If the gynecologist recommends an operation to remove the uterus, then for most women it causes serious confusion and fear. However, it is worth remembering that in some cases this is the only way to save life, for example, in the presence of a serious illness, the appearance of a neoplasm. In our article, we consider what constitutes a hysterectomy (excision of the uterus), what types of operations are, how to recover as quickly as possible after it.
Indications for removal of the uterus
In surgery, surgery to remove the uterus is called hysterectomy. Assign her to conduct if the therapy did not give the desired result or the woman too late went to the doctor. In some European countries, this procedure is also prescribed if there is a risk of developing oncology (for example, a hereditary factor) or if a woman does not consciously want to have children.
Hysterectomy is prescribed for a number of diseases of the genitourinary system and reproductive organs: fibroids, fibrioma, neoplasms, etc. Let's look at each case in more detail.
Myoma
Myoma is a benign neoplasm, and they can grow to an impressive size: for example, in some women, doctors find education more than 6-8 cm in diameter, which corresponds to the 12th week of pregnancy.
Surgical intervention is prescribed if there is a rapid growth of tumors, large tumors appear, when it is no longer possible to perform a more benign operation to remove them. It should be noted that in this case not only the uterus itself, but also the fallopian tubes, appendages will be removed, more than 50% of the ovaries are removed.
Endometriosis
It is a process of proliferation of the uterine mucosa into the fallopian tubes or ovaries, other organs, where it should not be.
This pathology is also accompanied by inflammation of adjacent organs, manifested by severe pain during menstruation, there are strong vaginal discharge.
It is worth noting that the operation to remove the uterus in this case is far from always justified - it is usually carried out if the woman is not going to have children.
Cervical cancer
In such cases, hysterectomy is often prescribed - during the procedure, the affected cervix, the uterus itself, the tubes, the ovaries and nearby tissues and nodes are removed. After the operation, the patient must undergo at least one course of radiation therapy. If a hysterectomy is performed in time, this will reduce the risk of developing the disease in the future.
Necrosis of fibromatous nodes
It is a serious complication of fibroids, which is associated with the lack of nutrition of fibromatous cells. On palpation, the patient experiences severe pain, which can lead to vomiting and fever. The type of treatment in this case depends on the stage of the pathology, the general analysis of the patient.
Omission or prolapse of the uterus
The main factor that leads to this pathology is muscle weakness. In addition, inflammation, endocrine disorders and, of course, hard physical labor can lead to this pathology. First, treatment therapy is prescribed, however, in the absence of positive results, hysterectomy is prescribed.
Types of hysterectomy
Excision of the uterus involves not only the complete removal of the affected organ, because in some cases, this operation involves other actions to eliminate anatomical tumors. Depending on the volume of work performed, hysterectomy may be:
- Subtotal, in which the uterus is removed, but the cervix remains.
- Total - with this operation, both the uterus and the cervix are removed.
- Extirpation during which the appendages and ovaries are removed.
- Radical - in this case, doctors remove the entire organ, the upper part of the vagina, tissue, growing around the uterus.
According to the access method, these types of operations are distinguished:
- Laparotomy hysterectomy (longitudinal or cross section of the cavity is performed).
- Laparoscopic removal (2-4 punctures are made in the abdominal wall for the installation of a laparoscope).
- Vaginal hysterectomy, in which the passage to the affected organ is carried out through the vaginal cavity.
Radical intervention is required in the presence of malignant tumors on the uterus with involvement in the pathological process of the cervix. Total cleansing is carried out in the presence of large fibroids, growing endometriosis.
It should be noted that the issue of removal of related organs is often solved during the operation, the surgeon himself decides which method to choose.
If we talk about abdominal removal of the affected organ, then the advantages of this procedure include a democratic cost, a low level of risk of complications. But among the minuses there is a serious scar after the operation, the stay in the hospital in the postoperative period should be at least 8-10 days, the recovery period is stretched by an average of 5 weeks.
Laparoscopic hysterectomy has the following advantages:
- Discharge the patient in the absence of complications for 5 days.
- The recovery period is up to 4 weeks.
- There is no scar.
- The risk of adhesions is minimized.
Among the shortcomings they note a rather high cost and the fact that such operations are most often carried out only in large cities or private medical centers, where there is the necessary equipment.
Vaginal hysterectomy is transferred quite simply, after it is performed, there are no scars on the body, the recovery period is about three weeks, and there is practically no pain after the procedure. The disadvantages include the complicated technique of performing the operation, which only highly qualified specialists possess.
Proper preparation for the operation
General tips
To perform the operation, the surgeon must have at least 0.5 liters of blood, you may need to perform a transfusion. If the patient suffers from iron deficiency, blood transfusion is performed first.
When diagnosing an atrophic collar, the patient is first prescribed therapy, which is aimed at restoring the damaged tissue. Especially carefully prepared for the operation of those who have a tendency to form blood clots: special drugs are prescribed that lower the risk of their development, blood density is regularly monitored, procedures for normalizing the tone of blood vessels and arteries are prescribed.
If there is a tendency to varicose veins, the patient is additionally prescribed an ultrasound of the legs. In addition, to avoid the occurrence of infections, prescribe a course of antibiotics, which are introduced into the body directly during hysterectomy. Also, before the procedure itself, it is necessary to consult a surgeon and a phlebologist.
Analyzes
Since this operation is complex, serious complications can occur after it. That is why it is so important before the excision to pass all the necessary tests that show the condition of the blood organs.
These include:
- Vaginal smear. Based on the results, it is possible to establish whether there are mutating cells in the body.
- Analysis for infectious diseases that are sexually transmitted.
- Blood tests (including the method of Lee White) and urine.
- MRI or ECG, ultrasound.
Intestines
You also need to prepare the intestines:
- Three days before the operation, you need to switch to a special diet that excludes fiber, any bakery products, vegetables, berries, fruits.
- Before the hysterectomy, you need to completely get rid of food.
- On the day of surgery can not drink, this will prevent the occurrence of vomiting.
- Before the operation, the stomach is cleaned with an enema.
Moral training
Removal of the uterus as the main reproductive organ is a huge stress for women. Therefore, the attending physician should explain why it is so important to perform the operation, how it will be performed, to tell about the possible consequences, if the hysterectomy is not performed in time.
A few nuances of hysterectomy
Cavitary
To ensure access to the organs, the surgeon makes an incision in the abdominal cavity, after which he performs a hysterectomy (excision of the uterus) after the removal is completed, the incision is sutured. The duration of the operation, depending on the complexity, is from 50 to 120 minutes.
Laparoscopic
The operation of this method is as follows:
- With the help of a cannula (special abdominal tube) gas is injected into the abdominal space. Due to this, the walls will rise above the organs, so that the doctor will be able to access the uterus.
- The surgery itself is carried out: to remove the uterus and other organs, the surgeon makes several incisions in the abdomen to install the tubes — through them, the camera for observation and instruments are lowered into the abdominal cavity.
The average time of the operation is about 2.5 hours.
Vaginal
This operation is carried out fairly quickly, there is no need to stitch up, there is no scar left. But she has a number of contraindications. For example, it is forbidden to carry out the operation in the following cases:
- If the uterus is large.
- Organs present malignant neoplasms.
- An inflammatory process takes place in the body.
- Previously carried out caesarean section.
How are the first day after surgery
The postoperative period is the time interval from the moment of the operation to the full resumption of working capacity. The time after uterus removal is divided into two periods:
- early;
- late.
If we talk about the early period, this is the time spent in the hospital under medical supervision. The duration of this period depends on the complexity of the operation, the general condition of the patient, the method of operation. On average, the hospital needs to spend from 3 to 10 days.
The most difficult period is the first day after the operation. During this period, the woman feels severe pain both in the abdominal cavity and near the sutures - this is the norm, since there is a rather serious wound inside.
To eliminate pain, prescribed pain medication. Lower limbs, in order to prevent the formation of thrombophlebitis, are bandaged with elastic bandages.
In addition, surgeons in most cases advise women to start getting up as early as possible. Due to motor activity, it starts to “run the blood”, the gastrointestinal tract normalizes.
Also worth remembering about the importance of adherence to diet. The first two days after the operation, you need to eat sparing food: broths, mashed food, drinks. Such a diet is a non-aggressive effect on the intestines and helps its self defecation. As soon as the work of the gastrointestinal tract is normalized, you can move on to the usual food.
Do not forget about some moments of treatment in this period. So, after the behavioral hysterectomy, doctors prescribe:
- Antibiotics. They are prescribed due to the fact that the internal organs of the woman during the operation were in contact with the environment and the bacteria and microorganisms contained in it. Treatment time with antibiotics is about 5-7 days.
- Means for blood thinning. They are prescribed in the first 2-3 days. Due to their use reduces the likelihood of thrombophlebitis.
- Parenteral infusion. This operation involves the loss of a large amount of blood, which is why an intravenous infusion of a special compound is often performed.
Rehabilitation and recovery
Recovery after hysterectomy is a rather complicated process, during which you need to carefully monitor your health and not forget about all the recommendations of doctors.
Nutrition
So, all food should be gentle: you should eliminate from the diet all foods that can aggressively affect the mucous. In addition, you need to temporarily abandon:
confectionery;- tea and coffee;
- cottage cheese;
- white bread;
- cheese
confectionery;Meals should be fractional, which will restore bowel function after surgery: eat in small portions, but often (about 6 times a day). You need to drink enough water: an average of three liters per day.
You also need to include in the diet dishes that will have a laxative effect on the body: cereal, broth, sour milk. In addition, it is important to absolutely follow all the recommendations of the doctor concerning nutrition.
Loads
It is worth remembering that during the first few months in no case can not lift weights - no more than 3 kg of weight. The same applies to sexual activity - for about the same period it is necessary to abandon sexual relations.
You can visit the pool no earlier than 1.5 months after the surgery. Despite the fact that the scar is retarded quite quickly, many surgeons recommend starting to play sports no earlier than six months after the hysterectomy.
Postoperative bandage
A good helper in the recovery period is a bandage, especially if we are talking about a woman who has already given birth or is nearing menopause. When choosing a bandage you need to remember that it should be comfortable, not cause discomfort when wearing. In addition, when choosing a corset, it is worth remembering that it should cover the postoperative suture from below and above at least 10 cm.
Useful recommendations of doctors
After the operation, it is very important to bring the body back to normal, to be engaged in recovery. All measures aimed at this will help to avoid serious complications. Essentially important tips include:
- You can have sex no sooner than two months after surgery, while during intercourse, a woman should not feel discomfort.
- Do not forget about the Kegel exercises, which will help to avoid difficulties with urination.
- You need to consult a doctor about taking medication.
- Strict adherence to the diet - an important point of recovery.
It is also worth remembering that the care of loved ones affects the recovery of the body - after such an operation, a woman may feel empty, it will be difficult for her to cope with her problems. That is why the support of loved ones is so important.
Complications and consequences after hysterectomy
Even if the operation takes place as efficiently and effectively as possible, in some cases complications may arise.
For example, in the first few days after surgery, adhesions may form or there may be slight blood loss, which leads to painful sensations. Consequences - vascular thrombosis, problems with urination, fever, the appearance of pus at the site of stitching, hematoma.
As complications can also be observed:
- decrease in sexual desire;
- the appearance of dryness in the intimate area;
- the development of pathologies such as atherosclerosis or osteoporosis.
But the most famous consequence is menopause. Her signs may begin to appear several months after the operation.
Causes of adhesions, treatment methods
More than 90% of women who have undergone this operation, appear spikes. Their formation is due to the fact that as a result of surgical intervention in the patient's body, various functional disorders can occur.
There are physiological or pathological adhesions, and they need to be distinguished. The first option always appears - in place of scars that remain after the operation. Over time, the scar disappears, the functioning of the organs is restored, the inflammation disappears.
But if the connective tissue continues to form at the site of the scar, it begins to grow into other organs, this is already a pathological process that requires surgical intervention.
You can suspect the appearance of pathological adhesions by symptoms such as:
- Pulling pains in the lower abdomen, which are relieved by taking analgesics.
- Violation of urination or defecation.
- Flatulence, severe flatulence, bowel problems.
- Increased body temperature.
- Intense pain when probing the scar, the appearance of swelling.
- Pain during intercourse, the appearance of bloody discharge.
If these symptoms do not go away after 2-3 weeks after surgery, you should immediately consult a doctor.
Adhesions of the disease are mainly treated surgically, since conservative treatment is usually ineffective. When pathological adhesions are detected, the following types of operations are used.
Laparoscopic, which is carried out with the use of special equipment. Several small cuts are made on the skin, the abdominal wall is punctured, and a special tool is used to cut the adhesions. The main advantage of this operation is that the removal occurs with minimal trauma to the organs. Recovery takes literally 1-2 days, and the symptoms disappear almost immediately.
Laparotomy, which is carried out in several cases: it is not possible to use a laparoscopic operation or with an extensive adhesive process. An incision is made to allow access to the internal organs. Such an operation is quite traumatic, the recovery period is delayed to two weeks.
Важно помнить, что ни один врач не может дать 100% гарантию того, что эта патология не вернется. По этой причине так важно вовремя посещать врача, сдавать анализы.
