Abdominal Hysterectomy (Removal of the Uterus)

What is an abdominal hysterectomy?

An abdominal hysterectomy is surgery to remove the uterus through a cut in the belly (abdomen). The uterus (womb) is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus.

• A subtotal hysterectomy, also called a supracervical hysterectomy, is the removal of the part of the uterus called the fundus. The cervix is not removed.
• A total hysterectomy is the removal of the uterus and the cervix.
• A radical hysterectomy is the removal of the uterus with the cervix and tissue on the sides of the cervix.

Other female organs—the ovaries and fallopian tubes—may also be removed when the uterus is removed.

When is it used?

There are many reasons why you and your healthcare provider may decide to take out your uterus. Some of the problems that may be treated with a hysterectomy are:

• cancer
• growths in the uterus called fibroids
• heavy bleeding that has not been controlled with medicine, dilatation and curettage (D&C), or endometrial ablation
• endometriosis that causes pain or bleeding and does not respond to other treatments (Endometriosis is a growth of tissue from the uterus outside the uterus.)
• pelvic pain that does not go away
• a prolapsed (fallen) uterus, which happens when the uterus drops down into the vagina from weakened muscles and weakened supporting tissues in the vagina
• precancerous or cancerous cells on the cervix or on the lining of the uterus

Examples of possible alternatives to an abdominal hysterectomy are:

• having the uterus removed through a cut in the vagina (vaginal hysterectomy) or with a lighted tube with a camera (laparoscopic hysterectomy)
• taking medicine to treat some types of problems
• having a hysteroscopy or laparoscopy to treat some problems
• having D&Cs to control abnormal bleeding
• treating precancerous cells of the cervix with conization (removing a cone-shaped part of the cervix)
• removing an area of endometriosis without removing the uterus
• removing fibroids without removing the uterus (a procedure called a myomectomy)
• knowing and understanding the risks of your condition but choosing not to have treatment

You should ask your healthcare provider about these choices.

How do I prepare for an abdominal hysterectomy?

Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest. Try to find other people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should stop smoking at least 2 weeks before the procedure. It is best to stop smoking 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery. Be sure to tell your healthcare provider what medicines you are taking, including nonprescription drugs and herbal remedies.

Follow any instructions your healthcare provider gives you. Your provider may tell you to eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Your healthcare provider may give you a laxative to take the night before the surgery or an enema the morning before the surgery.

What happens during the procedure?

You will be given a regional or general anesthetic. A regional anesthetic numbs part of your body while you stay awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles and causes a deep sleep. It will keep you from feeling pain during the procedure.

You will have an IV in your arm to give you fluids and medicines, including antibiotics. Usually a catheter (small tube) is put into your bladder through the urethra to drain urine from the bladder.

Your healthcare provider makes a cut in your belly. Your provider separates ligaments and blood vessels from the uterus and ties off the blood vessels so they will heal and not bleed. Your provider then removes the uterus by cutting it off at the top of the vagina. The top of the vagina is stitched closed so that a hole is not left.

What happens after the procedure?

The IV and bladder catheter are removed 1 or 2 days after the surgery. You may stay in the hospital about 2 to 5 days. Sometimes you may need to go home with the catheter still in your bladder until your bladder is working normally again. Your healthcare provider will check how your bladder is working at a follow-up visit.

After you go home, get plenty of rest. Don’t do any heavy lifting or strain the stomach muscles in any other way for 4 to 6 weeks. Follow your healthcare provider's instructions for activity, pain relief, and preventing constipation. Ask your provider what other steps you should take and when you should come back for a checkup.

If you were having menstrual periods before the surgery, you will no longer have them after the operation. Without your uterus you will not be able to get pregnant. If your ovaries were removed, menopause starts right away if you haven’t already had menopause. Your healthcare provider may prescribe medicine such as hormone therapy to help relieve some of the symptoms of menopause. Be sure to discuss any concerns you have about these effects and treatments with your provider before the surgery.

What are the benefits of this procedure?

A hysterectomy takes care of problems you may have been having with your uterus.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. However, regional anesthesia is considered safer than general anesthesia.
• Your bladder or the tubes leading to it from the kidneys may be injured and need surgical repair.
• You may have an infection or bleeding.
• The incision may not stay closed.
• You may get a hernia in the cut in your belly. A hernia is a weakening of the abdominal muscles that allows the intestines to push through the weakened area.
• Your intestine (bowel) may be injured during the surgery.
• You may have a blood clot in your legs, pelvis, or lungs.

Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever over 101.5°F (38.6°C).
• You get dizzy and faint.
• You have nausea and vomiting.
• You have chest pain.
• You get short of breath.
• You have heavy bleeding from the vagina.
• You have leakage from the cut in your belly, or the cut doesn’t stay closed.
• You have pain when you urinate.
• You have swelling, redness, or pain in your leg.
• You have diarrhea that does not stop.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.