectomy you will be encouraged to stand and have a short walk. You should be allowed home from hospital after a few days if you have had an abdominal hysterectomy or after 48-72 hours if you have had a vaginal hysterectomy. If the operation has been done via keyhole surgery, you may be able to go home on the same day or the next day. You will still need to rest and recover at home. Talk to your doctor about resuming activities after keyhole surgery,

While recuperating at home, you will be advised to rest and avoid lifting heavy weights. You should be able to drive a car or go swimming about six weeks after the operation. By the fth or sixth week you should be starting to get back to normal. You should gradually increase your activity much like an athlete recovering from an injury. It should be possible to return to work soon after the post-operative check up, six to eight weeks after leaving hospital. It is usual to feel unexpectedly tired in the second month after the operation, but this does not last.

There is no reason why you should gain weight after a hysterectomy.

It is common to feel numbness around abdominal scar. Sometimes, the feeling comes back after a few weeks, but in some women the area remains numb for much longer.

Gentle sexual intercourse should be possible by about the sixth week after the operation. Some women feel more relaxed about lovemaking once the fears of pregnancy or unpleasant symptoms have gone. Others might feel the point of sex has been removed, and experience a psychological loss of libido. If problems remain after several months, psychosexual counselling may help you achieve a relationship that’s as good as or even better than before.

We know that the ovaries, even after the menopause, continue to secrete androgen, and these hormones are very important in maintaining libido in women. Removing the ovaries during a hysterectomy denies a woman, whatever her age, this sexual stimulant. However, if testosterone therapy is taken after the operation some women notice that their sex drive returns to what is normal for them.

A few women will feel low in mood and lethargic after a hysterectomy. They may need a period of time to mourn the loss of their womb. Sometimes it is dif cult for friends and family, or even your partner, to understand a woman’s feelings about the operation. It is important to talk to your partner about your feelings and accept help and support from elsewhere if necessary.

Obstetrics & Gynecology of Atlanta

Hysterectomy is considered the ultimate cure for many conditions that affect the uterus but is nevertheless a major surgical procedure. Alternatives to hysterectomy are considered thoroughly before a hysterectomy is recommended. Nevertheless, hysterectomy is one of the most common surgical procedures done in this country

What is a hysterectomy?

Simply, hysterectomy means removing the uterus. Partial hysterectomy means that part of the uterus is removed, the part that contains the lining and is responsible for most causes of bleeding. Total hysterectomy means removing the entire uterus. That means the lining and the cervix.  Removing the uterus, whether total or partial, does not mean that the ovaries are removed. When appropriate the ovaries may be removed at the time of a hysterectomy, but not always. After any type of hysterectomy a woman is no longer able to become pregnant.

Why would I have a hysterectomy?

Hysterectomy may be done to treat many conditions that affect the uterus:

• Uterine fibroids
• Endometriosis
• Pelvic support problems (such as uterine prolapse)
• Abnormal uterine bleeding
• Cancer
• Chronic pelvic pain

Hysterectomy is major surgery, and as with any major surgery, it carries risks. For many of the problems listed previously, other treatments can be tried first.

How is a hysterectomy done?

A hysterectomy can be done in different ways. The way a hysterectomy is performed depends on the reason for the surgery and other factors, including your general health. Sometimes it is not possible to know before the surgery how the hysterectomy will be performed. Conditions which can not be assessed prior to the surgery can influence which technique would be the safest. The following video shows a robotic hysterectomy being performed by Dr. Genevieve Fairbrother.

Vaginal Hysterectomy

In a vaginal hysterectomy, the uterus is removed through the vagina. With this type of surgery, you will not have an incision on your abdomen. Because the incision is inside the vagina, the healing time may be shorter than with abdominal surgery. There may be less pain during recovery. Vaginal hysterectomy causes fewer complications than the other types of hysterectomy and is a very safe way to remove the uterus. It also is associated with a shorter hospital stay and a faster return to normal activities than abdominal hysterectomy.

A vaginal hysterectomy is not always possible. For example, women who have adhesions from previous surgery or who have a very large uterus may not be able to have this type of surgery.

Abdominal Hysterectomy

In an abdominal hysterectomy, the doctor makes an incision through the skin and tissue in the lower abdomen to reach the uterus. The incision may be vertical or horizontal.

This type of hysterectomy gives the surgeon a good view of the uterus and other organs during the operation. This procedure may be chosen if you have large tumors or if cancer may be present. Abdominal hysterectomy may require a longer healing time than vaginal or laparoscopic surgery, and it usually requires a longer hospital stay.

Laparoscopic Hysterectomy

In a laparoscopic hysterectomy, a laparoscope is used to guide the surgery. A laparoscope is a thin, lighted tube with a camera that is inserted into the abdomen through a small incision in or around the navel. It allows the surgeon to see the pelvic organs on a screen. Additional small incisions are made in the abdomen for other instruments used in the surgery.

There are three kinds of laparoscopic hysterectomy:

1. Total laparoscopic hysterectomy — A small incision is made in the navel for the laparoscope, and one or more small incisions are made in the abdomen for other instruments. The uterus is detached from inside the body. It then is removed in small pieces through the incisions, or the pieces are passed out of the body through the vagina. If only the uterus is removed and the cervix is left in place, it is called a supracervical laparoscopic hysterectomy.
2. Laparoscopically assisted vaginal hysterectomy (LAVH) — A vaginal hysterectomy is done with laparoscopic assistance. For example, the ovaries and fallopian tubes may be detached using laparoscopy, and then the uterus is detached and all of the organs are removed through the vagina.
3. Robot-assisted laparoscopic hysterectomy — Some surgeons use a robot attached to the laparoscopic instruments to help perform the surgery. It allows for more complex cases to be performed in a minimally invasive fashion allowing for faster patient recovery. Please review the section under robotic surgery.

Laparoscopic surgery has some benefits over abdominal surgery:

• The incisions are smaller, and there may be less pain.
• The hospital stay after laparoscopic surgery may be shorter.
• Quicker return to normal activities.
• The risk of infection is lower.

There also are disadvantages. It often takes longer to perform laparoscopic surgery compared with abdominal or vaginal surgery. The longer you are under general anesthesia, the greater the risks for certain complications. Also, there is an increased risk for bladder injury in this type of surgery.

Preparing for a hysterectomy

It is helpful to know what to expect before any major surgery. A physical exam is performed a few weeks before your surgery. Within 2 weeks of the surgery a Preop Appointment is scheduled with your physician to discuss and finalize plans for the type of hysterectomy to be performed and to be certain all questions are addressed.

Lab tests may be done at or after the preop appointment. A chest X-ray or electrocardiography (ECG) may need to be done for some patients.

Before any major surgery the use of all medications, including over the counter medicines, vitamins and supplements is reviewed to determine how they will affect the surgery. Some medications and supplements can cause complications during the surgery and may be discontinued on the day of surgery or earlier.

A laxative may be recommended before the day of surgery. Eat lightly the day before.

DO NOT EAT OR DRINK ANYTHING FOR 8 HOURS PRIOR TO SURGERY UNLESS SPECIFICALLY INSTRUCTED BY YOUR DOCTOR.  

Some medications are given on the morning of surgery with a sip of water only.

On the day of surgery, the following things may happen:

• A needle is placed in the arm, wrist, or hand. It is attached to a tube called an intravenous (IV) line that will supply fluids, medication, or blood.
• An antibiotic to prevent infection.
• Special stockings or devices may be placed on the lower legs to prevent deep vein thrombosis (DVT). This condition is a risk with any surgery. Women at high risk of DVT may be given a drug to prevent blood clots from forming in the legs.
• Monitors will be attached before anesthesia is given. Either general anesthesia, which puts you to sleep, or regional anesthesia, which blocks out feeling in the lower part of your body will be used before the surgery begins.
• Pubic hair may be clipped. You may be awake or asleep while this is done.
• Before you are given anesthesia, you likely will be asked to state your name, the type of surgery you are having, or other information. This standard procedure, called a “time-out,” is done to ensure that the right surgery is being done on the right patient.
• A thin tube called a catheter will be placed in your bladder after you are comfortable. The catheter will drain urine from your bladder during the surgery.

What are the risks?

Hysterectomy is one of the safest surgical procedures. But as with any surgery, problems can occur:

• Infection
• Bleeding during or after surgery
• Injury to the urinary tract or nearby organs
• Blood clots in the veins or lungs
• Problems related to anesthesia
• Death

Some problems related to the surgery may not show up until a few days, weeks, or even years after surgery. These problems include bowel blockage from scarring of the intestines or formation of a blood clot in the wound. These complications are more common after an abdominal hysterectomy.

Some people are at greater risk of complications than others. For example, someone with an underlying medical condition may be at greater risk for problems related to anesthesia. An assessment of risks for complications is made prior to surgery and preventive measures are taken. These risks are discussed with the doctor at the preop appointment.

Recovery

After a hysterectomy, a person may need to stay in the hospital for a few days. The length the hospital stay will depend on the type of hysterectomy and how it was performed.

A person is urged to walk around as soon as possible after your surgery. Walking will help prevent blood clots in the legs. They may receive medicine or other care to help prevent blood clots.

A person can expect to have some pain for the first few days after the surgery. They will be given medication to relieve pain. It is common to have some bleeding and discharge from the vagina for several weeks. Sanitary pads can be used after the surgery.

During the recovery period, it is important to follow recovery  instructions carefully to allow proper healing. Be sure to get lots of rest, and do not lift heavy objects until your doctor says you can. Do not put anything in your vagina during the first 6 weeks. That includes douching, having sex, and using tampons.

Your doctor will help plan your return to normal activities. Slowly increase activities such as driving, sports, and light physical work. If you can do an activity without pain and fatigue, it should be okay. If an activity causes pain, discuss it with your doctor.

Even after your recovery, you should continue to see your health care provider for routine gynecologic exams and general health care. Depending on the reason for your hysterectomy, you may still need pelvic exams and Pap tests.

Effects of Hysterectomy

Hysterectomy can have both physical and emotional effects. Some last a short time. Others may last a long time. You should be aware of these effects before having the surgery.

The ovaries are the glands that produce estrogen, a hormone that affects the body in many ways. Depending on your age, if your ovaries are removed during hysterectomy, you will have signs and symptoms caused by a lack of estrogen. A discussion of the possible need for hormone treatment is discussed at the preop appointment.

Physical Effects

After hysterectomy, the menstrual period will stop. In some cases of supracervical or partial hysterectomy menstrual bleeding can continue, but at a much lighter level than prior to the hysterectomy. If the ovaries are left in place and a woman has not yet gone through menopause, the ovaries will still produce estrogen and will continue to do so until they stop functioning naturally.

Emotional Effects

It is not uncommon to have an emotional response to hysterectomy. How you will feel after the surgery depends on a number of factors and differs for each woman.

Some women feel depressed because they can no longer have children. If depression lasts longer than a few weeks, see your health care provider. Other women may feel relieved because the symptoms they were having have now stopped.

Sexual Effects

Some women notice a change in their sexual response after a hysterectomy. Because the uterus has been removed, uterine contractions that may have been felt during orgasm will no longer occur.

Some women feel more sexual pleasure after hysterectomy. This may be because they no longer have to worry about getting pregnant. It also may be because they no longer have the discomfort or heavy bleeding caused by the problem leading to hysterectomy.

Some women wish to have a supracervical hysterectomy because they think it will have less of an impact on their sexual response compared with a total hysterectomy. Whereas sexual response is different for every woman, research comparing women who have had total hysterectomies with those who have had supracervical hysterectomies has shown that there is no difference in sexual response and orgasms in women who have had the two types of surgery.

If the ovaries are removed before menopause, you will experience effects caused by lack of estrogen. These effects are similar to those of menopause and include hot flashes, vaginal dryness, and sleep problems. However, symptoms may be more intense than what you would experience if you went through menopause over a few years, as is normal. You also may be at risk of a fracture caused by osteoporosis at an earlier age than women who go through natural menopause.

Most women who have these intense symptoms can be treated with estrogen therapy. Estrogen therapy is given in several different ways, including as a pill, injection, skin patch, vaginal cream, or vaginal ring. The form chosen depends on your specific symptoms. It is important to talk to your health care provider about all of the options and which ones are right for you.

In Summary

Hysterectomy is just one way to treat uterine problems. It is major surgery and carries some risks. For some conditions, other treatment options are available. For others, hysterectomy is the best choice. Your health care provider can help you weigh the options and make a decision.

About Your Total Abdominal Hysterectomy and Other Gynecologic Surgeries

This guide will help you get ready for your total abdominal hysterectomy and other gynecologic surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your care team will refer to it as you learn more about your recovery.

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About Your Surgery

A total abdominal hysterectomy is a surgery to remove your uterus and cervix. You may be having a hysterectomy because you have:

• Uterine cancer, cervical cancer, or ovarian cancer
• Uterine fibroids
• Endometriosis
• Heavy vaginal bleeding
• Pelvic pain

Your healthcare provider will talk with you about why you’re having the surgery.

About your reproductive system

Your reproductive system includes your ovaries, fallopian tubes, uterus, cervix, and vagina (see Figure 1). Your uterus is in your lower abdomen (belly) between your bladder and rectum. The lower narrow end of your uterus is called your cervix. Your ovaries and fallopian tubes are attached to your uterus.

After your hysterectomy, you won’t be able to have children naturally. You’ll also stop menstruating (getting your monthly period). A hysterectomy doesn’t cause menopause unless your ovaries are removed.

If you want to have biological children in the future, ask your healthcare provider for a referral to a fertility specialist.

Figure 1. Your reproductive system

Total abdominal hysterectomy

During your total abdominal hysterectomy, your surgeon will make an incision (surgical cut) on your abdomen. They’ll remove your uterus and cervix through the incision. They’ll then close your incision with sutures (stitches).

You might have 1, 2, or all 3 of the following procedures along with your hysterectomy. What you have depends on why you’re having surgery. Your surgeon will talk with you about the plan for your specific surgery.

Salpingo-oophorectomy

A salpingo-oophorectomy (sal-PIN-goh-oh-oh-foh-REK-toh-mee) is a surgery to remove your ovary and fallopian tube on one or both sides of your body.

If you haven’t started menopause, you’ll go into menopause if both of your ovaries are removed. You may have some of the common symptoms, including night sweats, hot flashes, and vaginal dryness. Talk with your healthcare provider about ways to manage these symptoms. If you’ve already gone through menopause, you shouldn’t notice any changes.

Sentinel lymph node mapping and lymph node dissection

Lymph nodes are small, bean-shaped glands that make and store the cells that help your body fight infections. Lymph nodes are found throughout your body. Sentinel lymph nodes are the lymph nodes most likely to be affected if you have cancer and it has spread.

If your surgeon thinks you may have cancer, they may do sentinel lymph node mapping and remove some of your lymph nodes during your surgery. This is called a lymph node dissection.

For sentinel lymph node mapping, your surgeon will inject a small amount of dye in the area where the cancer may be. They’ll talk with you the type of dye they’ll use. This dye will travel to the sentinel lymph nodes and turn them blue or green.

Once the sentinel nodes are located, your surgeon will make a small incision. They’ll remove the sentinel nodes and send them to the Pathology Department to be checked for cancer cells.

Colon resection

A colon resection is a surgery to remove part of your colon. You may be having a colon resection to:

• Remove part of your colon that has cancer
• Remove a mass near your colon

Your surgeon will talk with you about which part of your colon will be removed (see Figure 2). After they remove this part of your colon, they’ll connect the healthy ends of your colon back together.

Figure 2. Parts of your colon

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Before Your Surgery

The information in this section will help you get ready for your surgery. Read this section when your surgery is scheduled and refer to it as your surgery date gets closer. It has important information about what you need to do before your surgery.

As you read through this section, write down any questions you want to ask your healthcare provider.

Getting ready for your surgery

You and your care team will work together to get ready for your surgery.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

• I take a blood thinner, such as:
  • Aspirin
  • Heparin
  • Warfarin (Jantoven^® or Coumadin^®)
  • Clopidogrel (Plavix^®)
  • Enoxaparin (Lovenox^®)
  • Dabigatran (Pradaxa^®)
  • Apixaban (Eliquis^®)
  • Rivaroxaban (Xarelto^®)

  There are others, so be sure your healthcare provider knows all the medications you’re taking.

• I take prescription medications (medications my healthcare provider prescribes), including patches and creams.
• I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
• I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
• I have sleep apnea.
• I’ve had a problem with anesthesia (medication to make me sleep during surgery) in the past.
• I’m allergic to certain medication(s) or materials, including latex.
• I’m not willing to receive a blood transfusion.
• I drink alcohol.
• I smoke or use an electronic smoking device (such as a vape pen, e-cigarette, or Juul^®).
• I use recreational drugs.

About drinking alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

• If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help keep them from happening.
• If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do before your surgery to keep from having problems:

• Be honest with your healthcare providers about how much alcohol you drink.
• Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea (feeling like you’re going to throw up), increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
• Tell your healthcare provider if you can’t stop drinking.
• Ask your healthcare provider questions about drinking and surgery. As always, all of your medical information will be kept confidential.

About smoking

If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507.

About sleep apnea

Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device (such as a CPAP device) for sleep apnea, bring it with you the day of your surgery.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal account. You can use MyMSK to send and receive messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to create their own account so they can see information about your care.

If you don’t have a MyMSK account, you can visit my.mskcc.org, call 646-227-2593, or call your doctor’s office for an enrollment ID to sign up. You can also watch our video How to Enroll in MyMSK: Memorial Sloan Kettering’s Patient Portal. For help, contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.

About Enhanced Recovery After Surgery (ERAS)

ERAS is a program to help you get better faster after your surgery. As part of the ERAS program, it’s important to do certain things before and after your surgery.

Before your surgery, make sure you’re ready by doing the following things:

• Read this guide. It will help you know what to expect before, during, and after your surgery. If you have questions, write them down. You can ask your healthcare provider at your next appointment, or you can call their office.
• Exercise and follow a healthy diet. This will help get your body ready for your surgery.

After your surgery, help yourself recover more quickly by doing the following things:

• Read your recovery pathway. This is a written educational resource that your healthcare provider will give you. It has goals for your recovery and will help you know what to do and expect on each day during your recovery.
• Start moving around as soon as you can. The sooner you’re able to get out of bed and walk, the quicker you’ll be able to get back to your normal activities.

Within 30 days of your surgery

Presurgical Testing (PST)

Before your surgery, you’ll have an appointment for presurgical testing (PST). The date, time, and location will be printed on the appointment reminder from your surgeon’s office. It’s helpful to bring the following things to your PST appointment:

• A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
• Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
• The name(s) and telephone number(s) of your healthcare provider(s).

You can eat and take your usual medications the day of your appointment.

During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your surgery.

Identify your caregiver

Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home.

For caregivers

‌  Resources and support are available to help manage the responsibilities that come with caring for a person going through cancer treatment. For support resources and information, visit www.mskcc.org/caregivers or read A Guide for Caregivers.

Arrange for someone to take you home

You must have a responsible care partner take you home after your surgery. A responsible care partner is someone who can help you get home safely and report concerns to your healthcare providers, if needed. Make sure to plan this before the day of your surgery.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s usually a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you must still have a responsible care partner with you.

Complete a Health Care Proxy form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. If you’ve already completed one or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document that identifies the person who will speak for you if you can’t communicate for yourself. The person you identify is called your health care agent.

Talk with your healthcare provider if you’re interested in completing a health care proxy. You can also read the resources Advance Care Planning and How to Be a Health Care Agent for information about health care proxies, other advance directives, and being a health care agent.

Do breathing and coughing exercises

Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. For more information, read the resource How to Use Your Incentive Spirometer.

Exercise

Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.

Follow a healthy diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®)

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.

Buy supplies for your bowel preparation, if needed

Your healthcare provider may tell you to do a bowel preparation (clear the stool from your body) before your surgery. If they do, they’ll tell you what to do. You’ll need to buy the following supplies:

• 1 (238-gram) bottle of polyethylene glycol (MiraLAX^®). You can get this from your local pharmacy. You don’t need a prescription.
• 1 (64-ounce) bottle of a clear liquid. For examples of clear liquids, read the “Follow a clear liquid diet” section.
• Extra clear liquids to drink while you’re following a clear liquid diet.

Your healthcare provider may have sent prescriptions for the following antibiotics to your pharmacy:

• Metronidazole (Flagyl^®, Metrogel^®) 500 milligram tablets
• Neomycin (Neo-Fradin^®) 500 milligram tablets

Be sure to also pick up these antibiotics, if needed.

7 days before your surgery

Follow your healthcare provider’s instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Don’t stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.

2 days before your surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

Stop taking NSAIDs, such as ibuprofen (Advil^® and Motrin^®) and naproxen (Aleve^®), 2 days before your surgery. These medications can cause bleeding. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

1 day before your surgery

Follow a clear liquid diet, if needed

Your healthcare provider will tell you if you need to follow a clear liquid diet the day before your surgery.

A clear liquid diet includes only liquids you can see through. Examples are listed in the “Clear liquid diet” table. While you’re following this diet:

• Don’t eat any solid foods.
• Try to drink at least 1 (8-ounce) glass of clear liquid every hour while you’re awake.
• Drink different types of clear liquids. Don’t just drink water, coffee, and tea.
• Don’t drink sugar-free liquids unless you have diabetes and a member of your care team tells you to.

For people with diabetes

If you have diabetes, ask the healthcare provider who manages your diabetes what you should do while you’re following a clear liquid diet.

• If you take insulin or another medication for diabetes, ask if you need to change the dose.
• Ask if you should drink sugar-free clear liquids.
• Make sure to check your blood sugar level often while you’re following a clear liquid diet. If you have any questions, talk with your healthcare provider.

Start bowel preparation, if needed

Your healthcare provider will tell you if you need to do a bowel preparation the day before your surgery.

The morning of the day before your surgery, mix all 238 grams of MiraLAX with 64 ounces of clear liquid until the MiraLAX powder dissolves. Once the powder is dissolved, you can put the mixture in the refrigerator if you want to.

At 5:00 pm on the day before your surgery, start drinking the MiraLAX mixture. It will cause frequent bowel movements, so make sure you’re near a bathroom.

• Drink 1 (8-ounce) glass of the mixture every 15 minutes until it’s gone.
• When you finish the MiraLAX mixture, drink 4 to 6 glasses of clear liquids. You can keep drinking clear liquids until midnight or until you go to bed, but you don’t have to.
• Apply zinc oxide ointment or Desitin^® to the skin around your anus after every bowel movement. This helps prevent irritation.

At 7:00 pm on the day before your surgery, take your antibiotics as instructed.

At 11:00 pm on the day before your surgery, take your antibiotics as instructed.

Note the time of your surgery

A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you on the Friday before. If you don’t get a call by 7:00 pm, call 212-639-5014.

The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.

This will be the following location:

Presurgical Center (PSC) on the 6^th floor
1275 York Avenue (between East 67^th and East 68^th Streets)
New York, NY 10065
Take the B elevator to the 6^th floor.

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)

The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.

1. Use your normal shampoo to wash your hair. Rinse your head well.
2. Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
3. Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
4. Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Don’t put it on your face or genital area.
5. Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
6. Dry yourself off with a clean towel after your shower.
7. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Instructions for eating before your surgery

‌  
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
 

The morning of your surgery

Instructions for drinking before your surgery

• If your healthcare provider gave you a CF(Preop)^® drink, finish it 2 hours before your scheduled arrival time. Do not drink anything else after midnight the night before your surgery, including water.
• If your healthcare provider didn’t give you a CF(Preop) drink, you can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.

 
Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.

Take your medications as instructed

If your healthcare provider told you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)

Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.

Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to remember

• Wear something comfortable and loose-fitting.
• If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
• Don’t wear any metal objects. Remove all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
• Leave valuable items at home.
• If you’re menstruating (have your monthly period) or have any bleeding from your vagina, use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.

What to bring

• Your breathing device for sleep apnea (such as your CPAP device), if you have one.
• Your Health Care Proxy form and other advance directives, if you completed them.
• Your cell phone and charger.
• Only the money you may want for small purchases (such as a newspaper).
• A case for your personal items (such as your eyeglasses, hearing aids, dentures, prosthetic devices, wig, or religious articles), if you have any.
• This guide. You’ll use it when you learn how to care for yourself after surgery.

Where to park

MSK’s parking garage is located on East 66^th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.

To reach the garage, turn onto East 66^th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There’s a tunnel that you can walk through that connects the garage to the hospital.

There are also other garages located on East 69^th Street between First and Second Avenues, East 67^th Street between York and First Avenues, and East 65^th Street between First and Second Avenues.

Once you’re in the hospital

When you get to the hospital, take the B elevator to the 6^th floor. Check in at the desk in the PSC waiting room.

Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day.

When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.

Meet with a nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight (including prescription and over-the-counter medications, patches, and creams) and the time you took them.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it in the operating room.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They will:

• Review your medical history with you.
• Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
• Talk with you about your comfort and safety during your surgery.
• Talk with you about the kind of anesthesia you’ll get.
• Answer your questions about your anesthesia.

Your doctor and anesthesiologist may also talk with you about placing an epidural catheter. An epidural catheter is a thin, flexible tube that’s placed in your back, in the space just outside your spinal cord. An epidural catheter is a way to give you pain medication after your surgery.

Get ready for your surgery

When it’s time for your surgery, you’ll need to remove your hearing aids, dentures, prosthetic devices, wig, and religious articles, if you have them. You’ll either walk into the operating room or a staff member will bring you there on a stretcher.

A member of the operating room team will help you onto the operating bed and place compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs. You may also have a blood pressure cuff and EKG pads to monitor you during surgery.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.

During your surgery

After you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. A urinary (Foley) catheter may also be placed to drain urine (pee) from your bladder.

Once your surgery is finished, your surgeon will close your incision(s) with staples, sutures (stitches), Dermabond^® (surgical glue), or Steri-Strips^™ (thin pieces of surgical tape). They may also cover them with a dry dressing (bandage).

Your breathing tube is usually taken out while you’re still in the operating room.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You’ll learn how to safely recover from your surgery.

As you read through this section, write down any questions you want to ask your healthcare provider.

In the Post-Anesthesia Care Unit (PACU)

When you wake up after your surgery, you’ll be in the PACU. A nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You’ll also have compression boots on your lower legs.

Pain medication

You’ll get pain medication through your IV line, epidural catheter, or as a tablet that you swallow. Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers.

Tubes and drains

• You may have a urinary catheter in your bladder to help keep track of how much urine (pee) you’re making. If you do, it should be removed before you leave the hospital or PACU.
• You may have a drain in your abdomen. This lets fluid in your abdomen drain out of the area. If you have a drain, it will probably be removed before you’re discharged from the hospital.

Leaving the PACU

After your stay in the PACU, you’ll either be discharged from the hospital or taken to your hospital room in the inpatient unit. Your care team will tell you what to expect.

In your hospital room

The length of time you’re in the hospital after your surgery depends on your recovery and the exact type of surgery you had. Most people stay in the hospital for 3 to 5 days. You’ll stay in the hospital until:

• Your pain is managed by your pain medication(s).
• You can get up and walk around.
• You can urinate (pee) and pass gas.
• You can drink liquids and eat some foods.

When you’re taken to your hospital room, you’ll meet one of the nurses who will care for you while you’re in the hospital. Soon after you arrive in your room, your nurse will help you out of bed and into your chair.

While you’re in the hospital, your healthcare providers will teach you how to care for yourself while you’re recovering from your surgery. You can help yourself recover more quickly by doing the following things:

• Read your recovery pathway. Your healthcare provider will give you a pathway with goals for your recovery if you don’t already have one. It will help you know what to do and expect on each day during your recovery.
• Start moving around as soon as you can. The sooner you’re able to get out of bed and walk, the quicker you’ll be able to get back to your normal activities.

Managing your pain

You’ll have some pain after your surgery, especially in the first few days. Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better.

You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects and when to start switching to over-the-counter pain medications.

Moving around and walking

Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around, if needed.

Read the resource Call! Don’t Fall! to learn what you can do to stay safe and keep from falling while you’re in the hospital.

Using your incentive spirometer

Use your incentive spirometer 10 times every hour you’re awake. This will help your lungs expand fully, which helps prevent pneumonia. For more information, read the resource How to Use Your Incentive Spirometer.

Eating and drinking

If you didn’t have a colon resection as part of your surgery, you’ll be able to eat after your surgery. You’ll start by having small, frequent meals with foods that are soft and easy to digest, such as applesauce and chicken noodle soup. After that, you’ll start adding your regular foods back into your diet.

If you did have a colon resection during your surgery, you’ll get clear liquids for the first few days after your surgery. After that, you’ll start eating solid foods again. Read the “Eating and drinking” section in the “At home” part of this guide for more information.

If you have bloating, gas, or cramps, limit high-fiber foods, such as:

• Whole grain breads and cereal
• Nuts
• Seeds
• Salads
• Fresh fruit
• Broccoli
• Cabbage
• Cauliflower

Your healthcare provider will give you dietary guidelines to follow after your surgery. Your inpatient clinical dietitian nutritionist will go over these guidelines with you before you leave the hospital.

Leaving the hospital

By the time you’re ready to leave the hospital, your incision(s) may have started to heal. Before you leave, look at your incision(s) with one of your healthcare providers. Knowing what they look like will help you notice any changes later.

On the day of your discharge, plan to leave the hospital around 11:00 am. Before you leave, your healthcare provider will write your discharge order and prescriptions. You’ll also get written discharge instructions. One of your healthcare providers will review them with you before you leave.

If your ride isn’t at the hospital when you’re ready to be discharged, you may be able to wait in the Patient Transition Lounge. A member of your care team will give you more information.

At home

Read the resource What You Can Do to Avoid Falling to learn what you can do to stay safe and keep from falling at home and during your appointments at MSK.

Filling out your recovery tracker

We want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12:00 am). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information or ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. For more information, read the resource About Your Recovery Tracker .

Managing your pain

People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. This doesn’t mean something is wrong.

Follow the guidelines below to help manage your pain at home.

• Take your medications as directed and as needed.
• Call your healthcare provider if the medication prescribed for you doesn’t ease your pain.
• Don’t drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy. Alcohol can make the drowsiness worse.
• As your incision heals, you’ll have less pain and need less pain medication. An over-the-counter pain reliever such as acetaminophen (Tylenol^®) or ibuprofen (Advil^® or Motrin^®) will ease aches and discomfort.
  • Follow your healthcare provider’s instructions for stopping your prescription pain medication.
  • Don’t take more of any medication than the amount directed on the label or as instructed by your healthcare provider.
  • Read the labels on all the medications you’re taking, especially if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. Taking too much can harm your liver. Don’t take more than one medication that contains acetaminophen without talking with a member of your care team.
• Pain medication should help you resume your normal activities. Take enough medication to do your activities and exercises comfortably. It’s normal for your pain to increase a little as you start to be more active.
• Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual).

Preventing and managing constipation

Talk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.

• Go to the bathroom at the same time every day. Your body will get used to going at that time. If you feel like you need to go, though, don’t put it off.
• Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.
• Exercise, if you can. Walking is an excellent form of exercise.
• Drink 8 to 10 (8-ounce) glasses (2 liters) of liquids daily, if you can. Choose liquids such as water, juices (such as prune juice), soups, and ice cream shakes. Avoid liquids with caffeine (such as coffee and soda). Caffeine can pull fluid out of your body.
• Slowly increase the fiber in your diet to 25 to 35 grams per day. Unpeeled fruits and vegetables, whole grains, and cereals contain fiber. If you have an ostomy or have had recent bowel surgery, check with your healthcare provider before making any changes in your diet.
• Both over-the-counter and prescription medications are available to treat constipation. Check with your healthcare provider before taking any medications for constipation, especially if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medications for constipation include:
  • Docusate sodium (Colace^®). This is a stool softener (medication that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Don’t take it with mineral oil.
  • Polyethylene glycol (MiraLAX^®). This is a laxative (medication that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
  • Senna (Senokot^®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.

  If any of these medications cause diarrhea (loose, watery bowel movements), stop taking them. You can start again if needed.

Caring for your incision(s)

Your incision(s) will be closed with sutures, staples, Dermabond, or Steri-Strips.

• If you have sutures, they’ll dissolve on their own. They won’t need to be removed.
• If you have staples, they’ll probably be removed 10 to 14 days after your surgery. You’ll need to come back to the clinic to have them removed. This is done in your doctor’s office and isn’t painful.
• If you have Steri-Strips or Dermabond, they’ll loosen and may fall or peel off on their own. If they haven’t fallen off within 10 days, you can take them off. Don’t take them off before then.

Check your incision(s) for signs of infection every day until your healthcare provider tells you they’re healed. Call your healthcare provider if:

• The skin around your incision is very red.
• The skin around your incision is getting redder.
• The area around your incision is starting to swell.
• Swelling around your incision is getting worse.

• The skin around your incision is warmer than usual.
• You see drainage that looks like pus (thick and milky).
• Your incision smells bad.
• Your pain is getting worse.
• You have a fever of 101 °F (38.3 °C) or higher.

To prevent infection, don’t let anyone touch your incision(s). Clean your hands with soap and water or an alcohol-based hand sanitizer before you touch your incision(s).

Showering

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens) every day until your staples are removed. It’s OK to get your sutures, staples, Dermabond, or Steri-Strips wet. Don’t let your incision be directly under the shower stream for too long.

During your shower, use the 4% CHG solution to gently wash your incision(s). Don’t scrub or use a washcloth on them. This could irritate them and keep them from healing. After your shower, gently pat your incision(s) dry with a clean towel. Let them air dry completely before getting dressed. You can also use a blow dryer on the “cool” setting to dry the area.

When your staples are removed, your healthcare provider will tell if you can stop showering with a 4% CHG solution. Keep showering once day for 4 weeks after your surgery with a gentle, fragrance-free soap (such as Dove^®). Don’t use any harsh soaps or scented body washes.

Don’t take tub baths or go swimming until your healthcare provider says it’s OK.

Managing vaginal spotting or bleeding

It’s common to have some vaginal spotting or light bleeding for about 4 to 6 weeks after surgery. Use a pad or a panty liner so you can see how much you’re spotting or bleeding. Don’t use a tampon.

If you have heavy bleeding (you’re bleeding through a pad every 1 to 2 hours), call your healthcare provider right away.

Sexual activity

Don’t put anything in your vagina or have vaginal intercourse (sex) for 8 weeks after your surgery. Some people will need to wait longer than 8 weeks, so speak with your healthcare provider before starting to have vaginal sex again.

Managing changes in bowel function

If part of your colon was removed, the part that’s left will adapt to this change. It will start to adapt shortly after your surgery. During this time, you may have gas, cramps, or changes in your bowel habits (such as frequent bowel movements).

If you have soreness around your anus from having frequent bowel movements:

• Apply zinc oxide ointment (Desitin^®) to the skin around your anus. This helps prevent irritation.
• Don’t use harsh toilet tissue. You can use a flushable nonalcohol wipe instead.
• Take medication if your healthcare provider prescribes it.

Eating and drinking

If you have gas or feel bloated, avoid foods that can cause gas, such as beans, broccoli, onions, cabbage, and cauliflower.

Parts of your colon can be removed without having a major impact on your nutritional health. However, while your remaining colon is adjusting, your body may not absorb nutrients, liquids, vitamins, and minerals as well as before your surgery. It’s important to drink plenty of liquids and make sure you’re getting enough nutrients while you’re recovering from your surgery.

If you have questions about your diet, ask to see a clinical dietitian nutritionist.

Driving

Don’t drive until your surgeon tells you it’s OK. This will be sometime after your first follow-up appointment after surgery. If you’re still taking your prescribed pain medication, your surgeon may want you to wait longer before driving. The pain medication can slow your reflexes and responses, making it unsafe to drive. Also, you use your abdominal muscles (abs) when you brake, so driving may cause discomfort.

Traveling

It’s OK to travel after surgery. If you’re traveling by plane within a few weeks after your surgery, make sure you get up and walk every hour. Be sure to stretch your legs, drink plenty of liquids, and keep your feet elevated when possible.

Going back to work

The time it takes to return to work depends on the type of work you do, the type of surgery you had, and how fast your body heals. Most people can go back to work about 4 to 6 weeks after the surgery.

Physical activity and exercise

Check with your healthcare provider before you do any heavy lifting. Most people shouldn’t lift anything heavier than 10 pounds (4.5 kilograms) for at least 6 weeks after surgery. Ask your healthcare provider how long you should avoid heavy lifting.

Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed.

Don’t go jogging or do Pilates or yoga. Ask your healthcare provider before starting more strenuous exercises.

Managing your feelings

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.

The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.

Follow-up appointments after surgery

Your first appointment after surgery will be 2 to 4 weeks after surgery. Your nurse will give you instructions on how to make this appointment, including the phone number to call. Your healthcare provider will discuss your test results with you in detail during this appointment.

When to call your healthcare provider

Call your healthcare provider if:

• You have a fever of 101 °F (38.3 °C) or higher.
• You have pain that doesn’t get better after taking pain medication.
• There’s redness, drainage, or swelling near your incision(s).
• You have heavy vaginal bleeding.
• Your calves are swollen or tender.
• You cough up blood.
• You have any shortness of breath or trouble breathing.
• You don’t have any bowel movement for 3 days or longer.
• You have nausea, vomiting, or diarrhea (loose or watery bowel movements).
• You have any questions or concerns.

Contact information

Monday through Friday from 9:00 am to 5:00 pm, call your healthcare provider’s office.

After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask to speak to the person on call for your healthcare provider.

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Support Services

This section has a list of support services that may help you get ready for your surgery and recover safely.

As you read through this section, write down any questions you want to ask your healthcare provider.

MSK support services

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, including requesting a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you’re interested in donating blood or platelets.

Bobst International Center
888-675-7722
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.

Chaplaincy Service
212-639-5982
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

Counseling Center
646-888-0200
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Food Pantry Program
646-888-8055
The food pantry program provides food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service
646-888-0800
Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or speak with the library reference staff to find more information about your specific cancer type. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org.

Patient and Caregiver Education
www.mskcc.org/pe
Visit the Patient and Caregiver Education website to search our virtual library. There you can find written educational resources, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
You may find it comforting to speak with someone who has been through a treatment similar to yours. You can talk with a former MSK patient or caregiver through our Patient and Caregiver Peer Support Program. These conversations are confidential. They may take place in person or over the phone.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or if you have concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nursing Office
212-639-6892
You may request private nurses or companions. Call for more information.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can have an impact on your sexual health. MSK’s Sexual Health Programs can help you take action and address sexual health issues before, during, or after your treatment.

• Our Female Sexual Medicine and Women’s Health Program can help if you’re dealing with cancer-related sexual health challenges such as premature menopause or fertility issues. For more information or to make an appointment, call 646-888-5076.
• Our Male Sexual and Reproductive Medicine Program can help if you’re dealing with cancer-related sexual health challenges such as erectile dysfunction (ED). For more information or to make an appointment, call 646-888-6024.

Social Work
212-639-7020
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for more information.

Virtual Programs
www.mskcc.org/vp
MSK’s Virtual Programs offer online education and support for patients and caregivers, even when you can’t come to MSK in person. Through live, interactive sessions, you can learn about your diagnosis, what to expect during treatment, and how to prepare for the various stages of your cancer care. Sessions are confidential, free, and led by expert clinical staff. If you’re interested in joining a Virtual Program, visit our website at www.mskcc.org/vp for more information.

For more online information, visit the Cancer Types section of www.mskcc.org.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25^th & 26^th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medications that they have trouble affording.

Back to top

Educational Resources

This section has the educational resources mentioned in this guide. These resources will help you get ready for your surgery and recover safely after surgery.

As you read through these resources, write down any questions you want to ask your healthcare provider.

For information about lymphedema, you can also read the New York State Department of Health’s resource Understanding Lymphedema.

Back to top

Hysterectomy – Harvard Health

What Is It?

A hysterectomy is the surgical removal of the uterus. Depending on the type of hysterectomy, other pelvic organs or tissues also may be removed. The types of hysterectomy include:

• Subtotal, supracervical or partial hysterectomy. The uterus is removed, but not the cervix.
• Total or complete hysterectomy. Both the uterus and the cervix are removed.
• Total hysterectomy plus unilateral salpingo-oophorectomy. This procedure removes the uterus, cervix, one ovary and one fallopian tube, while one ovary and one fallopian tube are left in place. This procedure is usually done if a problem confined to one ovary is detected at the time of hysterectomy. After surgery, the remaining ovary should produce enough female hormones if the woman has not reached menopause.
• Total hysterectomy plus bilateral salpingo-oophorectomy. This is the removal of the uterus, cervix, and both fallopian tubes and ovaries. Removing both ovaries will cause surgical menopause in a woman who has not reached menopause because the production of female hormone stops when the ovaries are removed.
• Radical hysterectomy. This procedure removes the uterus, cervix, both ovaries, both fallopian tubes and nearby lymph nodes in the pelvis. This procedure is only done in some women who have gynecological cancer.

Hysterectomies can be done with different types of surgical incisions (surgical cuts). Until recently most hysterectomies were abdominal hysterectomies, in which the uterus is removed through a horizontal or vertical incision in the lower abdomen.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
Please note the date of last review or update on all articles. No content on this site, regardless of date,
should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Recovering from your hysterectomy – Dana-Farber Cancer Institute

The Susan F. Smith Center for Women’s Cancers at Dana-Farber provides a variety of services to help patients and their families cope with the many physical, emotional, and spiritual challenges of
a cancer diagnosis and its treatment. We are committed to helping patients regain a sense of control over their lives and feel their best throughout treatment and beyond.

Many women have asked what they can do to help themselves recover after having a hysterectomy. Most of the strategies are common sense tips to overall good health. The suggestions listed below are meant to help you feel better faster and prevent complications.
This can be used as a useful guide during your recovery and in the future.

Things to do

Diet

• Eat a well-balanced diet, including protein, fruits and vegetables, which will help with healing after surgery.
• Drink about 8-10 glasses of fluids a day (especially water) to keep your body well hydrated. If you have a cardiac problem, ask your doctor about your fluid intake.
• If you have a tendency towards constipation, increase your fiber intake as well. Please speak with a dietician if you need help with your diet.

Special instructions

Physical Activities

• Balance exercise with rest. You may walk and stretch. Walking is one of the best ways to recover and heal more quickly. Pace yourself and listen to your body. You may find yourself getting tired during the day. When this happens, lie down to rest
  or take a nap. A good time to take a walk is after your rest or nap.
• You may go up and down stairs. You will probably need to climb stairs slowly at first, one leg at a time. As your body heals, this will get easier and easier. No heavy lifting – objects greater than 20 pounds – for six weeks after surgery. Twenty
  pounds is about as heavy as a bag of groceries.
• You may resume driving after two weeks, if you feel well enough and have stopped all pain medication. Your responses will be a little slower at first and leg activities such as braking or clutching may be uncomfortable. Remember to resume driving
  only when you don’t have to hesitate at all and when you are not taking pain medication.

Bathing

• Once you are home, it is important to keep the incision clean and dry. Your doctor will give you specific bathing instructions, often to wait at least 4 weeks before submerging in a bath tub. Physicians have various opinions on bathing, which can depend on your exact surgery.
• You may take a shower immediately, but allow the water to run over your incision; avoid having water hit it directly. You may gently wash away dried material from around the incision. Make sure to dry completely by gently patting, instead of rubbing.

Sexual Activity

Discuss this with your surgeon during your first postoperative visit, but the general rule is nothing in the vagina for eight weeks. (This includes tampons, douche products, and having sexual intercourse).

Incision care/hygiene

• Keep the incision clean and pat dry. Every day, wash your incision and personal area with warm water and mild soap. Be sure to rinse and pat dry thoroughly.
• Check the area of your incision every day for redness, swelling, drainage or wound opening.
• If you have drains, you may wash by taking a sponge bath or a shower, making certain that the area of the drain and incision are dried carefully.
• You will probably go home with staples or steri-strips (thin, white Band-Aids). They will help your incision heal. Staples are metal clips that are used in addition to sutures to help close the incision. Your incision may be slightly red around the
  stitches or staples. This is normal. The staples are removed 10-14 days after surgery. After removing the staples, steri-strips may be applied. You may shower with the staples or steri-strips in place. When the steri-strips begin to curl up, you
  may peel them off. With time, the color of your incision will fade and become less noticeable. This will take six to 12 months.
• Wear loose fitting clothing that will not rub or irritate the incision area. You may put a clean piece of gauze over the incision to prevent irritation from your garments.
• Do not put anything into your vagina. This includes tampons, douching or having sexual intercourse. Your doctor will advise you when this area is healed well enough. This is usually in about eight weeks.
• Avoid direct sun exposure to the incision area. Also, do not use any ointments or lotions directly on the incision unless you were instructed to do otherwise.
• You may see a small amount of clear or light red fluid draining from the incision or staining your dressing or clothes. If there is a large amount of drainage (for example, the dressings become soaked), please call your surgeon immediately.

Medications

• Your doctor will write you a prescription for pain medication and an anti-inflammatory (Motrin) when you go home. After surgery, discomfort and mild to moderate pain are common. Take your pain medication before the pain becomes severe. This will give
  you better pain control. It is also helpful to alternate your pain medication with an anti-inflammatory. If you find that you are having a lot of discomfort as your activity increases, try taking your pain medication one-half hour before that
  activity. If your pain is not relieved by medication, please call your physician. Pain medication may cause constipation. To prevent constipation, when you are taking pain medication drink more fluids, eat more high fiber foods and take a stool
  softener such as Colace (docusate) and a laxative such as Senokot (sennosides) or milk of magnesia daily.
• Take all of the medications you were on before the operation, unless any of those medications have been changed or stopped. If you have any questions about what medicine to take or not to take, please call your surgeon. Your primary care physician
  is another resource to help answer such questions.

Bowel function

Your bowel takes time to recover from surgery. By the time you are discharged, you should be passing “gas” or flatus. This should continue once you are home. Your first bowel movement should occur 4-5 days after surgery. You may experience “gas” pain.
Drinking hot liquids and walking will help relieve discomfort. You should use a stool softener such as Colace (docusate) and a mild laxative such as Senekot (sennosides) or Milk of Magnesia, which you can purchase at the drugstore. You should continue
the Colace and laxative until you have stopped taking the pain medication or your stools become unusually loose.

Body changes

• You may have a vaginal discharge for up to eight weeks. (At first this may be bloody, but with time should gradually get lighter and thinner.)
• Two weeks after surgery, some women experience an increase in vaginal bleeding for 24 hours. This is normal. However, if it persists or becomes very heavy, call your doctor.
• If both ovaries are removed, you may experience symptoms of menopause, which may include hot flashes, vaginal dryness and night sweats. Hormone replacement therapy may be an option to treat these symptoms and should be discussed with your physician
  before surgery.

How you may feel after your surgery:

• You may feel tired, weaker than usual, or “washed out” for up to six weeks after a major surgery. Try to take naps, or frequent rest breaks, during the day. Simple tasks may initially exhaust you.
• You may feel a sense of loss or become depressed. You may have trouble concentrating or encounter difficulty sleeping.
• You may have a poor appetite for a while and food may not seem to have its normal taste or appeal.
• All of these feelings and reactions are normal and should go away in a short time. If they persist please tell your surgeon. At all times please feel free to contact his/her office with any questions.

Call if you experience any of the following:

1. Temperature greater than 100.5.
2. Redness, swelling, tenderness, drainage from your wound or opening in operative site.
3. Bleeding – heavy vaginal bleeding soaking a pad an hour.
4. Pain that is not relieved by your pain medication.
5. A foul odor from your vagina.
6. Nausea and/or vomiting.
7. Prolonged constipation or diarrhea, even though you have eaten foods and taken medication to relieve it. Call your doctor if you do not have a bowel movement after 5 days.
8. Urinary symptoms such as frequency, pain or inability to urinate.
9. If you experience chest pain, shortness of breath, palpitations or calf pain, you must go to a local emergency room for evaluation.

Sexual Health Program

Sometimes cancer and cancer treatment can change sexual function and desire. The Sexual Health Program at Dana-Farber provides a comfortable, supportive environment where you can talk with a health care professional about your questions and concerns.

Complications of Hysterectomy

US Pharm.
2006;31(9):HS-16-HS-24.

According
to the most recent surveillance data from the CDC, hysterectomy is the second
most frequently performed surgical procedure for women of reproductive age,
topped only by cesarean delivery.¹ The United States has the
highest rate of hysterectomy in the industrialized world, with 5.5 per 1,000
women undergoing the procedure each year.^1,2 Many indications for
hysterectomy are poorly defined and based more on expert opinion than on
evidence from well-designed clinical trials.^2,3

Regardless of the surgical
technique used, hysterectomy is associated with short- and long-term
complications. All women considering hysterectomy should be aware of these
risks prior to surgery, in order to make an informed decision as to whether
the procedure is the best treatment option. This article reviews the short-
and long-term complications associated with hysterectomy and thereby aids
pharmacists in providing care for this large population of women.

Indications for Hysterectomy

Health care
providers have limited data from well-designed clinical trials to guide
determination of when hysterectomy is the most appropriate treatment option.
Some well-established indications for hysterectomy include life-threatening
conditions such as serious complications during childbirth, unmanageable
uterine hemorrhage, and invasive cancer of the uterus, cervix, va­ gina,
fallopian tubes, or ovaries.^2,4 Outside of these situations,
however, guidance is scarce regarding the appropriate indications for
hysterectomy.

According to the CDC, from
1994 to 1999, uterine leiomyoma, endometriosis, and uterine prolapse were the
most common indications for hysterectomy and accounted for 73% of all
hysterectomies performed.¹ This figure is quite staggering,
considering that much of the current literature recommends conservative
management of most benign gynecologic conditions, with hysterectomy considered
as a last resort in refractory cases.⁵

In 2002, the Society of
Obstetricians and Gynecologists of Canada (SOGC) published clinical practice
guidelines that provide common indications for hysterectomy.⁴
According to these guidelines, endometriosis with severe symptoms that are
refractory to other medical treatment options, symptomatic leiomyomas (uterine
fibroids), and pelvic relaxation are benign conditions in which hysterectomy
may be considered. In the case of abnormal uterine bleeding, endometrial
lesions must be excluded and medical alternatives should be considered
first-line therapy prior to consideration of surgical intervention.⁴
The SOGC guidelines recommend that in all cases pertaining to benign
conditions, risks and benefits of surgery as well as loss of fertility should
be discussed prior to surgery, and a woman’s preference should be highly
respected.

Types of Hysterectomy

There are several
types of hysterectomy, all of which include the removal of the uterus. In a
subtotal hysterectomy (also referred to as a supracervical or partial
hysterectomy), the upper two thirds of the uterus is removed, while the cervix
is left in place.² Although this procedure is common, the majority
of women decide to have a total hysterectomy. A total hysterectomy (or
complete hysterectomy) involves the removal of the entire uterus as well as
the cervix. If both the ovaries and the fallopian tubes are removed during a
total hysterectomy, the procedure is called a bilateral salpingo-oophorectomy.
Finally, the most extreme type of hysterectomy, a radical hysterectomy,
involves removal of the uterus, cervix, ovaries, fallopian tubes and,
possibly, upper portions of the vagina and affected lymph glands. This
procedure is strongly recommended for serious complications and diseases such
as cancer.²

A hysterectomy may be
performed via abdominal, vaginal, or laparoscopic-assisted abdominal or
vaginal approaches.² The appropriate route of surgery is determined
by the type of pathology expected, anatomic considerations, patient
preference, and physician experience and training. According to the SOGC
clinical practice guidelines, vaginal hysterectomy should be considered the
first choice for all benign indications, while laparoscopic-assisted
approaches should be considered when using such an approach reduces the need
for a laparotomy.⁴ Although there is limited information concerning
direct comparisons of hysterectomy procedures, preliminary data suggest that
LAVH may be associated with shorter hospital stays, less pain, more rapid
recovery, and fewer complications; however, this approach is associated with
higher surgical costs.¹

Surgical and Postsurgical
Complications

Hysterectomy is
generally a safe procedure, but with any major surgery comes the risk of
surgical and postsurgical complications. Such complications commonly include
infection, hemorrhage, vaginal vault prolapse, and injury to the ureter,
bowel, or bladder.^6,7 Although hysterectomy is associated with
fewer complications than many other major operations, risks and complications
depend upon the type of hysterectomy performed, the individual woman’s health
status, and the surgeon’s expertise and experience.^4,6,7

Infection:
Postoperative fever and infection are responsible for the majority of minor
complications following hysterectomy. Infection occurs in approximately 6% to
25% of patients who undergo abdominal hysterectomy versus 4% to 10% of those
who undergo vaginal hysterectomy. Despite impeccably sterile surgical
technique and careful patient selection, women undergoing a hysterectomy
procedure have a 30% chance of postoperative febrile infection.²

In both abdominal and vaginal
hysterectomy, pelvic infection occurs in approximately 4% of cases.^8,9
Pelvic cellulitis is an infection of the soft tissues and usually occurs
around the third day following surgery. Although some degree of cuff
cellulitis probably occurs following the majority of hysterectomies,
antibiotics are not required unless fever persists. Additionally, the rate of
postoperative symptomatic urinary tract infection is approximately 1% to 5% in
patients who undergo hysterectomy. Immediate catheter removal postoperatively
is strongly recommended to reduce the risk of this complication.^8-10

Risk of postoperative
infection can be lowered substantially with the use of prophylactic
antibiotics.^8,9 Studies reveal that women who receive prophylactic
antibiotics prior to an abdominal or vaginal hysterectomy have a reduced rate
of wound infection, pelvic cellulitis, vaginal cuff abscess, and pelvic
abscess.⁹ The proper dosage should be administered 30 minutes prior
to surgery to ensure that therapeutic levels are achieved in tissue at the
surgical site. Agents such as cefazolin, cefotetan, cefoxitin, metronidazole,
and clindamycin have all proved effective.^8-10 If postoperative
fever persists and infection is suspected or identified, a broad-spectrum
intravenous antibiotic covering anticipated pathogens should be initiated.
Antibiotics should be continued for 24 to 48 hours after the resolution of
fever and symptoms.^8,9

Ureteral Injury:
Ureteral injury is becoming a more frequent posthysterectomy complication as
the number of laparoscopic-assisted procedures increases. The incidence rate
of this complication in laparoscopic-aided procedures is 0.7% to 1.7% with
abdominal hysterectomy and 0% to 0.1% with vaginal hysterectomy.¹⁰
Injuries generally occur with excessive electrocautery and lasering adjacent
to the ureter. These injuries are best managed with resection of the damaged
portion and reimplantation of the ureter.¹¹ Surgeons should
recognize urologic injuries and correct them intraoperatively to avoid serious
postoperative complications that occur from urinary extravasation.^10,11

Bladder Injury:
Injury to the bladder occurs in approximately 0.5% to 2% of all hysterectomies.
^8,12 Bladder injury most likely occurs during entry to the peritoneum or
during dissection of the bladder off the lower uterine segment, cervix, and
upper vagina. Several studies have concluded that partial disruption of the
innervation of the bladder during hysterectomy may result in postoperative
incontinence.^13,14 A systematic review reported that hysterectomy
was considered a risk factor for urinary incontinence in women older than 60.
¹⁴ In another study, urge incontinence was found to be more common than
stress incontinence in women posthysterectomy.¹³ In 2002, a large
cohort study revealed that women older than 50 were less likely to have
improvement with urinary incontinence after hysterectomy compared to younger
women.¹⁵

Bowel Injury:
Although bowel injury is uncommon, particularly with vaginal hysterectomy, it
is a serious complication associated primarily with laparoscopic-assisted
abdominal hysterectomy. During both abdominal and vaginal surgery, the rectum
and ascending and descending colon can be injured.⁸ Bowel injuries
occur during the lysis of adhesions involving the bowel and dissection of the
posterior cul-de-sac. Preoperative bowel preparations will allow for
incidental colon surgery without the necessity of colostomy. If a large bowel
injury should occur and no preoperative bowel preparation was given, a
temporary diverting colostomy may be indicated to protect the suture line and
lower the risk of peritonitis and sepsis.¹⁰

Hemorrhage:
One of the most serious postoperative complications associated with
hysterectomy is hemorrhage. Excessive bleeding complicates approximately 1% to
3% of all hysterectomies.¹² In most cases, bleeding originates at
the lateral vaginal angles and is amenable to vaginal resuturing. Average
intraoperative blood loss can range anywhere from 300 to 400 mL.¹⁶
Early postoperative signs of hemorrhage after vaginal hysterectomy include
bleeding from the vagina, deterioration in vital signs, decreased hematocrit
level, and flank abdominal pain.

It is routine to cross-match
blood in patients undergoing hysterectomy. Two to four units of packed red
blood cells should be available at all times. Women who are more likely to
need blood transfusion include those undergoing peripartum hysterectomy or
hysterectomy for gynecologic cancer, as well as those undergoing elective
hysterectomy with pelvic inflammatory disease, or pelvic abscesses or
adhesions.¹⁰

Thromboembolic Disease:
The risk of venous thromboembolism following abdominal hysterectomy in low-
and high-risk patients is 0.2% and 2.4%, respectively.^9,10 The risk
of deep venous thrombosis and pulmonary embolism can be minimized with the use
of graduated compression stockings perioperatively and early ambulation
postoperatively. The type of prophylaxis recommended depends upon each
patient’s risk factors. Risk factors include obesity, malignancy, previous
radiation therapy, immobilization, estrogen use, prolonged anesthesia, radical
surgery, and personal or family history of thromboembolic disease. Patients at
high risk for thromboembolism may be given a low-molecular-weight heparin or
5,000 units of subcutaneous heparin preoperatively and then every eight to 12
hours postoperatively to reduce the risk of thromboembolic events.^8-10

Fallopian Tube Prolapse:
Fallopian tube prolapse is an uncommon postoperative complication of
hysterectomy. A predisposing factor for prolapse is the presence of a hematoma
or abscess at the vaginal apex.^8,9,11 If the tissue does not
respond to conservative treatment, such as cryotherapy or silver nitrate
application, a biopsy of the area may be warranted.⁹ Surgical
interventions are recommended for the management of fallopian tube prolapse.
^8,9

Vaginal Vault Prolapse:
Vaginal vault prolapse is a type of pelvic organ prolapse that can happen
following surgical removal of the uterus. It often occurs when the top of the
vagina loses the support of the uterus and then sags or drops into the vaginal
canal. Most women with vaginal vault prolapse will also have bulging of the
small bowel into the vagina, as well as other bladder and bowel problems such
as urinary incontinence and constipation.^6,7,15,16 It is important
to note that vaginal vault prolapse may be treated with a vaginal pessary, a
special device that holds the vagina in place; in some cases, surgery may be
warranted.¹⁶

Vaginal Cuff
Evisceration: A rare
complication that can occur following a hysterectomy is evisceration of the
small intestine into the vagina.^7,9,17 It is associated with the
Valsalva’s maneuver, severe vomiting, or coughing. Symptoms usually include
vaginal bleeding or discharge, abdominal-pelvic pain, pressure in the vagina,
and protrusion of bowel. Although eviscerations usually occur early in the
postoperative period, one study of 12 patients reported occurrence 27 months
after various pelvic procedures.¹⁷ Medical treatment usually
includes administration of intravenous fluids and broad-spectrum antibiotics
and immediate laparotomy with replacement of the mesentery and small bowel.
^6,7,9

Possible Long-Term
Complications

Many of the
clinical findings concerning the long-term side effects of hysterectomy are
conflicting. Data show some women develop the complication, while others
experience relief from the same complication. For example, some studies have
shown increases in psychosexual dysfunction after hysterectomy, while others
have shown improvements in this area.^3,18 Discrepancies in the data
make it difficult for clinicians to clearly identify the long-term risks of
hysterectomy and for women to determine if the possible benefits of
hysterectomy outweigh the risks.

Early Menopause:
Many of the long-term complications associated with hysterectomy arise
secondary to changes in hormonal balance. Bilateral oophorectomy is performed
in more than 50% of hysterectomies in the U.S. and is controversial.¹
Some practitioners believe the ovaries should be removed to prevent future
development of malignancy, while others prefer to conserve “normal ovaries” to
preserve sex hormone secretion and avoid long-term hormone therapy (HT),
especially in women with contraindications to estrogen therapy (Table 1
).¹⁹ When the ovaries are removed, levels of ovarian sex hormones,
namely estrogen, progesterone, and testosterone, rapidly decline, resulting in
sudden menopause.

Studies have found that even
those women who keep one or both ovaries experience menopause at an earlier
age. A retrospective trial found that women who had had a hysterectomy with
preservation of one or both ovaries experienced menopause an average of 5.5
years earlier than women who had not undergone hysterectomy. In this study, no
difference was found between women with one versus both ovaries, though some
studies have reported differences.¹⁹ It has been theorized that
early ovarian failure may occur due to disruptions in ovarian blood flow,
which is necessary for proper sex hormone production.^19,20

Studies have consistently
shown HT to be effective for the reduction of menopausal symptoms.^21-24
Common symptoms of menopause include hot flashes, night sweats, vulvar and
vaginal atrophy, vaginal dryness, insomnia, and sleep disturbances. Initiating
estrogen therapy immediately after hysterectomy with bilateral oophorectomy is
important in order to prevent onset of menopausal symptoms, although some
practitioners may be hesitant to prescribe long-term HT due to the findings
that led to the early termination of the Women’s Health Initiative (WHI) trial.
²⁵

In February 2004, the NIH
decided to terminate the WHI estrogen-only trial before its proposed March
2005 end. Because this trial failed to show that estrogen protects women from
coronary heart disease and demonstrated statistically significant increases in
the incidence of stroke and deep venous thrombosis, the NIH deemed it
unacceptable to subject healthy women to these risks and therefore stopped the
trial early. It is important to note that the WHI estrogen-only trial did find
a significant reduction in hip and other fractures, as well as an unexpected
decrease in breast cancer incidence (P = .06). The WHI trial also demonstrated
that when estrogen replacement therapy (ERT) is used for the treatment of
menopausal symptoms after hysterectomy, an overall balance of risks and
benefits exists, and most importantly, no effect on total mortality was seen
throughout the 6.8-year follow-up period.²⁵

Women whose ovaries are
preserved should be counseled concerning common menopausal symptoms, and
estrogen therapy may be considered when these symptoms are present.¹⁹
The duration of ERT after hysterectomy has been debated, and no current
guidelines are available to aid practitioners with this treatment decision.
Many clinicians are now using ERT through the average age of natural menopause
(approximately age 50) and then tapering women off therapy slowly to help
prevent reappearance of symptoms.²⁵ If symptoms recur during dose
tapering, ERT may need to be restarted or nonhormonal agents may be tried.
Nonpharmacologic techniques for treating menopausal symptoms are outlined in
Table 2. If a woman simply undergoes oophorectomy and her uterus is
preserved, progesterone should be added to the treatment regimen to prevent
endometrial hyperplasia.^24,26

Impaired Sexual Function:
Studies have found
that concern about posthysterectomy sexual dysfunction is the most common
cause of anxiety for women undergoing the procedure.²⁰ There are
many plausible mechanisms by which sexual dysfunction may occur, including
shortening of the vagina, disruption of innervation of the vagina, and vaginal
dryness due to estrogen deficiency.^3,20,28,29

Conversely, sexual function
may improve posthysterectomy. It has been postulated that sexual function is
improved through relief of pain during intercourse due to removal of pelvic
pathology, relief of dysmenorrhea, and increased libido due to decreased fear
of conception.²⁰

Clinical data are split
concerning the true effects of hysterectomy on a woman’s sexual function.
Early retrospective data found that hysterectomy causes a significant decline
in sexual function.³ To the contrary, more current data derived
from prospective clinical trials show improvements in sexual function,
including increases in frequency of intercourse, sexual desire, and strength
and occurrence of orgasms, as well as reductions in dyspareunia.^20,28

It was once thought that
retaining the cervix would result in less sexual dysfunction due to a decrease
in neurologic and anatomic disruption, although clinical trials have not
supported this theory.^28,29 A 2003 prospective observational study
examined the differences between the effects of vaginal, subtotal abdominal,
and total abdominal hysterectomy on sexual function and found significant
improvements in sexual function with all three types of hysterectomy, with no
significant differences among the three types.²⁸

Psychological Effects

Data are also mixed concerning the
effects of hysterectomy on psychological functioning. As seen with other
complications of hysterectomy, retrospective studies have reported adverse
psychological outcomes, whereas prospective studies have not supported these
claims.³ In fact, prospective studies have shown that hysterectomy
improves mood and quality of life in many women by relieving preexisting
distressing gynecologic symptoms.^3,26

It has been well established
that one of the most important influences on postoperative psychiatric
morbidity is preoperative psychiatric state.²⁶ Women with
psychiatric illness prior to surgery are much less likely to show improvement
in this regard after hysterectomy.^3,26 Other factors that have been
associated with increased risk of emotional distress posthysterectomy include
loss of childbearing capacity, adverse effects on a woman’s self-image, social
disruption due to a long recovery time, and history of inadequately dealing
with loss.^3,30 The results of a meta-analysis showed that early
detection of ovarian failure, immediate initiation of HT in perimenopausal
women and in those undergoing oophorectomy, and regular follow-up may improve
psychological outcomes of hysterectomy.³¹

Conclusions

Although
hysterectomy is generally a safe procedure, it is pertinent for pharmacists to
be aware of the surgical, postsurgical, and long-term complications involved.
Educating women concerning the possible complications involved with
hysterectomy may ease patients’ preoperative anxiety and ultimately improve
outcomes. Pharmacists have an important role in the care of this population of
women and can aid in the prevention and treatment of complications associated
with hysterectomy by providing proper education, identifying high-risk
patients, and assisting with the management of medications.

REFERENCES

1. Keshavarz H,
Hillis SD, Kieke BA, Marchbanks PA. Hysterectomy surveillance–United States,
1994-1999. MMWR. 2002;51(SS05):1-8.

2. Hysterectomy.
National Women’s Health Network Web site. Available at:
www.nwhn.org/content/index.php?pid=133. Accessed July 17, 2006.

3. Falcone R,
Cogan-Levy SL. Overview of Hysterectomy. UpToDate Online 14.2 Web site.
Available at:
www.utdol.com/utd/content/topic.do?topicKey=gyn_surg/11669&type=A&selectedTitle=2~58.
Accessed July 14, 2006.

4. Lefebvre G, Allaire
C, Jeffrey J, et al. SOGC clinical guidelines. Hysterectomy. J Obstet
Gynaecol Can. 2002;24:37-61.

5. Kramer MG, Reiter
RC. Hysterectomy: indications, alternatives and predictors. Am Fam Physician
. 1997;55:827-834.

6. McPherson K,
Metcalfe MA, Herbert A, et al. Severe complications of hysterectomy: the VALUE
study. BJOG. 2004;111:688-694.

7. Garry R, Fountain J,
Mason S, et al. The eVALuate study: two parallel randomised trials, one
comparing laparoscopic with abdominal hysterectomy, the other comparing
laparoscopic with vaginal hysterectomy. BMJ. 2004;328:129.

8. Stovall TG, Mann WJ.
Vaginal Hysterectomy. UpToDate Online 14.2 Web site. Available at:
www.utdol.com/utd/content/topic.do?topicKey=gyn_surg/6246&type=A&selectedTitle=2~7.
Accessed July 14, 2006.

9. Stovall TG, Mann WJ.
Abdominal Hysterectomy. UpToDate Online 14.2 Web site. Available at:
www.utdol.com/application/index/indexResults.asp?index=211494&title=Abdominal%20hysterectomy&order=1~2.
Accessed July 14, 2006.

10. Dandade D, Malinak
LR, Wheeler JM. Therapeutic Gynecologic Procedures. Current Obstetric &
Gynecologic Diagnosis and Treatment. STAT!Ref Online Medical Database.
Available at: online.statref.com/document.aspx?fxid=30&docid=554. Accessed
July 14, 2006.

11. Stovall TG, Mann
WJ. Overview of Laparoscopic Surgery. UpToDate Online 14.2 Web site. Available
at:
www.utdol.com/utd/content/topic.do?topicKey=gyn_surg/10533&type=A&selectedTitle=2~71.
Accessed July 14, 2006.

12. Maresh MJ, Metcalfe
MA, McPherson K, et al. The VALUE national hysterectomy study: description of
the patients and their surgery. BJOG. 2002;109:302-312.

13. van der Vaart CH,
van der Bom JG, de Leeuw JR, et al. The contribution of hysterectomy to the
occurrence of urge and stress urinary incontinence symptoms. BJOG.
2002;109:149-154.

14. Brown JS, Sawaya G,
Thom DH, Grady D. Hysterectomy and urinary incontinence: a systematic review.
Lancet. 2000;356:535-539.

15. Kjerulff KH,
Langenberg PW, Greenaway L, et al. Urinary incontinence and hysterectomy in a
large prospective cohort study in American women. J Urol.
2002;167:2088-2092.

16. Meeks GR, Harris
RL. Surgical approach to hysterectomy: abdominal, laparoscopy-assisted, or
vaginal. Clin Obstet Gynecol. 1997;40:886-894.

17. Croak AJ, Gebhart
JB, Klingele CJ, et al. Characteristics of patients with vaginal rupture and
evisceration. Obstet Gynecol. 2004;103:572-576.

18. Harris WJ.
Complications of hysterectomy. Clin Obstet Gynecol. 1997;40:928-938.

19. Ahn EH, Bai SW,
Song CH, et al. Effect of hysterectomy on conserved ovarian function.
Yonsei Med J. 2002;43:53-58.

20. Rhodes JC, Kjerulff
KH, Langenberg PW, Guzinski GM. Hysterectomy and sexual functioning. JAMA
. 1999;282:1934-1941. 

21. Rozenberg S, Caubel
P, Lim PC. Constant estrogen, intermittent progestogen vs. continuous combined
hormone replacement therapy: tolerability and effect on vasomotor symptoms.
Int J Gynaecol Obstet. 2001;72:235-243.

22. Nelson HD.
Assessing benefits and harms of hormone replacement therapy: clinical
applications. JAMA. 2002;288:882-884.

23. Kalantaridou SN,
Davis SR, Calis KA. Hormone therapy in women. In: DiPiro JT, Talbert RL, Yee
GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 6th ed.
New York: McGraw-Hill; 2005:1493-1510.

24. Premarin Package
Insert. Philadelphia, PA: Wyeth Pharmaceuticals Inc.; April 2006.

25. Anderson GL,
Limacher M, Assaf AR, et al; Women’s Health Initiative Steering Committee.
Effects of conjugated equine estrogen in postmenopausal women with
hysterectomy: the Women’s Health Initiative randomized controlled trial.
JAMA. 2004;291:1701-1712.

26. Randomised
comparison of oestrogen versus oestrogen plus progestogen hormone replacement
therapy in women with hysterectomy. Medical Research Council’s General
Practice Research Framework. BMJ. 1996;312:473-478.

27. Hickey M, Davis SR,
Sturdee DW. Treatment of menopausal symptoms: what shall we do now? Lancet
. 2005;366:409-421.

28. Roovers JP, van der
Bom JG, van der Vaart CH, Heintz AP. Hysterectomy and sexual wellbeing:
prospective observational study of vaginal hysterectomy, subtotal abdominal
hysterectomy, and total abdominal hysterectomy. BMJ. 2003;327:774-778.

29. Thakar R, Ayers S,
Clarkson P, et al. Outcomes after total versus subtotal abdominal
hysterectomy. N Engl J Med. 2002;347:1318-1325.

30. Wright JB, Gannon
MJ, Greenberg M. Psychological aspects of heavy periods: does endometrial
ablation provide the answer? Br J Hosp Med. 1996;55:289-294.

31. Khastgir G, Studd
JW, Catalan J. The psychological outcome of hysterectomy. Gynecol Endocrinol
. 2000;14:132-141.

To comment on this article, contact
[email protected].

Post Op Guide: Recovery After Hysterectomy Surgery

A hysterectomy is the second most common surgery that women undergo in the United States (first being the C-section). Around 20 million American women have experienced a hysterectomy and it’s estimated that doctors perform 600,000 hysterectomies every year.

A hysterectomy is an operation that takes out a woman’s reproductive organs, which include the uterus, the cervix, ovaries, and fallopian tubes.

There are several reasons why women undergo this surgical procedure. A hysterectomy is a viable option if you have a condition like endometriosis, chronic pelvic pain, or cervical cancer that cannot be managed with chemotherapy.

The procedure is generally safe and low-risk. If you want to learn more about the types of hysterectomies and the post op recovery process, read on.

In this article, we will discuss: 

• Types of Hysterectomies
• How Is a Hysterectomy Performed?
• Post-Op
• 1 Week Post Op
• 1-2 Months Post Op
• When to Seek Medical Attention
• Final Thoughts

Types of Hysterectomies

Different women get different types of hysterectomies.

There are 4 types of hysterectomy procedures:

(1) partial orsupracervical hysterectomy, (2) total hysterectomy, (3) radical hysterectomy,  and (4) hysterectomy and salpingo-oophorectomy.

Photo from National Women’s Health Network

The type you’ll have is based on the reason behind the surgery and how much of your uterus and reproductive organs can stay intact.

Here’s what you should know about the various kinds of hysterectomies:

Partial/Supracervical Hysterectomy

In partial/supracervical hysterectomy, only a part of your uterus will be taken out and your doctor will keep your cervix as is.

Asupracervical hysterectomy willNOT be appropriate for you if you have cervical cancer or an abnormal pap smear. You can leave your cervix intact if you don’t have any reason to remove it. But it will mean you’re still at risk of cervical cancer.

Total Hysterectomy

A total hysterectomy removes all of your uterus, which includes the cervix. With this procedure, you won’t have to worry about developing cervical cancer in the future. This is why many doctors recommend it over asupracervical hysterectomy.

Out of all the types, a total hysterectomy is the one that is performed the most often. 

Radical Hysterectomy

This type of hysterectomy is typically done if you have a form of gynecological cancer like ovarian or cervical cancer. You may need a radical hysterectomy if your body can’t handle chemotherapy or radiotherapy, or if these haven’t been effective in treating your cancer.

A radical hysterectomy will involve removing the following:

• Cervix
• Womb
• A part of your vagina
• Tissue on the sides of your womb

Hysterectomy and Salpingo-Oophorectomy

During this surgery, the doctor will take out your entire uterus as well as your fallopian tubes and/or ovaries.

Doctors will recommend a hysterectomy and salpingo-oophorectomy if you’re at high risk of ovarian cancer since your ovaries should only be taken out as a last resort. Should you proceed with having both ovaries removed, you may need hormone replacement therapy.

How Is a Hysterectomy Performed?

There are 3 ways surgeons perform a hysterectomy. For all of these methods, you’ll need a local or general anesthetic so you won’t experience any pain during the surgery.

Abdominal

This procedure will involve making a big incision in your belly to remove your uterus. Your surgeon may do the cut horizontally or vertically. Usually, a vertical cut will be done if you have an enlarged uterus caused by fibroids or gynecologic cancer. Thehysterectomy scar will be minimal regardless of how the incision is made.

A vaginal hysterectomy is typically recommended for fibroids that develop because of endometriosis. However, your doctor may suggest an abdominal hysterectomy when your fibroids are large and cannot be taken out through your vagina. It may also be recommended if your cancer causes pelvic tumors.  

It will take around an hour to carry out this operation. 

Vaginal

Total hysterectomies are performed vaginally. A vaginal hysterectomy will require cutting a small incision in the top of your vagina, enough to fit small surgical instruments. Your doctor will insert the tools into your vagina to separate the uterus from the ligaments that keep it attached. 

Once your uterus and cervix have been taken out, the cut will be stitched. You won’t have a visiblehysterectomy scar since the incision is internal. 

Vaginal hysterectomies are usually about an hour to three hours long.

Laparoscopic

A laparoscopic hysterectomy uses a tool known as a laparoscope. A laparoscope is a long tube with a lighted camera that helps your surgeon view your uterus without making a large incision.

Once the laparoscope is in, the surgeon will then place surgical instruments in your abdomen (making further small incisions) in order to remove your uterus.

What to do Post Op?

You’ll need to spend some time in the hospital after your hysterectomy. This can be 2-5 days depending on the type of surgery you had.

Here are some things you should remember immediately after the surgery:

• You might wake up exhausted and in pain, but don’t be alarmed. It’s common after having an operation like this.

• You’ll be provided with painkillers to help make the pain more bearable. But if you prefer a more natural way of relieving your pain, you can use cold therapy. Putting a cool oversized clay pack over your tummy, for instance, will keep swelling down following an abdominal hysterectomy. 

• A catheter will be inserted into your bladder before your procedure. This collects your urine and transfers it to a bag. Once it’s removed (usually the day after your operation), they’ll measure your pee to find out whether your bladder is working fine. 

• Sometimes, people feel queasy after anesthesia. If you’re one of them, your nurse can give you medicines that get rid of the icky feeling.

• Your doctor or nurse will give you directions on how to care for your wound. Follow these to a tee to prevent infection and to let the incision heal faster.

• You’ll need assistance in the shower if you had an abdominal hysterectomy. This is during the first day after your operation. The next day, though, they’ll encourage you to shower on your own. If your hysterectomy was vaginal or laparoscopic, you’ll be helped if needed.

• You’ll be encouraged to go for a short walk the day after your surgery. This will help keep your blood flowing normally and stop blood clots from developing.

• Your lady parts will be covered in gauze for a few days to manage bleeding. After it’s removed, expect a bloody or brownish discharge from your vagina. This can last up to 6 weeks. Wear a sanitary pad to prevent staining your sheets and clothes OR use absorbent pads that double as an ice pack. 

• Vaginal discharge is typical, but it’s not supposed to be as heavy as a period. Make sure to let your doctor know if you experience persistent or heavy bleeding.

1 WeekPost Op

After you’re discharged from the hospital, you have to take it easy. Your body needs time to heal.

Take note of the followingafter care tips:

• Drink lots of fluids and add more fruits and fiber to your diet. Constipation is one side effect of a hysterectomy.

• While you’re recovering, you’re going to feel weak and exhausted. You’ll need to take frequent naps and breaks throughout the day. Getting as much rest as you can during the first two weekspost op is crucial for your healing.

• You still need to keep walking, whether that’s around your yard or your neighborhood. But don’t overdo the physical activity. Skip bending and lifting heavy objects.Sex after hysterectomy should also be avoided for at least six weeks.

• Avoid taking baths; have showers instead. When showering, don’t let the water hit your incision directly. Pat it gently to let it dry after. Rubbing your wound will irritate it.

• When you’re feeling sore and swollen, it can be difficult to get comfortable. Wear loose and stretchy clothes to let your body breathe.   

• If your ovaries were removed, expect to start having mood swings, hot flashes, and other menopausal symptoms (if you didn’t already go through menopause, that is). Hormone replacement therapy can help you control these symptoms in the long run.

1-2 MonthsPost Op

You can fully recover from your operation within a span of 2 to 8 weeks, subject to the kind of hysterectomy you underwent.

After an abdominal hysterectomy, it will take about 6-8 weeks for you to heal. You’ll have a shorter recovery period if you had a vaginal hysterectomy, which can heal in as early as 2 weeks.

A laparoscopic hysterectomy is the least invasive surgery and therefore has the quickest recovery time of 6 days to 2 weeks. 

Here’s other important information to know:

• Most women experience grief after their hysterectomy. You may mourn the loss of your womb and not being able to carry a baby. This is normal. Don’t hesitate to seek comfort from a professional or your family and friends.

• If you had your hysterectomy before menopause and didn’t get rid of your ovaries, there’s a chance you’ll experience menopause at a younger age.

• You may visit your doctor for apostoperative check-up around a month after your surgery. Use this opportunity to bring up any questions or concerns. 

• It may take 3 to 8 weeks for you to drive again following your operation, though you should only do it once you can wear a seatbelt comfortably. 

• Many women experience a loss of libido post-op, so it’s not really a cause for concern if it’s the same for you. It should come back when you’re completely healed. In fact, your sex life may improve because the pain you felt prior to your hysterectomy will disappear.

• Since you can’t get pregnant after having your womb taken out, you don’t need contraception. But your partner should still use a condom so you can stay safe from sexually transmitted infections (STIs).

When to Seek Medical Attention

While all forms of hysterectomies are considered safe, like any surgery, there is a chance of complications. You should seek medical attention if you experience any of the following:

• Temperature higher than 101°F
• Nausea
• Vomiting
• Heavy vaginal bleeding or discharge
• Redness, drainage, or swelling from your wound
• Opening of stitches in the operative site
• Foul odor from your vagina, wound, or dressing
• Pain that isn’t alleviated by painkillers
• Urinary and bowel movement issues
• Chest pain, palpitations, and shortness of breath

Final Thoughts

Every year, thousands of women undergo a hysterectomy. You shouldn’t worry about getting one, as it’s a safe procedure. Remember to follow your doctor’spost operative care instructions, report any major side effects, and don’t overexert yourself.

Icewraps’ wide selection of gel and clay packs can support you as you recover.that can make yourpost op recovery more pleasant. You can use our oversized clay pack to soothe your swollen belly, or use our while our 4×10 cooling gel pack is good for alleviating pain in your incision site. We also recommend our instant perineal packs are also specifically designed to relieve discomfort in your vagina and help with any discharge.

If you’re a clinic or a hospital, we offer custom gel packs in a variety of colors and sizes for your patients. Check out our complete list here.

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90,000 After removal of the uterus: rehabilitation, recommendations

People often come to us from cities, villages and regional centers.We have treated patients from such cities as:

Bila Tserkva, Brovary, Boryspil, Fastov, Irpen, Vishnevoe, Vasilkov, Boyarka, Obukhov, Bucha, Pereyaslav-Khmelnitsky, Vyshgorod, Slavutich, Yagotin, Boguslav, Skvira, Berezan, Ukrainka, Kagarlyk, Mironovka, Uzin Rzhishchev

We accept patients from all cities and towns of Ukraine. Patients from the following cities came to us:

Kharkiv, Odessa, Dnepropetrovsk, Dnipro, Donetsk, Zaporozhye, Lviv, Kryvyi Rih, Nikolaev, Mariupol, Lugansk, Vinnitsa, Simferopol, Kherson, Chernigov, Poltava, Cherkassy, ​​Zhitomir, Sumy, Khmelnitsky, Chernivtsi, Horlivka, Rovno, Dneprodzerzhinsk Kamensk, Kropyvnytskyi, Kirovograd, Ivano-Frankivsk, Kremenchuk, Ternopil, Lutsk, Bila Tserkva, Kramatorsk, Melitopol, Kerch, Nikopol, Uzhgorod, Slavyansk, Berdyansk, Alchevsk, Pavlograd, Severodonetsk, Evpatoria, Lisichansk, Kamenets-Podolsky , Krasny Luch, Yenakiyevo, Stakhanov, Konstantinovka

Surgical removal of the uterus is called a hysterectomy, this operation is performed when there are certain indications.The operation can be performed using several methods: vaginal (through the vagina), laparotomic (through an incision on the abdominal wall) or laparoscopic (through mini-incisions). The duration of the postoperative period and the speed of recovery depends on the chosen method of the operation and the behavior of the patient herself after surgery.

On the first day after the operation, patients are in the hospital under the supervision of a doctor.

In order to replenish the circulating blood volumes, the patient is given infusion therapy.The pains are relieved by non-narcotic anesthetic drugs, and antibacterial therapy is carried out for prophylactic purposes.

Bloody discharge is possible after surgery to remove the uterus, the healing period of sutures in the uterine stump and vagina lasts 10-14 days. After removal of the uterus, the abdomen remains painful and tender for 3 to 10 days. This indicator is individual, since each woman has a different pain threshold. Surgeons are of the opinion that patients should try to get out of bed and walk as early as possible.The more active the patient is after surgery, the higher the chances of a quick recovery and the lower the likelihood of possible complications.

To avoid thrombophlebitis, it is recommended to wear compression stockings or bandage your legs with elastic bandages. In the first 2-3 days, anticoagulants (blood thinners) are also prescribed.

Locomotor activity is also important for the restoration of normal bowel function. It is very important to follow a special gentle diet after the operation. The diet should contain mashed diet food, broths, still mineral water.You need to eat often, in small portions. When the bowel function returns to normal, you can switch to regular food, but the restrictions still remain: no spicy, smoked, fried foods, coffee, alcohol.

After discharge from the hospital, it is worth adhering to the following recommendations:

• Wear a special bandage
• Limit physical activity
• Do not lift more than 5 kg
• For the first 1.5 months after surgery, do not go to saunas or baths
• take a shower instead of a bath
• If there is discharge, use pads, not swabs

To restore the tone of the muscles of the vagina and pelvic floor, there is a set of special Kegel exercises that must be performed daily.Make sure that physical education in the postoperative period does not tire you, but, on the contrary, helps to improve your condition and mood.

Moderate exercise is recommended for those who went in for sports: yoga, body flex, Pilates. You can return to regular exercise three months after surgery.

Doctor of the highest category, gynecologist, kmn.

PS: This article was written by the doctors of the Dobry Forecast clinic in a popular science style, easy and understandable for people without medical education.The stated medical facts are based on data from medical literature, protocols, orders and treatment plans approved by the Ministry of Health of Ukraine. And also on the data of foreign medical literature and Internet publications.

PSS: The determination of the diagnosis and the choice of the treatment method remains the exclusive prerogative of your attending physician!
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• PhD in Medicine
• Experience 36 years

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• Oncogynecologist
• Doctor of the highest category
• Head of inpatient department
• Expert on STB
  “I am going to ruin my tila”
• Work experience over 26 years

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• Gynecologist
• Oncogynecologist
• Experienced Surgeon
• Expert on STB
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• Work experience over 10 years

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Benefits of diagnosis and treatment in the Dobry Forecast clinic

Why do patients choose the Dobry Prognosis Specialized Clinic?

PROFESSIONALISM – highly experienced doctors, doctors of the highest category, candidates of medical sciences, authors of modern clinical treatment protocols and innovative methods

• Organ-preserving techniques
• Minimally invasive surgery
• Modern operating theaters and departments

EXPERIENCE – we have been treating and operating for 10 years, since 2009

CARE OF PATIENTS

• Patient follow-up 1 month after surgery – free of charge
• Follow-up of patients after recovery – clinical examination
• Individual approach to nonresident patients

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• Clinic in Kiev – it’s easy to get to us
• We advise and operate daily – Mon-Sat 8: 00-22: 00
• 24/7 – 24-hour hospital in Kiev – we are always ready to provide our patients with support and emergency hospitalization

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Learn about the removal of the uterus

90,000 Ovarian cancer – symptoms, signs and stages in women, treatment of the disease

Ovarian cancer: symptoms, causes, precautions

About 1 in 75 women are diagnosed with ovarian cancer.The National Ovarian Cancer Coalition reports that ovarian cancer is the fifth leading cause of cancer death in women aged 35 to 74.

Given the serious consequences late stages of ovarian cancer can have, prevention (exercise, diet, examination) and awareness of the symptoms and signs of cancer are very important.

What are the first signs of ovarian cancer? In the early stages, cancer may not show any signs.Later stages can have “non-specific symptoms” that can indicate the presence of a variety of diseases. Symptoms of ovarian cancer include pelvic pain, bloating, constipation, increased urination, and others.

More than 90% of women who are diagnosed and treated early for ovarian cancer live at least another 5 years. Treatment may include chemotherapy, radiation therapy, and surgery. Natural therapies (healthy eating, resting, stress-free) can also speed up the healing process and reduce the side effects of therapy.

What is ovarian cancer?

Ovarian cancer is a disease that occurs only in women. It occurs when malignant (cancerous) cells form inside or on the ovaries. The ovaries are two almond-shaped organs located on either side of the uterus. They store and release eggs and also produce female hormones, including estrogen and progesterone.

There are three types of cells in the ovaries, each of which can develop into a cancerous tumor.The type of cell where the cancer started developing determines the type of ovarian cancer in general.

• Epithelial tumors (the most common type, about 90% of cases) cover the outer surface of the ovaries. These tumors may not be cancerous and do not always lead to disease. Borderline epithelial ovarian cancer (includes atypical proliferative serous carcinoma and atypical proliferative mucinous carcinoma) often occurs in young women. It is a slow growing cancer and is usually not life threatening.
• Germ cell tumors begin with cells that produce eggs. These include less than 2% of cases. Approximately 9 out of 10 patients with this type of cancer live for at least 5 more years from the date of diagnosis.
• Stromal tumors form from the structural cells of the tissue that holds the ovaries together, they also produce female hormones. This includes 1% of cases. Stromal tumors are usually diagnosed earlier than other types. This type of cancer usually occurs in older women and causes abnormal vaginal bleeding.

Symptoms and Signs

Symptoms of ovarian cancer may be mild and vague at first, but become more pronounced as the disease progresses.

The most common symptoms of ovarian cancer include:

• Bloating
• Pelvic pain, feeling of tightness in the abdomen
• Increased urination or feeling that you urgently need to use the toilet
• Eating problems, fast satiety, loss of appetite, sometimes weight loss
• Fatigue
• Digestive problems, including constipation, gas, bowel upset, heartburn
• Back pain
• Pain during intercourse
• Irregular menstruation
• Depending on the type of tumor, hair growth on the face and body may increase

What are the first signs of cancer? They can be different for each woman, depending on the type of cancer, stage and area of ​​spread.Most often, the first noticeable signs are bloating, pelvic discomfort, feeling full quickly, urinary problems, and unexplained bowel changes.

What about pain? Pain in the abdomen, pelvis usually becomes more intense over time. It is mild at first and is often confused with menstrual cramps or abdominal pain, but it gets worse after a few months.

Granulosa cell tumor (GRT), a rare type of tumor in stromal cells, can have a number of additional symptoms:

• Abnormal vaginal bleeding
• Endometrial hyperplasia (thickening of the uterus causing bleeding)
• Chest pain
• Unusual vaginal bleeding
• Signs of increased testosterone (appearance of masculine features such as facial hair)
• In prepuperty girls, early onset of puberty (70-80%) and the appearance of male characteristics are observed

Causes and risk factors

All cancers develop when abnormal cells in the body begin to grow out of control, usually forming tumors and sometimes spreading to other parts of the body.Recent research suggests that many cases of ovarian cancer originate in the fallopian tubes, which carry eggs from the ovaries to the uterus.

Metastasis is the term used for the spread of cancer cells through the blood and lymph to other parts of the body. Sometimes cancer cells can appear in the ovaries if they have entered (metastasized) there from other parts of the body, such as the breast or colon. In this case, we are not talking about ovarian cancer, since the original site of the malignant neoplasm determines the type of cancer.Ovarian cancer can spread to the digestive system or the pelvic region.

A number of risk factors have been identified that can increase the risk of developing epithelial ovarian cancer (studies suggest an unlikely increase in the risk of developing germ cell and stromal tumors). While certain features may contribute to the onset of cancer, it is not fully understood why some women do develop cancer and some do not.

Risk factors for ovarian cancer include:

• Genetic predisposition
• Personal or family history of breast, ovarian or colon cancer
• Age over 40.Most cases of ovarian cancer are diagnosed in women aged 50-60, but younger women are often at risk 90,024
• Infertility
• Obesity
• Smoking and alcohol abuse
• The appearance of children after 35 years, the absence of children
• Taking hormone replacement therapy (including estrogen) after menopause
• Early onset of menstruation or later onset of menopause
• Exposure to certain chemicals and toxins, including talc, which is often found in sanitary napkins, diaphragms and condoms

Is there a link between cysts and ovarian cancer? Cysts, small, about 3 cm in diameter, appear relatively frequently (in women with polycystic ovary syndrome) and are mostly benign (non-cancerous).However, if a woman develops a cyst larger than 6 cm, it persists for several menstrual cycles, or it develops in childhood or after menopause (when cysts appear less frequently), they should be examined. These types of cysts are called “abnormal” and may not be cancerous, but in some cases they can affect the development of ovarian cancer.

Staging and Diagnostics

The American Cancer Society estimates that about 22,280 new cases of ovarian cancer are diagnosed in the United States each year, with 14,240 women dying of the disease.Women who begin immediate treatment for the disease in the early stages are much more likely to recover. But, unfortunately, only in 20% of diagnosed cases, cancer is at stages I or II. At later stages (III and higher), the survival rate is only 28%.

Determination of the stage depends on how much the disease has developed and spread throughout the body. The concept of “shape” is also used to describe the behavior of cells and the aggressiveness of their growth.The early stages are usually treatable with surgery or chemotherapy. Later stages require more aggressive treatment and regular follow-up examinations.

• Stages of ovarian cancer are indicated by Roman numerals from I (1) to IV (4). Stage I, the earliest, indicates that the cancer is limited to the ovaries. The last stage IV indicates that the cancer has spread to other parts of the body. (6)
• Other factors that determine the stage of the disease include: the size of the tumor (T), whether the cancer has spread to the lymph nodes (N), the presence of metastases in more distant sites (M).The numbers and letters assigned to the T, N, and M indicate how aggressive ovarian cancer is.
• For example, ovarian cancer “Stage I, TI, N0, M0” means that the cancer is confined to the ovary (or ovaries) or fallopian tube (s) and has not spread to lymph nodes (N0) or more distant parts of the body (M0).
• Ovarian cancer “IVB, any T, any N, M1b” indicates that the cancer has spread to the inside of the spleen or liver, lymph nodes other than the retroperitoneal lymph nodes, and / or to other organs and tissues outside the abdominal cavity, for example, lungs and bones.

How to detect early ovarian cancer?

With an annual diagnosis, the gynecologist must carefully examine the woman for any abnormalities. If they are found, additional tests are needed to diagnose and rule out ovarian cancer, including transvaginal ultrasound and / or a blood test for a tumor marker called CA-125.

• A doctor may use a number of tests and diagnostic methods to examine a patient with ovarian cancer, including examining the pelvic organs, external genitalia (vagina, cervix), imaging studies (ultrasound, CT), scans and blood tests to help evaluate general condition of the body and detect tumor markers.
• Assessment of CA-125 is performed on a blood sample and the concentration of CA-125 is measured. CA-125 is a protein made by cancer cells and sometimes inflamed non-cancerous cells. Women may have elevated levels of CA-125, which are not associated with cancer, so this test should not be used as the only way to diagnose the disease.
• If an ovarian removal is prescribed, the doctor may diagnose ovarian cancer, depending on the patient’s health condition.
• The PAP test alone cannot detect ovarian cancer. The PAP test is aimed at examining the cervix, it will not show that there is ovarian cancer. However, it can show the presence of abnormalities, it is worth noting that in patients with ovarian cancer, the PAP test may be within normal limits.

How to detect early ovarian cancer?

Traditional treatment

Ovarian cancer is usually diagnosed and treated by a gynecologist (specializing in women’s reproductive health) or an oncologist (specializing in cancer treatment).They use the following treatments:

• Chemotherapy: Targets cells that grow and divide rapidly. Standard treatment for ovarian cancer involves surgery to remove the tumor (or as much of it as possible), followed by six courses of chemotherapy. Unfortunately, chemotherapy also kills healthy cells, causing side effects (nausea, indigestion, diarrhea, hair loss, decreased immunity, fatigue and anemia).
• Hormone therapy: Allows to shrink tumors by reducing the production of hormones that promote tumor growth.
• Radiation therapy: helps to shrink the tumor.
• Targeted drug therapy or immunotherapy: Typically used to treat advanced cancers and target specific types of cells.
• Surgery: Most women with ovarian cancer have surgery at least once. Sometimes several operations are required during the treatment.
• Medications: Medications including angiogenesis inhibitors and targeted therapy can be prescribed in addition to chemotherapy or alone.New types of drugs are currently being developed to shrink tumors. These medications include Avastin and Sovenifib.

Natural Ways to Speed ​​Up Healing

Here are some tips to help make your treatment more comfortable and effective:

1. Eat right

There is evidence that women who eat a healthy diet rich in plant foods and antioxidants are less likely to develop ovarian cancer (and other cancers) and tolerate therapy more easily.A study known as the Swedish Mammography Cohort found that consuming more vegetables (≥3 servings per day versus <1 serving per day) reduced the risk of ovarian cancer by 39%.

Aim to eat at least 2½ plates of a variety of fruits and vegetables a day. Vegetables containing antioxidant flavonoids are especially effective against ovarian cancer.

We recommend that you include the following anti-cancer foods in your diet:

• Leafy greens such as kale and spinach
• Seaweed
• Fresh herbs and condiments such as turmeric, ginger, basil, parsley or oregano
• Fresh garlic
• Citrus fruits, berries, apples, pears, kiwi, coconuts, dates and figs
• Mushrooms, carrots, beets, tomatoes, bell peppers, artichokes, okra, green peas, zucchini, Brussels sprouts, turnips, sweet potatoes
• Cruciferous vegetables such as broccoli and cauliflower
• Organic Free Range Livestock
• Fish caught in free waters, e.g. salmon, mackerel or herring
• Green tea
• Cocoa
• Olive and coconut oil
• Avocado
• Legumes and beans, e.g. black beans, lentils, chickpeas or adzuki
• Nuts, e.g. almonds or walnuts, flax and chia seeds
• Cereals, e.g. quinoa, brown rice, buckwheat, oats

To avoid inflammation, digestive problems and maintain overall health, we advise you to refrain from consuming the following foods: factory-made red meat (beef, pork, veal) and semi-finished meats (sausages, sausages, deli meats), foods and drinks with added sugar, refined vegetable oils, fried foods, fast food and hydrogenated fats.

Nutritious foods also help maintain a healthy weight. Overweight and obesity are associated with a high risk of ovarian cancer and other cancers such as the colon. Healthy food, good sleep, and regular exercise can help you lose weight.

2. Rest more often

Accepting a diagnosis of ovarian cancer is always very difficult, especially if the disease is at an advanced stage and requires aggressive treatment. Try to incorporate stress-relieving activities into your life.Perhaps you need to set aside an hour for naps to relieve fatigue and gain strength, or go to bed earlier (you should sleep at least 8 hours at night). Also try taking time out for yoga, meditation, walking in the fresh air, reading, massage, or acupuncture. Stress-free and self-care can help build the immune system you need to fight cancer.

3. Avoid nausea, constipation and indigestion

If you experience nausea, bloating, loss of appetite, or constipation during treatment, the following tips may help:

• Get enough fiber, but keep in mind that too much may worsen symptoms.On average, about 20-30 grams of dietary fiber is needed per day, adjust the amount consumed, focusing on your own well-being.
• Drink plenty of water. Avoid dehydration during exercise, illness, or hot, humid weather.
• Limit or eliminate alcohol and caffeine as they can worsen gastrointestinal problems.
• Avoid high-fat portions.Interval between meals will make digestion easier.
• For constipation, try to eat foods and drinks that are natural laxatives (for example, prune juice, plantain, aloe vera, chia and flax seeds, flax oil, leafy greens, kombucha, kefir, and coconut water). Dietary supplements with magnesium and fiber may also be helpful.
• For nausea, drink ginger herbal tea or ginger essential oil. Spray peppermint or lemon essential oil, go for walks in the fresh air, ventilate more often, try meditation and acupuncture.
• If pelvic pain is causing discomfort, try natural pain relievers. Chiropractic treatment, physical therapy, stretching, and warm baths will also help relax your muscles. Always check with your healthcare professional before taking any medications or supplements.

Prevention

1. Have an annual examination by a gynecologist

At the moment, there is no exact method for diagnosing the early stages of ovarian cancer.Therefore, many experts strongly recommend that you undergo rectal and vaginal examinations of the pelvic organs every year. The specialist should know your medical history and the risk factors to which you may be exposed. If your family has had ovarian or breast cancer, talk to your doctor about it.

2. Pay attention to genetic testing

If the doctor believes that the patient may be at an increased risk of ovarian cancer (taking into account a number of factors), he may schedule a consultation with a geneticist, who will perform tests for the presence of genetic mutations.Some gene mutations can increase the risk of ovarian and breast cancers, but only a small percentage of ovarian cancers are caused by inherited gene mutations.

The genes that increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). Gene mutations associated with Lynch syndrome can also increase the risk of ovarian cancer. If a woman is diagnosed with gene mutations that can lead to ovarian cancer, she may be offered surgery to remove them to prevent the development of the disease.Of course, it is worth weighing all the pros and cons of such a decision in each case individually.

3. Avoid exposure to toxins such as talc.

Overall, research results regarding chemical exposure and the risk of ovarian cancer have been mixed. Some studies have found that exposure to talc, a chemical that can enter the ovaries through the vagina, uterus, and fallopian tubes, may slightly increase the risk of ovarian cancer.Talc (a mineral containing magnesium, silicone and oxygen) is often used in many products women use, such as baby powder, cosmetics, sanitary napkins, soaps, lotions, and feminine hygiene products.

One study, published in the journal Epidemiology , found that exposure to talcum powder in the genital area increased the risk of ovarian cancer by 33% (similar results were not seen with exposure to other parts of the body).Look for “talcum powder” or “cosmetic talcum powder” on the packaging before purchasing any product that contains talcum powder. Opt for talc-free products, especially if you are using it in the genital or pelvic area. You can also try homemade products to cleanse and protect your skin, such as baking soda, cornstarch, coconut oil, shea butter, nanoparticle free zinc oxide, and vitamin E.

4. Breastfeed after childbirth

Breastfeeding can reduce your risk of ovarian cancer.Experts believe that breastfeeding can have a positive effect on hormones in the post-pregnancy period, and it is also very beneficial for your baby.

Some doctors do not recommend the use of birth control pills all the time, but research has found that oral contraceptives can reduce the risk of ovarian cancer. A hysterectomy (surgical removal of the uterus, but not the ovaries) can also reduce the risk of ovarian cancer by 30%.However, it should be noted that this operation is assigned in exceptional cases.

5. Limit alcohol consumption and quit smoking

Studies have found that people who abuse alcohol or smoke are more likely to suffer from various types of cancer compared to those who limit alcohol and do not smoke. Women should consume no more than one glass of alcohol a day. To quit smoking, you can seek help from a doctor, try various drugs or mobile apps that help you quit bad habits.

Give up bad habits

Precautions

If you have had any symptoms of ovarian cancer (pelvic pain, pain during intercourse, bloating, irregular menstruation) for several weeks, be sure to see your doctor. Listen to yourself and note any symptoms that you experience more than 12 times a month or that you have never experienced before.This kind of attentiveness is especially important if you are at risk.

If symptoms persist even after treatment, see another specialist for a second opinion to rule out cancer. Be aware that ovarian cancer symptoms can also be associated with a variety of other medical conditions. Pain and discomfort doesn’t necessarily indicate cancer, so don’t panic, just see your doctor for advice.

Final conclusions

• Ovarian cancer occurs when malignant (cancerous) cells form inside or on the surface of the ovaries, two almond-shaped organs located on either side of the uterus.They contain eggs and produce female hormones, including estrogen and progesterone.
• Not every woman experiences signs of cancer in the early stages of the disease. Symptoms of ovarian cancer include bloating, pelvic pain, satiety, frequent urination, irregular menstruation, constipation, pain during intercourse.
• Risk factors for ovarian cancer include a family history of cancer, genetic mutations, age over 40, obesity, smoking, hormone replacement therapy, children over 35, exposure to certain chemicals such as talc.
• Treatments for ovarian cancer include chemotherapy, radiation therapy, immunotherapy, and / or surgery.

7 Ways To Prevent Ovarian Cancer And Deal With The Side Effects Of Treatment:

1. Proper nutrition
2. Rest
3. Fight nausea and bowel upset
4. Annual examination by a gynecologist
5. Breastfeeding
6. Eliminate exposure to toxins
7. Restriction of alcohol and tobacco consumption

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Gynecological Surgery – Nutricia Advanced Medical Nutrition

Gynecological operations

If you are about to have surgery, then you are probably worried, and this is quite natural. The thought that the necessary operation, especially done on time, will help you to calm down, gives you the opportunity to get rid of the disease, often saves your life. And the state of health in the future largely depends on how the postoperative period goes, so it is worth doing everything possible to recuperate.Specialized nutrition is of particular importance at this stage. Nutrition for fibroids and other gynecological diseases should be balanced and include a complex of nutrients necessary to prepare well for the operation, because any surgical intervention is stress for the body, and it is important to satisfy its needs, avoiding unnecessary stress.

A special time

Women who have undergone gynecological surgeries such as removal of the uterus or ovaries, excision of fibroids, cesarean section or abortion can quickly regain their health and return to normal life.But it must be remembered that surgical intervention and anesthesia cause a specific reaction in the body, in other words, stress that must be overcome during the postoperative period. processes, affecting only their activity and intensity.

The postoperative period is usually divided into several stages: at the beginning (from the 1st to the 3rd day), the body mobilizes all its forces in order to eliminate the negative consequences of the operating load and restore metabolic processes.Then, within 3 – 5 days, a protective reaction occurs, aimed at the rapid delivery of the necessary substances to the cells, because after the operation it is very important to replenish energy losses, therefore, nutrition after removal of the uterus or ovaries and other gynecological operations should be complete and balanced.

Increased protein breakdown causes not only a decrease in muscle mass and a decrease in the amount of connective tissue, but also a deficiency of enzyme proteins. It is worth noting that at this stage the level of stress hormones rises and the level of insulin decreases.During the next phase, metabolic processes are activated: the synthesis of protein, fats and other substances lost during the operation and at the previous stage is enhanced. Due to this, an extremely important process of growth and development of connective tissue occurs. The functions of the cardiovascular and respiratory systems, and the gastrointestinal tract are also restored.

There are general recommendations of specialists that should be followed in order for the postoperative period to be successful.First of all, a woman needs complex medical treatment for rehabilitation. It includes antibacterial, analgesic, sedative therapy and general strengthening drugs. Secondly, nutrition after removal of the uterus, caesarean section or abortion should contain the optimal amount of proteins, fats and carbohydrates, a complex of vitamins and minerals, as well as omega 3 fatty acids. Thirdly, a complex of restorative therapy is needed, including physiotherapy procedures and therapeutic exercises.

Correct diet

Specialized nutrition after removal of the uterus and other operations is necessary in order to reduce the load on the body, help normalize metabolism, increase the body’s resistance against inflammation and intoxication, and accelerate the healing of the surgical wound.Another important task of such nutrition is to eliminate the deficiency of proteins and vitamins, which often develops in operated women under the influence of factors such as blood loss, breakdown of tissue proteins and fever. In addition, after the operation, it is necessary to start the “standing” intestines, the manifestations of which are constipation, flatulence. In this regard, it is recommended to use meat broths, dairy products, fresh fruits and vegetables, friable cereals, vegetable oil. Remember, the diet should consist primarily of foods that have a laxative effect.The fact is that after many gynecological operations, in particular, after removal of fibroids, it is not allowed to push, since such tension is a threat to the stitches left on the uterus. Accordingly, the occurrence of constipation should not be allowed. They are also dangerous because irregular bowel movements provoke inflammation in the appendages and uterus. Exclude from the diet those foods that slow down the bowel movement. These are “slimy” soups, mashed potatoes and cereals, as well as jelly and mashed food. It is not recommended to consume chocolate, strong tea and coffee, cocoa, cottage cheese and pomegranates.White bread and pastries are also not desirable.

Nutrition after removal of the uterus should be fractional. As for the calorie content of food, it is gradually increased. It is very important to know that at this stage many people are prone to dehydration. The daily requirement for fluid in the postoperative period ranges from 2 to 4.5 liters per day, depending on the patient’s condition. These recommendations must be followed for 2-4 months, and then you can switch to a normal diet.

We make up for the losses

During the postoperative period, the body intensively loses proteins. The special specialized nutrition Nutridrink Compact helps to compensate for their deficiency. It is worth noting that protein from this product is absorbed much better than, for example, from cottage cheese. Protein in specialized Nutridrink Compact is highly digestible.

Nutridrink Compact is a complete and balanced diet that fully satisfies the needs of a woman’s body after a gynecological operation.This product is rich in energy, vitamins, trace elements and polyunsaturated omega fatty acids. The latter, which is especially important, help to reduce the inflammatory response. In addition, Nutridrink Compact can be used as an additional food for fibroids and many other gynecological diseases.

Nutridrink Compact gives you a boost of energy, which is so necessary for recuperation after surgery.