Has your doctor informed you that you may need a hysterectomy, or have you already had one and are wondering about possible hysterectomy complications? This article will explain what a hysterectomy is, how it is performed, the different types of hysterectomies performed and why some methods are chosen over others. It will also explain what the short term and longer term hysterectomy complications are. Some of them may even surprise you. This is a very common procedure, but complications from a hysterectomy can be minimized by an experienced physician.
What Is a Hysterectomy?
A hysterectomy is a surgical procedure to remove a woman’s uterus. Many years ago, if a hysterectomy became necessary the surgeon would remove all reproductive organs at once. But as science has advanced and doctors and patients realized just how many functions a woman’s reproductive organs fulfill aside from reproduction, less radical and more advanced minimally invasive surgical procedures have been developed.
Two overall methods of hysterectomy are now employed:
- Traditional Abdominal. The tissue is removed through an incision similar to a c-section or a vertical incision.
- MIP, Minimally Invasive Procedure. This minimally invasive procedure removes the tissue through your vagina or through a small laparoscopic incision. There are several methods employed, with the main benefit being that many hysterectomy complications are significantly reduced as well as recovery time.
Three general types of hysterectomies are now performed:
- Supracervical. This is also known as a subtotal hysterectomy as it removes the upper and middle part of your uterus. This procedure leaves your cervix in place.
- Total hysterectomy. This procedure removes the entire uterus and the cervix.
- Radical hysterectomy. This procedure removes the cervix, uterus, all tissue on the sides of your uterus and even the top part of the vagina.
In addition to these three procedures, your doctor may also elect to remove one or both fallopian tubes, which is called a salpingectomy, and or one or both ovaries, which is called an oophorectomy. This was often standard procedure in the past, but as doctors began to understand the hysterectomy complications of this type of surgery, the procedure became much less common.
Now, fallopian tubes are sometimes removed as possible prevention of rare cancer or in cases of tubal pregnancy. Additionally, now ovaries are usually only removed in severe cases of ovarian cysts, unrepairable endometriomas, postmenopausal, or cancer.
Who Needs a Hysterectomy?
There are many reasons that this procedure may become necessary or an option that you may have to consider:
- Cancer. This is a reason for performing a total hysterectomy along with the removal of the fallopian tubes and ovaries.
- Fibroid tumors. Sometimes, fibroids get so large that they are simply unmanageable and too large to remove without removing the uterus too. Pain, cramps, and bleeding from fibroids is frequently worse than the discomfort from the hysterectomy.
- Uterine Prolapse. Occasionally, the uterine ligament connections to the surrounding tissue will stretch and weaken and “fall out” or prolapse through the vaginal canal.
- Endometriosis. If endometriosis has become medically unmanageable, hysterectomy may become the only reasonable option, especially if a woman is done with childbearing.
- Chronic pelvic pain. This can happen for many reasons, including endometriosis, fibroids or adenomyosis, which are painful glands in the muscle layer of the uterus. It can also happen for other reasons or be unexplained.
- Hemorrhage during childbirth, usually a cesarean section. This is a medical emergency and can result in the necessary removal of the uterus to save the mother’s life.
In all of these cases, the risk of hysterectomy complications is weighed against the symptoms of the condition itself and the benefits of removing the uterus. It’s best to learn as much as you can about hysterectomy and possible alternatives and make a very informed decision.
Possible Complications of a Hysterectomy
The chances of developing more urinary incontinence increases with a hysterectomy. It can be a common hysterectomy complication. However, Kegel exercises and even Pelvic Floor Physical Therapy can reduce and even cure it in a majority of cases.
Tissue scarring and adhesions can result from any major surgery and this is no exception. Sometimes these scars can become very painful, especially if they place pressure on nerves. Experienced, efficient, and precise surgeons and surgery can minimize the potential for scar tissue as well as prevent the post-op complications. If you do have this after surgery, one of the most common and effective methods for healing pain from scarring and adhesions is with Pelvic Floor Physical Therapy.
Very rarely, women can and do contract an infection from the surgery. Modern sterilization techniques ensure this almost never happens, but if it does you will likely need to be treated with antibiotics. If the infection is severe you will need to be hospitalized for IV antibiotic therapy.
Uncommon risks of this surgery include:
Since a hysterectomy is a major surgery that removes a major organ, the risk of blood clots is slightly higher than with minor procedures. But it is still extremely rare and precautions are taken during surgery to prevent this problem by using SCDs, “leg squeezer velcro wraps” during the surgery and or heparin injection preoperatively.
As your tissue heals post surgery, it’s possible for your scar tissue to develop a tube, called a fistula, between your bladder and your vagina or rectum and vagina. It would be necessary to correct this surgically as such a fistula would cause pain and infections. Luckily this is very rare and women notice symptoms such as urine or gas coming from their vagina. Usually, these symptoms would occur in the first 8 weeks after surgery.
If you are having a hysterectomy due to cancer and are considering laparoscopic surgery instead of traditional, you should discuss this very thoroughly with your doctor. This is because as the tissues are pulled through a laparoscopic incision, a process called morcellation is used to divide the tissue into smaller pieces for easier removal. If done improperly, cancer cells can spread throughout the abdominal cavity and the rest of the body. Although laparoscopic robotic hysterectomy is a recommended option for cancer surgery, your doctor can discuss with you the ways of preventing further cancer spread during the surgery. Frequently, the morcellator will not be used in suspected cancer cases.
The tissues surrounding your uterus and ovaries is very vascular. This means that the surgeon must be very careful when removing the organs to ensure that all blood supplies are properly sealed off. Even a very experienced surgeon may face large vasculature, but they usually have the experience to deal with this without losing a large amount of blood. However, if there is a lot of bleeding, you may need a blood transfusion. If it is very severe and not corrected with a transfusion, it can result in death.
This is only a risk if your ovaries are removed as well. This is because your ovaries produce most of the hormones responsible for your menstrual cycle. They also produce necessary estrogen, which is responsible for regulating many other bodily functions including those that regulate bone density. This makes osteoporosis a very real risk for those who have their ovaries removed. It is manageable with hormone replacement therapy, or non-hormonal therapies. But hormone replacement therapy and non-hormonal therapies have side effects as well, so the best option is to keep your ovaries if at all possible.
Again, this is a rare, but possible consequence of any major surgery. Every year, hundreds of thousands of hysterectomies are performed. The chance of dying during this surgery is roughly 1 in 1,000, or 99.9% chance of surviving
Alternatives to Hysterectomy
Because hysterectomy comes with risks of hysterectomy complications, possible safer alternatives should always be discussed first:
- Myomectomy. This is a surgical procedure to remove fibroids from the uterus and allow the uterus to heal and return to normal. In most cases, the woman can still retain her fertility and go on to have pregnancies and children, but the delivery will need to be a cesarean section. If a woman doesn’t want any more children, then this procedure will preserve her natural organs and return them to normal as they were before the fibroids developed.
- Uterine artery embolization. If the cause of the problem is fibroids, this procedure cuts off the blood supply to fibroid tumors and is effective for improving symptoms in 85% to 90% of the patients. Appropriate candidates for this procedure typically have smaller fibroids and only a few of them. This procedure is done in the hospital Xray department by an interventional radiologist.
- Endometrial ablation. This procedure removes the lining of your uterus, so it is only an option for those who no longer want to have children. It significantly reduces bleeding but doesn’t help very much with cramps.
Is your doctor considering recommending a hysterectomy? You are not alone as currently, over half a million hysterectomies are performed a year. Or perhaps you are dealing with one of the above-listed hysterectomy complications? There are possible consequences of this surgery that make this a complicated topic of discussion. If you would like to share your story below, hopefully, others who face what you have can learn from your experiences. Thank you for sharing!
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