In gynecology, various conservative methods are used to treat uterine bleeding. But all these methods do not always give the desired result, therefore, they recommend a planned or emergency operation to remove the uterus.
The frequency of this surgical intervention in gynecology is observed in 25-40% of cases with an average age of women who are recommended to be removed, 40 years old. More and more often, doctors, instead of using conservative therapy for uterine fibroids in forty-year-old women, recommend removing the genital organ, motivating this decision by the fact that the function of childbearing has already been realized and the uterus is no longer needed. But when is the removal of the uterus justified? What methods are used, what are the consequences and rehabilitation?
Indications for the operation to remove the genital organ
Removal of the uterus (hysterectomy) is indicated in such cases:
- Multiple fibroids or a single node that grows rapidly is accompanied by heavy bleeding.
- Myomas in women over 50 years. Although there is no tendency to malignancy, they easily turn into a malignant form, so removal of the uterus in this case is necessary to prevent cancer. But often, such an intervention is associated with subsequent pronounced autonomic-vascular and psychoemotional disorders, for example, the manifestation of post hysterectomy syndrome.
- Necrosis of the myoma node.
- Subserous nodes that threaten the patient with torsion.
- Submucous nodes affecting the myometrium.
- Polyposis and regular heavy menstrual bleeding, which are complicated by anemia.
- 3-4th stage of endometriosis or adenomyosis.
- Malignant neoplasm of the genital organ and appendages, radiation therapy has played a role. Most often, women of advanced age are recommended to remove the uterus and appendages precisely because of cancer.
- The omission of the organ.
- Chronic pelvic pain that does not respond to other treatment methods.
- Rupture of the organ during childbirth or during gestation.
- Uncompensated organ hypotension with severe bleeding.
- Gender change.
Despite the fact that a hysterectomy is considered the perfect method, it still remains technically difficult and is accompanied by frequent complications during and after the intervention.
Complications during surgery can be associated with damage to the rectum, bladder, ureters, hematomas are formed in the parametric region, heavy bleeding is observed.
Types and methods of surgical intervention
Despite the fact that the outcome is always the same, the operation to remove the uterus can be carried out in several ways at different levels, which has different consequences.
The types of operations depend on the amount of intervention:
- Radical (hysterectomy) technique involves the complete removal of the genital organ with the neck and ovaries. The upper part of the vagina and the lymph nodes located in the pelvic area are also removed.
- Total when the uterus and cervix are removed.
- The supravaginal involves the removal of the uterus, but the cervix remains.
If it is possible to preserve the reproductive organ and ovary, especially for women under 40, then the doctor must do this.
Also, all operations are divided into types according to the technique of their implementation.
Laparoscopic method
Laparoscopic removal of the uterus involves the use of a special chamber, which is inserted into the patient’s abdominal cavity through an incision. The selection of organs occurs with the help of tools that are inserted into the peritoneum through other openings. The image from the camera enters the monitor, and the surgeon can see everything he does. The woman lies with her legs raised during this operation.
This method cannot be used if the patient’s organ fell out, with large formations, since it will not work to remove them through a small hole in the peritoneum.
Laparotomy method
This technique is used for an extensive adhesive process in the abdominal cavity, for enlarged uterus, if neighboring organs are involved, or if the intervention is urgent.
This technique involves an incision from the navel to the pubis. The entire area of the peritoneum and pelvis are clearly visible, the genital organ is removed. At the time of the operation, the woman lies on her back and is under anesthesia.
Surgery through the vagina
This technique is recommended in the presence of small benign neoplasms in the uterus or appendages.
An incision is made in the upper part of the vagina, through which the surgeon conducts all further actions. This technique can be combined with the introduction of the camera, and then laparoscopy is performed. Organ removal is carried out with a special tool.
But you can not use the operation through the vagina in such cases:
- if the uterus is too large;
- the patient is diagnosed with cancer, and there is no exact information about its prevalence;
- if there are a lot of adhesions in the pelvic area;
- a cesarean section was previously performed;
- when there is inflammation or fungal discharge.
Laser removal
Laser removal of the uterus is the latest technique, which is especially popular with doctors, because it has a number of undeniable advantages over other methods of surgery:
- reduces the risk of bleeding, the operation is performed almost without blood;
- recovery time is significantly reduced;
- no damage to the main muscles;
- pain and discomfort during the rehabilitation period are reduced;
- minimal risk of urinary incontinence;
- the risk of infection is reduced;
- less risk of scarring;
- decrease in sexual desire after surgery is minimal;
- Laser removal is excellent with laparoscopy and endoscopy.
With the help of a laser scalpel, many operations are performed to remove the uterus. The procedure is performed under intubation anesthesia. Instruments are inserted through incisions in the umbilical and iliac regions. The separated organ is removed through the vagina.
How to prepare for surgery?
Preparation for the planned operation is to conduct surveys:
- blood tests biochemical and clinical;
- Analysis of urine;
- blood type determination;
- identification of causative agents of sexually transmitted infections.
- the doctor recommends an ultrasound scan;
- chest x-ray and ECG;
- bacteriological and cytological analysis of a smear taken from the genital tract;
- colposcopy.
Women in hospital can undergo hysteroscopy, MRI, and sigmoidoscopy.
A week before the operation, in order to prevent complications such as thrombosis or thromboembolism, the doctor appoints specialist consultations and taking medications.
For prophylactic purposes and to reduce the severity of symptoms of post hysterectomy syndrome, which often develops in women after removal of the uterus, the operation is performed in the first phase of menstruation, if any.
A couple of weeks before the operation, psychotherapeutic procedures are carried out, 5-6 visits by a psychologist and psychotherapist, which are aimed at reducing the feeling of uncertainty, fear and suspense before and after the operation. Herbal medicine, hormonal and sedative medications are also prescribed, it is recommended to stop smoking and drinking alcohol. All these measures will help to facilitate the course of the recovery period after the organ removal operation. Removing the uterus in this case, the woman will endure more emotionally and physically.
How long does the operation take?
It is impossible to determine the exact time of the operation. First of all, you need to know which method will be used in each case. It also depends on the size of the uterus, the presence of adhesions and other factors. The average operation time is 1-3 hours.
Rehabilitation and recovery
After removal of the uterus by surgery, much attention is paid to inflammatory processes, normalization of water-electrolyte balance, blood composition, harmonization of the patient’s mental state. Recovery after abdominal surgery is a month and a half, after laparoscopy - 2-4 weeks. Vaginal intervention involves a full recovery after a month.
The suture after removal of the uterus by abdominal surgery resolves after a month and a half. To prevent adhesive disease, the patient may be prescribed magnetotherapy. If necessary, the doctor may recommend suppositories, injections or tablets to eliminate the serious consequences of surgery. If the uterus was removed, the postoperative period lasts a month and a half, at this time a sick leave is issued.
Diet after removal of the genital organ
It is important to follow a diet after surgery to remove the genital organ. Be sure to exclude irritating mucous products. Porridge, dairy products, broths, nuts - all this should be present daily on the woman’s menu. It is also important to eat fruits and vegetables to prevent constipation. At the time of rehabilitation, it is better to exclude coffee, sweets, tea, chocolate and white flour bread.
Complications after surgery
If the uterus is removed along with the ovaries, then the woman can feel all the symptoms of menopause:
- insomnia;
- hot flashes;
- mood swings;
- sweating.
This condition is called medical menopause. In the event that the ovaries are not removed during the operation, then only one of the symptoms of menopause is observed - the absence of menstruation.
Doctors say that menopause in women who only had their genital organs removed is only 5 years after surgery. Such patients often develop:
- atherosclerosis;
- osteoporosis;
- decreased sex drive;
- burning sensation;
- dry vagina.
The consequences of removing the uterus and ovaries in the first few days, weeks, months can be observed as follows:
- inflammation of the skin around the seam;
- heavy bleeding;
- cystitis;
- the occurrence of thromboembolism;
- vaginal prolapse;
- urinary incontinence;
- pain caused by adhesions or bleeding.
Do I need a bandage after removal?
A bandage after removal of the uterus is necessary. At a young age, it must be worn for three weeks, for women after 45 years - at least 2 months. The bandage helps the rapid healing of wounds, reduces pain, improves bowel function, reduces the likelihood of hernia formation. Use the bandage in the first days only in the daytime, and after only during long walks or during physical exertion.
After the operation, the location of the pelvic organs changes, the tone and elasticity of the muscles are lost. All this leads to constipation, urinary incontinence, worsening of sexual life, vaginal prolapse and the development of adhesions. In this case, only prevention can help, or rather Kegel exercises, which will help strengthen and increase muscle tone.
Sex life after surgery
After removing the genital organ for two months, it is better not to have a sex life in order to prevent infection. The operation can lead to a decrease in sexual desire, and all due to the fact that the risk of hormonal disorders, the development of neurological, autonomic and vascular problems is increased.
All of them, in interaction with one another, aggravate the general condition and reduce sexual desire. Basically, sex is not prohibited, you can use a specialist to choose a set of exercises that will help increase sensitivity. Consultation with a doctor will help to establish a sexual life.
Are there periods after removal of the uterus?
Do menstruation persist after surgery to remove the genital organ? This question interests many women. Preservation of menstruation is possible, and there are several reasons for this. For example, an organ can be removed and the neck left, and then, under the influence of the appendages, the endometrium continues to form in a small area, as a result, a woman can have periods. But this is not abundant discharge, but scanty bleeding during menstruation.
After removal of the organ and neck, menstruation should not go. If they are observed, then this may be a consequence of the development of pathologies of the genital area, in such a situation it is better not to hesitate to visit a doctor.
Sometimes women take bleeding as a period, which can be dangerous. That is why with any spotting, it is better to consult a doctor to exclude the development of complications.