How long is the recovery period after removal of the uterus. How to recover after hysterectomy surgery. How much can not lift weights after removal of the uterus

A hysterectomy is a surgical procedure in which the reproductive organ is removed. This type of operation is considered the most popular in gynecology and is performed if women have certain indications. Usually, a hysterectomy is resorted to in the case when the treatment of pathology in other ways does not bring the desired effect.Postoperative period after removal of the uterus- this is one of the important stages of ongoing therapy and can be accompanied by the development of unpleasant consequences, therefore, it requires a careful approach on the part of doctors.

Hysterectomy is usually performed for certain indications:

multiple myomatous nodes, which are rapidly increasing in size;
detection of myomatous nodes in patients older than 50 years;
myoma necrosis;
severe prolapse of the uterus or its prolapse;
persistent pain in the pelvic region, which cannot be eliminated by other methods;
advanced stage of endometriosis and adenomyosis;
subserous nodes with an increased risk of torsion of their legs;
polyposis and heavy menstruation leading to anemia;
rupture of the reproductive organ during pregnancy and childbirth;
placental accreta or purulent endometritis;
submucous nodes that grow into the endometrium.

Hysterectomy is a rather complicated operation and is often accompanied by the development of many complications. Unpleasant consequences of such an operation can be injuries to the gastrointestinal tract, ureters and bladder, as well as the formation of hematomas and severe bleeding.

The degree of damage is determined by both the type of operation and the method of its implementation. The most radical is the abdominal operation, when access to the organ is opened by cutting the abdominal wall. Another method of surgical treatment is the vaginal method, which is characterized by an incision in the genital organ. The least traumatic way to remove the reproductive organ is the laparoscopic method, during which a minimal incision is made. In the event that surgical intervention is carried out in this way, then the risk of developing dangerous complications is minimal.

Recovery period principles

After removal of the uterus postoperative perioddivided into early and late stages. After a successful abdominal surgery, the early postoperative period can last up to 12 days, after which the woman's stitches are removed and she is discharged from the hospital. In the event that the removal of the reproductive organ was carried out using a laparoscope, then the duration of early rehabilitation reaches 3-4 days. At the very beginning of rehabilitation it is important:

relieve pain;
eliminate bleeding;
exclude infection in the affected tissues;
avoid malfunctions in the work of internal organs;
ensure the formation of a scar on the tissues.

After discharge from the hospital, the late stage beginsrehabilitation after removal of the uteruswhich usually takes place at home. In the absence of any complications after the operation, the recovery of the body lasts about a month, and with a complex surgical intervention it can be 45 days. The main task of the laterecovery period after hysterectomyserves to improve the condition of the entire female body, normalize the immune system and heal tissues. About the endrecovery period after hysterectomythey speak only if it was possible to normalize the mental state of the patient and restore her working capacity.

Activities after a hysterectomy

To know how to recover after hysterectomy surgery,needed from your doctor. On the first day after surgery to remove the reproductive organ, all measures must be taken to exclude the development of any complications. In addition, it is important to prevent the progression of pathological processes in the genital organs, avoid internal bleeding and eliminate pain. On the first dayrehabilitation after removal of the uterus by abdominal surgerythe following activities are carried out:

After removal of the organ, the patient is tormented by severe pain localized in the lower abdomen. In order to alleviate the patient's condition, the use of potent drugs is prescribed.
Measures are taken to normalize the movement of blood in the body and stimulate the intestines. If there are indications, Proserpine is injected by injection, thanks to which it is possible to activate bowel functions.
Rehabilitation after surgery to remove the uterusinvolves the restoration of normal intestinal motility, and this can be done with the help of a special diet. In the diet of a woman, mashed foods, broths and drinks should be present. An independent act of defecation at the end of the first day after hysterectomy indicates that the rehabilitation measures were chosen correctly.

Immediately after a hysterectomy, a woman is prescribed antibiotics for 5-8 days, which makes it possible to exclude infection. In order to prevent the formation of blood clots in the vessels of the circulatory system, coagulants are shown that are introduced into the body of a woman within 2-3 days. It is possible to normalize blood circulation and restore blood volume by intravenous droppers.

Possible Complications

After the operation to remove the reproductive organ, the woman will no longer be able to become pregnant and give birth to a child, and her pelvic organs are slightly displaced. With successful surgery and no complicationsrecovery after hysterectomygoes by pretty quickly. It is necessary to seek medical help if a woman has severe pain in the lower abdomen and bleeding from the genitals develops.

Visit a doctor duringrecovery after hysterectomynecessary in the following cases:

suppuration of the imposed seams began;
swollen lymph nodes in the groin area;
severe bleeding developed;
the body temperature has risen;
there were difficulties with urination;
suffer from pain of a chronic nature;
the vagina fell out or fistulas formed.

After surgery to remove the uterus, the position of the intestines and bladder changes. In addition, the muscles that provide support to the vagina are greatly weakened.

One of the unfortunate consequencesabdominal surgery to remove the uterus in the postoperative periodadhesive process is considered. In most cases, it is not accompanied by the development of pronounced symptoms, but can lead to dangerous complications. The main sign of the adhesive process after removal of the uterus is severe pain in the pelvic area.

With adhesive disease inrehabilitation period after removal of the uterusintestinal obstruction develops due to a violation of the movement of feces through the large intestine. Women are tormented by periodic cramping pains, constant constipation, gas retention and flatulence. It is possible to eliminate such a pathological condition using conservative methods, but surgery may be required.

Late recovery after surgery to remove the uterusthe following activities are recommended:

be sure to wear a bandage;
refuse to lift weights and limit physical activity on the body;
perform gymnastic exercises and exercise therapy;
do not visit baths, saunas and refuse to swim in the pool;
do not take hot baths throughout the entire rehabilitation period;
eat properly.

Surgical treatment to remove the uteruscarried out only when absolutely necessary, and especially in women of reproductive age.Rehabilitation after surgerycan proceed in different ways and in some cases be accompanied by the development of some complications. It is for this reason that it is important to comply with all necessary measures of the early and late recovery period, and follow all the doctor's prescriptions.

If the hysterectomy was performed under general anesthesia, then in the first hours after the operation, you may feel nausea. You will be able to drink water 1-2 hours after surgery and eat 3-4 hours later, or when the nausea subsides.

You may still have a catheter in your bladder for up to 1-2 days after the operation, through which urine will be excreted into an airtight container.

When can you get out of bed?

Get out of bed as early as possible. If during the operation a large incision was made on the skin of the abdomen, then it will be possible to rise on the second day after the operation. If the operation was performed using laparoscopy, then you can get out of bed on the day of the operation, in the late afternoon. The sooner you can get up and walk, the faster your recovery from surgery will be and the lower your risk of future complications.

Pain after surgery

After a hysterectomy, the pain can be quite severe. This is due to the inflammatory process, which is the very first stage of wound healing. Pain can be felt both in the suture area and inside.

Pain medications will be prescribed to relieve pain. For very severe pain, narcotic analgesics may be required.

Some women experience tingling or aching pain in their abdomen for several months after surgery. This is normal and is associated with damage to the nerve endings, without which no surgical intervention can do. Usually, all these symptoms gradually disappear.

When will they be released from the hospital?

How long you have to stay in the hospital after surgery depends on the type of surgery. After a laparoscopic hysterectomy, you may be discharged from the hospital the very next day. If the operation was performed through a large incision in the skin, then they are discharged from the hospital 2-3 days after the operation. The duration of hospitalization also depends on your diagnosis (the reason for the removal of the uterus), your well-being, the presence or absence of complications.

How long does recovery take after hysterectomy?

Recovery after surgery can take several weeks:

after abdominal hysterectomy: 4-6 weeks
after vaginal hysterectomy: 3-4 weeks
after laparoscopic hysterectomy: 2-4 weeks

You can leave the city no earlier than 3 weeks after the operation if you do not have a large abdominal stitch, or no earlier than 6 weeks after an abdominal hysterectomy (if you have a large abdominal stitch). The same applies to air travel.

How long can you not lift weights after removal of the uterus?

For at least another 6 weeks, you should not lift anything heavy, as this can lead to abdominal pain, smearing vaginal discharge, or even a hernia, which will have to be operated on again.

How long can you not have sex after removing the uterus?

You will have to refrain from sex for at least 6 weeks after the operation.

How long can you swim after removing the uterus?

Diet after hysterectomy

You can return to your normal diet immediately after you leave the hospital. But try to avoid foods that make you bloated (gas in the intestines) at first.

Suture after hysterectomy

After an abdominal hysterectomy, the suture on the skin of the abdomen can be quite large. It must be carefully looked after until complete healing.

If the sutures do not dissolve on their own, you will need to return to the hospital after a few days: your surgeon will tell you when the sutures can be removed after the operation. If the stitches should dissolve on their own (the surgeon will tell you this), then they usually dissolve 6 weeks after the operation.

In the first days after the operation, it will be necessary to additionally process the suture to reduce the risk of inflammation. Betadine, which can be found in a pharmacy, is suitable for this.

You can take a shower or bath without fear: the skin in the area of the seam can be gently washed with shower gel and then rinsed with water.

The skin around the seam may itch due to stretching: to relieve itching, gently lubricate the skin with lotion or cream.

Some women report that the skin around the seam "bakes" or vice versa, becomes numb. All these phenomena are also normal and usually disappear a few months after the operation.

Brown vaginal discharge after hysterectomy

After a hysterectomy, bleeding from the vagina is almost always observed: it can be dark brown, reddish, light brown or pink. All this is normal.

Discharge usually persists for several weeks after surgery: 4 to 6 weeks. In the first 2 weeks, the discharge will be most noticeable, and then it will become more and more scarce. The amount of discharge is individual, but almost always depends on physical activity: the more you move, the more discharge.

The discharge may have a peculiar smell and this is also normal. But if the discharge still smells unpleasant, then you need to contact a gynecologist. After removal of the uterus, local immunity of the vagina may be reduced, which is accompanied by a slightly increased risk of inflammation. A foul-smelling discharge will be the first sign that something is wrong.

If the discharge is plentiful, as with normal menstruation, or comes out with blood clots, then you should also consult a doctor. This symptom may indicate that one of the vessels is bleeding and without the help of a gynecologist, the bleeding will not stop.

Temperature after hysterectomy

In the first days after the operation, the body temperature may be slightly elevated. During this time, you will still be under the supervision of doctors and, if necessary, you will be prescribed antibiotics.

After being discharged home, you may also notice that the body temperature stays around 37C, or rises to 37C in the late afternoon. And that's okay. You should consult a doctor if the body temperature is above 37.5C.

Removal of the uterus and menopause

If during the hysterectomy not only the uterus, but also the ovaries were removed, then already in the first weeks after the operation you may notice symptoms of menopause: hot flashes, mood swings, excessive sweating, insomnia, etc. This is due to a sudden decrease in the level of female sex hormones in the blood: before they were produced by the ovaries, but now there are no ovaries. This condition is called surgical or artificial menopause.

Surgical menopause is no different from natural (when menopause occurs on its own), and yet, after surgery, menopause symptoms may be more pronounced. If you cannot cope with the symptoms of menopause on your own, consult a gynecologist. Your doctor may prescribe a course of hormone replacement therapy for you, which will help you move on to menopause more smoothly (the only exception is women who have had their uterus removed due to cancer, in which case hormones are contraindicated).

If only the uterus was removed during the operation, and the ovaries remained, then the only difference that you will notice after the operation is the absence of menstruation. At the same time, hormones will be produced in the ovaries, which means that there will be no other symptoms of menopause. However, it has been observed that even if the ovaries remain, the removal of the uterus "accelerates" the onset of menopause: in many women, the first symptoms of menopause (, sweating, mood swings, etc.) appear within the first 5 years after hysterectomy.

There is a whole section on our website dedicated to the problems of menopause:

What complications are possible after removal of the uterus?

Complications of a hysterectomy are rare, but you need to be aware of them in order to seek medical help in time.

In the first weeks or months after surgery, the following complications are possible:

Inflammation of the wound: the skin around the seam becomes red, swollen, it hurts or pulsates a lot, the body temperature rises to 38 ° C and above, poor health, headaches, nausea are observed.
Bleeding: After surgery, some blood vessels may open again, and blood begins to flow from them. In this case, abundant bloody discharge from the vagina appears. The blood is usually red or dark red in color and may come out in clots.
Inflammation of the urethra or bladder: Some women experience pain or cramps during urination after the catheter is removed. This is due to mechanical damage to the mucous membranes by the urinary catheter. Usually, after 4-5 days the pain disappears. If the symptoms do not go away and get worse, then you need to see a doctor again.
Thromboembolism: This is the blockage of blood vessels by blood clots, blood clots. To prevent this complication, it is recommended to get out of bed as soon as possible and start moving after the operation.

In the following months or years after surgery, the following complications are possible:

The onset of menopause: even if the ovaries were not removed along with the uterus, menopause may occur after the operation. See Removal of the uterus and menopause.
Omission of the walls of the vagina: manifested by the sensation of a foreign body in the vagina, incontinence of urine or feces. Our website has .
Urinary incontinence: an unpleasant consequence of hysterectomy, which is most often associated with the prolapse of the anterior vaginal wall. Our website has .
Chronic pain: This is a rare complication that can develop after any surgery. Chronic pain can last for years, impairing the quality of life. To cope with this problem, you need to contact a doctor who treats pain.

Collapse

Removal of the uterus with appendages is perhaps one of the most serious and difficult operations in gynecology. It can carry quite a lot of complications, and in addition, be characterized by a long and difficult recovery period, during which various restrictions apply to many areas of life. But it is precisely the careful adherence to the doctor's recommendations at this stage that can significantly speed up the recovery from the disease, recovery after the procedure and improve the quality of life. About how the postoperative period goes after the removal of the uterus, what features it has and what recommendations should be followed at this stage of treatment, is described in this material.

Duration

How long does the rehabilitation of the patient after such an intervention actually last? To some extent, this is influenced by its method and volume. For example, if the uterus with appendages was removed, then the recovery period can be up to two months, and if only the organ cavity itself, then up to six weeks or one and a half months.

It is customary to distinguish between early and late rehabilitation period. Early is understood as the first three days after the operation, and the first 24 hours have the maximum value. Late means the rest of the period - up to one and a half to two months.

Quick Recovery

How to quickly recover after removal of the uterus? Express methods of recovery after this intervention does not exist. This intervention is quite serious and voluminous, accompanied by hormonal changes in the reproductive system. And also, they have their own effects and symptoms of the disease, due to which it was necessary to amputate the organ. Therefore, the recovery period after removal is normally long and is accompanied, to the greatest extent in the first weeks, by a deterioration in well-being.

Taking into account the individual characteristics of the body, recovery after removal of the uterus can go a little faster or a little slower, but there will still not be a significant difference. And even if the state of health improved after 2-3 weeks, this does not mean that the implementation of the doctor's recommendations should be stopped.

Within 24 hours after the laparotomy was carried out, it is necessary to observe bed rest. It takes a lot of time just to get out of anesthesia. You should not sit down and get up even to the toilet. Although by the end of the first day, gently, with the help of hands, it is already permissible to roll over on its side. Only liquid food is allowed.

First 72 hours

Over time, it is necessary to increase physical activity. At this stage, the patient should already half-sit in bed, get up to use the toilet, roll over on her side. There should still be liquid and semi-liquid food, by the third day starting to include easily digestible ordinary food. It is important to control the work of the intestines so that there is no constipation and gas formation.

These days, treatment is already being carried out after removal of the uterus - broad-spectrum antibiotics are taken to avoid infection.

It is necessary to pay attention to your general condition - a high temperature after the procedure at this stage may be a sign of an inflammatory process.

One and a half to two months

About a week after the abdominal operation was performed, antibiotic treatment ends. Often, at this stage, hormone treatment may be prescribed to facilitate entry into menopause (when the ovaries are removed). At the same stage, consultations of a psychologist are appointed, if they are needed.

The patient can eat normal food, but it is important that it is healthy and natural, and does not cause constipation and gas formation. Bed rest is moderate for the first two weeks. Then it can be canceled, but physical exertion should be avoided.

Rehabilitation after removal of the uterus excludes saunas, baths, any overheating. You can not swim in natural reservoirs, you can maintain hygiene with the help of a shower.

What should be done at this stage? It also depends on the type of intervention. Depending on it, the patient may be given additional instructions for rehabilitation.

Subtotal hysterectomy

Perhaps the simplest removal of the uterus, the postoperative period in which is short. With such an intervention, only the body of the organ is removed, the neck and appendages remain unaffected. The duration of the rehabilitation period is about one and a half months, the scar is small, hormonal treatment is not required.

Total hysterectomy

The uterus and cervix are removed, without appendages. The duration of the recovery period is about the same, you can return to sexual activity no earlier than two months later. Hormonal treatment is also not required.

Hysterosalpingo-oophorectomy

Not only the body of the organ is removed, but also the appendages - the ovaries and fallopian tubes. Extirpation of the uterus with appendages is a rather difficult operation, involving a long, up to two months, rehabilitation period. The scheme of the procedure in the photo in the material.

Radical hysterectomy

The entire organ is removed. Rehabilitation has the same features as with total hysterectomy.

intimate life

During the entire recovery time after removal of the uterus, it is advisable to abandon intimate life. Although in many ways this can be determined only on the basis of the method by which the intervention was carried out. For example, when only the uterine cavity is removed and the vagina and cervix are completely preserved, doctors are allowed to resume sexual activity after a month and a half. If the cervix and the upper third of the vagina were removed, then the period of abstinence may be longer, since the suture after the intervention may be injured.

Thus, during the first five weeks, sex is prohibited. After this period, it is worth consulting with a specialist on this issue. This is true for any period that has passed since the abdominal surgery to remove the uterus - before resuming sexual activity, consult your doctor.

Sport

When can I exercise after hysterectomy? This question can only be answered taking into account the type and intensity of loads. At the initial stages of recovery after the procedure, any physical activity should be at a minimum. After the first week of rehabilitation, therapeutic exercises can be added to prevent the formation of adhesions, etc. After a full rehabilitation period, you can again do gymnastics and aerobics in moderation and without excessive loads and strength exercises.

You can also start doing fitness no earlier than 2 months after the intervention, and only with the permission of the attending physician. As for professional sports, bodybuilding, the time to start such exercises should be discussed with the doctor separately, since the nature of the load, the nature of the intervention, the speed and characteristics of healing play an important role.

Example of daily routine

Rehabilitation after surgery is faster with the correct daily routine. You need to sleep more - in the first 7 days after the procedure, you need to sleep as much as you want. Then it is recommended to sleep for at least 8 hours, but you can’t sleep for more than 10 hours either, since at this stage it’s no longer worth lying too much. Physical activity is needed to avoid stagnation of blood and the formation of adhesions. That is, bed rest should still be observed, but not excessively - taking into account sleep, it is worth spending 13-15 hours a day in bed, the rest of the time it is better to sit, walk, do simple, non-stressful household chores.

Starting from the second week walks are shown. First, short - 15-20 minutes. Over time, their duration can be increased to one hour in good weather. Every day for 10-15 minutes you need to do therapeutic exercises.

Diet Example

As already mentioned, the first three days it is better to eat fairly light food - natural vegetable broths and mashed potatoes. Then you can gradually introduce food of the usual consistency, and by the end of 5-6 days the patient should switch to a diet of the general table. Although the food should meet the requirements of a healthy diet, it is necessary to avoid fried, fatty, canned, smoked, and in addition, sweet, preservatives and dyes. For example, the diet might be:

Breakfast - oatmeal porridge, egg, black tea;
Late breakfast - fruit, cottage cheese;
Lunch - vegetable or chicken / meat broth soup, lean beef with rice, rosehip broth;
Snack - vegetable / fruit salad or yogurt;
Dinner - white fish with fresh or stewed vegetables, tea.

In general, after the operation to remove the uterus, it is necessary to adhere to the rules of a healthy diet, eat fractionally, do not overeat. The calorie content of the diet should remain the same.

Effects

The consequences after removal of the uterus in the recovery period are possible if the rules for its passage are violated, as well as with some features of the body. For example, complications such as:

Depression, nervous breakdowns, other complications of an emotional and psychological nature;
Bleeding due to poor healing of sutures or stress on them;
Suture endometriosis - a condition in which the endometrium begins to form on the peritoneum (it is extremely rare);
Infection of the blood or peritoneum, neighboring organs in the hodge operation manifests itself just during this period;
Prolonged and persistent pain syndrome that develops when the nerve trunks are damaged;
Inflammatory process, temperature after removal of the uterus is its sign;
Accession of viruses and infections, fungi, as a result of reduced local immunity;
Some deterioration in the quality of sexual life, which usually disappears after hormone therapy;
Decreased libido, which is also regulated by hormones;
Possible problems with the intestines, constipation;
Symptoms of early menopause when removing not only the cavity, but also the ovaries.

Moreover, after abdominal surgery, which was performed under general anesthesia, complications after anesthesia can always appear. But they appear already in the first 24 hours after the procedure.

Conclusion

Regardless of the method of surgical intervention to remove the organ, a well-conducted recovery period is no less important than careful preparation for the intervention and its high-quality conduct. It is now that healing is taking place, and it depends on it whether the patient will be worried about the consequences of this intervention in the future. For example, if the postoperative period after removal of the uterus is carried out correctly, then adhesions are not formed, which can later cause pain, the scar will be more or less aesthetically smoothed out, etc.

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Update: October 2018

Hysterectomy or removal of the uterus is a fairly common operation, which is performed according to certain indications. According to statistics, about a third of women who have crossed the 45-year mark have undergone this operation.

And, of course, the main question that worries patients who have been operated on or are preparing for surgery is: “What consequences can there be after removal of the uterus”?

Postoperative period

As you know, the period of time that lasts from the date of the surgical intervention to the restoration of working capacity and good health is called the postoperative period. Hysterectomy is no exception. The period after the operation is divided into 2 "sub-periods":

early
late postoperative period

In the early postoperative period, the patient is in the hospital under the supervision of doctors. Its duration depends on the surgical approach and the general condition of the patient after surgery.

After surgery to remove the uterus and / or appendages, which was carried out either vaginally or through an incision in the anterior abdominal wall, the patient stays in the gynecological department for 8-10 days, it is at the end of the agreed period that the sutures are removed.
After laparoscopic hysterectomy The patient is discharged after 3-5 days.

First day after surgery

The first postoperative days are especially difficult.

Pain - during this period, a woman feels significant pain both inside the abdomen and in the area of \u200b\u200bthe sutures, which is not surprising, because there is a wound both outside and inside (just remember how painful it is if you accidentally cut your finger). To relieve pain, non-narcotic and narcotic painkillers are prescribed.

lower limbs remain, as before the operation, in or bandaged elastic bandages (prevention of thrombophlebitis).

Activity - surgeons adhere to active management of the patient after surgery, which means getting out of bed early (after laparoscopy after a few hours, after laparotomy after a day). Motor activity "accelerates the blood" and stimulates the bowels.

Diet - the first day after a hysterectomy, a sparing diet is prescribed, in which there are broths, pureed food and liquid (weak tea, non-carbonated mineral water, fruit drinks). Such a treatment table gently stimulates intestinal motility and contributes to its early (1-2 days) self-emptying. An independent stool indicates the normalization of the intestines, which requires a transition to regular food.

abdomen after hysterectomy remains painful or sensitive for 3-10 days, depending on the patient's pain threshold. It should be noted that the more active the patient is after the operation, the faster her condition is restored and the lower the risk of possible complications.

Treatment after surgery

Antibiotics - usually, antibacterial therapy is prescribed for prophylactic purposes, since the internal organs of the patient during the operation were in contact with air, and therefore with various infectious agents. The course of antibiotics lasts an average of 7 days.
Anticoagulants - also in the first 2-3 days, anticoagulants (blood thinners) are prescribed, which are designed to protect against thrombosis and the development of thrombophlebitis.
Intravenous infusions- in the first 24 hours after a hysterectomy, infusion therapy (intravenous drip infusion of solutions) is performed to replenish the volume of circulating blood, since the operation is almost always accompanied by significant blood loss (the volume of blood loss in uncomplicated hysterectomy is 400-500 ml).

The course of the early postoperative period is considered smooth if there are no complications.

Early postoperative complications include:

inflammation of the postoperative scar on the skin (redness, swelling, purulent discharge from the wound and even divergence of seams);
problems with urination(pain or cramps when urinating) caused by traumatic urethritis (damage to the mucous membrane of the urethra);
bleeding of varying intensity, both external (from the genital tract) and internal, which indicates insufficient hemostasis during surgery (discharge may be dark or scarlet, blood clots are present);
pulmonary embolism- a dangerous complication that leads to blockage of the branches or the pulmonary artery itself, which is fraught with pulmonary hypertension in the future, the development of pneumonia and even death;
peritonitis - inflammation of the peritoneum, which passes to other internal organs, is dangerous for the development of sepsis;
hematomas (bruises) in the suture area.

Bloody discharge after removal of the uterus by the type of "daub" is always observed, especially in the first 10-14 days after the operation. This symptom is explained by the healing of the sutures in the area of the uterine stump or in the area of \u200b\u200bthe vagina. If the nature of the discharge has changed in a woman after the operation:

accompanied by an unpleasant, putrid odor
the color resembles meat slops

you should immediately consult a doctor. Perhaps there was inflammation of the sutures in the vagina (after hysterectomy or vaginal hysterectomy), which is fraught with the development of peritonitis and sepsis. Bleeding after surgery from the genital tract is a very alarming signal, and requires a second laparotomy.

Suture infection

In case of infection of the postoperative suture, the general body temperature rises, usually not higher than 38 degrees. The patient's condition, as a rule, does not suffer. The prescribed antibiotics and suture treatment are quite enough to stop this complication. The first time the postoperative dressing is changed with the treatment of the wound on the next day after the operation, then the dressing is carried out every other day. It is advisable to treat the sutures with a solution of Curiosin (10 ml 350-500 rubles), which provides soft healing and prevents the formation of a keloid scar.

Peritonitis

The development of peritonitis more often occurs after a hysterectomy performed according to emergency indications, for example, necrosis of the myomatous node.

The patient's condition is rapidly deteriorating
The temperature "jumps" to 39 - 40 degrees
Pronounced pain syndrome
Signs of peritoneal irritation are positive
In this situation, massive antibiotic therapy is carried out (appointment of 2-3 drugs) and the infusion of saline and colloidal solutions
If there is no effect from conservative treatment, surgeons go for relaparotomy, remove the uterine stump (in case of amputation of the uterus), wash the abdominal cavity with antiseptic solutions and install drainage

The performed hysterectomy somewhat changes the patient's habitual lifestyle. For a quick and successful recovery after surgery, doctors give patients a number of specific recommendations. If the early postoperative period proceeded smoothly, then at the end of the woman's stay in the hospital, she should immediately take care of her health and the prevention of long-term consequences.

Bandage

A good help in the late postoperative period is wearing a bandage. It is especially recommended for women of premenopausal age who have had a history of many births or patients with weakened abdominals. There are several models of such a supporting corset, you should choose exactly the model in which the woman does not feel discomfort. The main condition when choosing a bandage is that its width should exceed the scar by at least 1 cm above and below (if a lower median laparotomy was performed).

Sex life, lifting weights

Discharge after surgery continues for 4 to 6 weeks. Within one and a half, and preferably two months after a hysterectomy, a woman should not lift weights of more than 3 kg and do heavy physical work, otherwise it threatens with a divergence of internal sutures and abdominal bleeding. Sexual life during the agreed period is also prohibited.

Special exercises and sports

To strengthen the vaginal and pelvic floor muscles, it is recommended to perform special exercises using an appropriate simulator (perineum). It is the simulator that creates resistance and ensures the effectiveness of such intimate gymnastics.

The described exercises (Kegel exercises) got their name from the gynecologist and developer of intimate gymnastics. You need to do at least 300 exercises a day. A good tone of the muscles of the vagina and pelvic floor prevents the prolapse of the walls of the vagina, prolapse of the uterine stump in the future, as well as the occurrence of such an unpleasant condition as urinary incontinence, which is experienced by almost all women in menopause.

Sports after hysterectomy are not burdensome physical activities in the form of yoga, Bodyflex, Pilates, shaping, dancing, swimming. You can start classes only 3 months after the operation (if it was successful, without complications). It is important that physical education in the recovery period is a pleasure, and not exhausting a woman.

About baths, sauna, use of tampons

Within 1.5 months after surgery, it is forbidden to take baths, visit saunas, baths and swim in open water. As long as there is spotting, you should use sanitary pads, but not tampons.

Nutrition, diet

Equally important in the postoperative period is proper nutrition. To prevent constipation and gas formation, you should consume more fluids and fiber (vegetables, fruits in any form, wholemeal bread). It is recommended to give up coffee and strong tea, and, of course, alcohol. Food should not only be fortified, but contain the required amount of proteins, fats and carbohydrates. Most of the calories a woman should consume in the morning. You will have to give up your favorite fried, fatty and smoked dishes.

Sick leave

The period of incapacity for work in total (including the time spent in the hospital) is from 30 to 45 days. In the event of any complications, the sick leave, of course, is extended.

Hysterectomy: what next?

In most cases, women after surgery face problems of a psycho-emotional nature. This is due to the prevailing stereotype: there is no uterus, which means there is no main female distinguishing feature, respectively - I am not a woman.

In fact, everything is not so. After all, not only the presence of the uterus determines the female essence. To prevent the development of depression after surgery, the issue of hysterectomy and life after that should be studied as carefully as possible. After the operation, the husband can provide significant support, because outwardly the woman has not changed.

Fears regarding changes in appearance:

increased facial hair growth

decreased sex drive

weight gain

voice change, etc.

are far-fetched, and therefore easily overcome.

Sex after hysterectomy

Sexual intercourse will give the woman the same pleasure, since all sensitive areas are not located in the uterus, but in the vagina and external genitalia. If the ovaries are preserved, then they continue to function as before, that is, they secrete the necessary hormones, especially testosterone, which is responsible for sexual desire.

In some cases, women even notice an increase in libido, which is facilitated by getting rid of pain and other problems associated with the uterus, as well as a psychological moment - the fear of unwanted pregnancy disappears. Orgasm after amputation of the uterus will not disappear anywhere, and some patients experience it brighter. But the occurrence of discomfort and even is not excluded.

This point applies to those women who have had a hysterectomy (a scar in the vagina) or a radical hysterectomy (Wertheim's operation), in which part of the vagina is excised. But this problem is completely solvable and depends on the degree of trust and mutual understanding of the partners.

One of the positive aspects of the operation is the absence of menstruation: no uterus - no endometrium - no menstruation. So, forgive the critical days and the troubles associated with them. But it is worth making a reservation, rarely, but in women who have undergone an operation to amputate the uterus with the preservation of the ovaries, there may be slight spotting on the days of menstruation. This fact is explained simply: after amputation, the stump of the uterus remains, and hence a little endometrium. Therefore, you should not be afraid of such allocations.

Loss of fertility

The issue of loss of reproductive function deserves special attention. Naturally, since there is no uterus - a fetus-place, then pregnancy is impossible. Many women put this fact in the column of advantages of a hysterectomy, but if the woman is young, this is certainly a minus. Doctors, before offering to remove the uterus, carefully evaluate all risk factors, study the anamnesis (in particular, the presence of children) and, if possible, try to save the organ.

If the situation allows, the woman either has her fibroids removed (conservative myomectomy) or her ovaries are left. Even with a missing uterus, but preserved ovaries, a woman can become a mother. IVF and surrogacy is a real way to solve the problem.

Suture after removal of the uterus

The seam on the anterior abdominal wall worries women no less than other problems associated with hysterectomy. Laparoscopic surgery or a transverse incision of the abdomen in the lower section will help to avoid this cosmetic defect.

adhesive process

Any surgical intervention in the abdominal cavity is accompanied by the formation of adhesions. Adhesions are connective tissue strands that form between the peritoneum and internal organs, or between organs. Almost 90% of women suffer from adhesive disease after a hysterectomy.

Forcible introduction into the abdominal cavity is accompanied by damage (dissection of the peritoneum), which has fibrinolytic activity and provides lysis of fibrinous exudate, gluing the edges of the dissected peritoneum.

An attempt to close the area of the peritoneal wound (suturing) disrupts the process of melting early fibrin deposits and promotes increased adhesion formation. The process of formation of adhesions after surgery depends on many factors:

the duration of the operation;
the volume of surgical intervention (the more traumatic the operation, the higher the risk of adhesion formation);
blood loss;
internal bleeding, even blood leakage after surgery (blood resorption provokes adhesion formation);
infection (development of infectious complications in the postoperative period);
genetic predisposition (the more genetically determined enzyme N-acetyltransferase is produced that dissolves fibrin deposits, the lower the risk of adhesive disease);
asthenic physique.

pain (constant or intermittent)
urination and defecation disorders
, dyspeptic symptoms.

To prevent the formation of adhesions in the early postoperative period, the following are prescribed:

antibiotics (suppress inflammatory reactions in the abdominal cavity)
anticoagulants (thin the blood and prevent the formation of adhesions)
physical activity already in the first day (side turns)
early start of physiotherapy (ultrasound or, hyaluronidase, and others).

Properly conducted rehabilitation after a hysterectomy will prevent not only the formation of adhesions, but also other consequences of the operation.

Menopause after hysterectomy

One of the long-term consequences of the operation to remove the uterus is menopause. Although, of course, any woman sooner or later comes to this milestone. If during the operation only the uterus was removed, and the appendages (tubes with ovaries) were preserved, then the onset of menopause will occur naturally, that is, at the age for which the woman's body is "programmed" genetically.

However, many doctors are of the opinion that after surgical menopause, menopausal symptoms develop on average 5 years ahead of schedule. Exact explanations for this phenomenon have not yet been found, it is believed that the blood supply to the ovaries after a hysterectomy worsens somewhat, which affects their hormonal function.

Indeed, if we recall the anatomy of the female reproductive system, the ovaries are mostly supplied with blood from the uterine vessels (and, as you know, quite large vessels, the uterine arteries, pass through the uterus).

To understand the problems of menopause after surgery, it is worth deciding on medical terms:

natural menopause - the cessation of menstruation due to the gradual extinction of the hormonal function of the gonads (see)
artificial menopause - cessation of menstruation (surgical - removal of the uterus, medical - suppression of ovarian function by hormonal drugs, radiation)
surgical menopause - removal of both the uterus and ovaries

Women endure surgical menopause more difficult than natural, this is due to the fact that when natural menopause occurs, the ovaries do not immediately stop producing hormones, their production decreases gradually, over several years, and eventually stops.

After the removal of the uterus with appendages, the body undergoes a sharp hormonal restructuring, since the synthesis of sex hormones suddenly stopped. Therefore, surgical menopause is much more difficult, especially if the woman is of childbearing age.

Symptoms of surgical menopause appear within 2-3 weeks after surgery and are not much different from the signs of natural menopause. Women are concerned about:

tides (see)
sweating()
emotional lability
depressive states often occur (see and)
dryness and wilting of the skin later join
fragility of hair and nails ()
urinary incontinence when coughing or laughing ()
vaginal dryness and related sexual problems
decreased sex drive

In the case of removal of both the uterus and the ovaries, it is necessary to prescribe hormone replacement therapy, especially for those women who are under 50 years old. For this purpose, both gestagens and testosterone are used, which is mostly produced in the ovaries and a decrease in its level leads to a weakening of libido.

If the uterus with appendages was removed due to large myomatous nodes, then the following is prescribed:

estrogen monotherapy in continuous mode, used as tablets for oral administration (Ovestin, Livial, Proginova and others),
funds in the form of suppositories and ointments for the treatment of atrophic colpitis (Ovestin),
and preparations for external use (Estrogel, Divigel).

If an adnexal hysterectomy was performed for internal endometriosis:

carry out treatment with estrogen (kliana, proginova)
together with gestagens (suppression of the activity of dormant foci of endometriosis)

Hormone replacement therapy should be started as early as possible, after 1 to 2 months after the hysterectomy. Hormone treatment significantly reduces the risk of cardiovascular disease, osteoporosis and Alzheimer's disease. However, hormone replacement therapy may not be prescribed in all cases.

Contraindications to hormone treatment are:

operation for;
pathology of the veins of the lower extremities (thrombophlebitis, thromboembolism);
severe pathology of the liver and kidneys;
meningioma.

The duration of treatment is from 2 to 5 years or more. You should not expect immediate improvement and disappearance of menopausal symptoms immediately after the start of treatment. The longer hormone replacement therapy is carried out, the less pronounced the clinical manifestations.

Other long-term effects

One of the long-term consequences of hysterovariectomy is the development of osteoporosis. Men are also susceptible to this disease, but the fairer sex suffers from it more often (see). This pathology is associated with a decrease in estrogen production, therefore, in women, osteoporosis is more often diagnosed in periods of pre- and postmenopause (see).

Osteoporosis is a chronic disease prone to progression and is caused by metabolic disorders of the skeleton, such as calcium leaching from the bones. As a result, the bones become thinner and brittle, which increases the risk of fractures. Osteoporosis is a very insidious disease, for a long time it proceeds hidden, and is detected in an advanced stage.

The most common fractures are the vertebral bodies. Moreover, if one vertebra is damaged, there is no pain as such, a pronounced pain syndrome is characteristic of a simultaneous fracture of several vertebrae. Spinal compression and increased bone fragility lead to curvature of the spine, changes in posture and reduced height. Women with osteoporosis are prone to traumatic fractures.

The disease is easier to prevent than to treat (see), therefore, after amputation of the uterus and ovaries, hormone replacement therapy is prescribed, which inhibits the leaching of calcium salts from the bones.

Nutrition and physical activity

You also need to follow a certain diet. The diet should include:

dairy products
all varieties of cabbage, nuts, dried fruits (dried apricots, prunes)
legumes, fresh vegetables and fruits, greens
you should limit the intake of salt (promotes the excretion of calcium by the kidneys), caffeine (coffee, Coca-Cola, strong tea) and give up alcoholic beverages.

Exercise can be helpful in preventing osteoporosis. Physical exercise increases muscle tone, increases joint mobility, which reduces the risk of fractures. Vitamin D plays an important role in the prevention of osteoporosis. The use of fish oil and ultraviolet radiation will help to fill its deficiency. The use of calcium-D3 Nycomed in courses of 4 to 6 weeks compensates for the lack of calcium and vitamin D3 and increases bone density.

Vaginal prolapse

Another long-term consequence of a hysterectomy is omission/prolapse (prolapse) of the vagina.

Firstly, prolapse is associated with trauma to the pelvic tissue and the supporting (ligament) apparatus of the uterus. Moreover, the wider the volume of the operation, the higher the risk of prolapse of the walls of the vagina.
Secondly, the prolapse of the vaginal canal is caused by the descent of neighboring organs into the freed small pelvis, which leads to a cystocele (bladder prolapse) and rectocele (rectal prolapse).

To prevent this complication, a woman is advised to perform Kegel exercises and limit heavy lifting, especially in the first 2 months after a hysterectomy. In advanced cases, an operation is performed (plastic surgery of the vagina and its fixation in the small pelvis by strengthening the ligamentous apparatus).

Forecast

Hysterectomy not only does not affect life expectancy, but even improves its quality. Having got rid of the problems associated with the disease of the uterus and / or appendages, forever forgetting about contraception, many women literally flourish. More than half of the patients note emancipation and increased libido.

Disability after removal of the uterus is not granted, since the operation does not reduce the woman's ability to work. A disability group is assigned only in the case of severe pathology of the uterus, when the hysterectomy entailed radiation or chemotherapy, which significantly affected not only the ability to work, but also the patient's health.

In gynecology, in the treatment of uterine bleeding in recent years, various conservative methods of influencing the uterus have been used, for example, hysteroscopic removal of the myomatous node and endometrial ablation, thermal ablation of the endometrium, and hormonal suppression of bleeding. However, they are often ineffective. In this regard, the operation to remove the uterus (hysterectomy), performed both on a planned and emergency basis, remains one of the most common abdominal interventions and ranks second after appendectomy.

The frequency of this operation in the total number of gynecological surgical interventions on the abdominal cavity is 25-38% with an average age of operated women for gynecological diseases of 40.5 years and for obstetric complications - 35 years. Unfortunately, instead of trying conservative treatment, there is a tendency among many gynecologists to recommend removal of the uterus to a woman with fibroids after 40 years, citing the fact that her reproductive function has already been realized and the organ no longer performs any function.

Indications for removal of the uterus

Hysterectomy indications are:

Multiple uterine fibroids or a single size of more than 12 weeks with a tendency to rapid growth, accompanied by repeated, profuse, prolonged uterine bleeding.
The presence of fibroids in women over 50 years of age. Although they are not prone to malignancy, cancer develops much more often against their background. Therefore, the removal of the uterus after 50 years, according to many authors, is desirable in order to prevent the development of cancer. However, such an operation at approximately this age is almost always associated with subsequent pronounced psycho-emotional and vegetative-vascular disorders as a manifestation of post-hysterectomy syndrome.
Necrosis of the myomatous node.
with a high risk of pedunculated torsion.
growing into the myometrium.
Widespread polyposis and constant profuse menstruation, complicated by anemia.
and 3-4 degrees.
, or ovaries and related radiation therapy. Most often, the removal of the uterus and ovaries after 60 years is carried out precisely for cancer. In this age period, the operation contributes to a more pronounced development of osteoporosis and a more severe course of somatic pathology.
Omission of the uterus of 3-4 degrees or its complete prolapse.
Chronic pelvic pain, not amenable to therapy by other methods.
Uterine rupture during pregnancy and childbirth, placenta accreta, development of consumption coagulopathy during childbirth, purulent.
Uncompensated hypotension of the uterus during childbirth or in the immediate postpartum period, accompanied by profuse bleeding.
Sex change.

Despite the fact that the technical performance of hysterectomy has been improved in many respects, this method of treatment still remains technically difficult and is characterized by frequent complications during and after the operation. Complications are damage to the intestines, bladder, ureters, the formation of extensive hematomas in the parametric region, bleeding, and others.

In addition, the consequences of hysterectomy for the body are not uncommon, such as:

long-term recovery of bowel function after surgery;
development (menopause after removal of the uterus) - the most common negative consequence;
development or more severe course of endocrine and metabolic and immune disorders, coronary heart disease, hypertension, neuropsychiatric disorders, osteoporosis.

In this regard, an individual approach in choosing the volume and type of surgical intervention is of great importance.

Types and methods of removal of the uterus

Depending on the volume of the operation, the following types are distinguished:

Subtotal, or amputation - removal of the uterus without appendages or with them, but with the preservation of the cervix.
Total, or extirpation of the uterus - removal of the body and cervix with or without appendages.
Panhysterectomy - removal of the uterus and ovaries with fallopian tubes.
Radical - panhysterectomy combined with resection of the upper 1/3 of the vagina, with the removal of part of the omentum, as well as the surrounding pelvic tissue and regional lymph nodes.

Currently, abdominal surgery to remove the uterus is carried out, depending on the access option, in the following ways:

abdominal, or laparotomic (median incision of the tissues of the anterior abdominal wall from the umbilical to the suprapubic region or a transverse incision above the womb);
vaginal (removal of the uterus through the vagina);
laparoscopic (through punctures);
combined.

Laparotomy (a) and laparoscopic (b) access options for surgery to remove the uterus

Abdominal access

Used most often and for a very long time. It is about 65% when performing operations of this type, in Sweden - 95%, in the USA - 70%, in the UK - 95%. The main advantage of the method is the possibility of performing surgical intervention under any conditions - both in planned and in case of emergency surgery, as well as in the presence of another (extragenital) pathology.

At the same time, the laparotomy method also has a large number of disadvantages. The main ones are a serious injury directly to the operation itself, a long stay in the hospital after the operation (up to 1 - 2 weeks), long-term rehabilitation and unsatisfactory cosmetic consequences.

The postoperative period, both immediate and long-term, is also characterized by a high frequency of complications:

long physical and psychological recovery after removal of the uterus;
adhesive disease develops more often;
bowel function is restored for a long time and the lower abdomen hurts;
high, compared with other types of access, the likelihood of infection and elevated temperature;

Mortality with laparotomy access per 10,000 operations averages 6.7-8.6 people.

Vaginal removal

It is another traditional access used when removing the uterus. It is carried out by means of a small radial dissection of the vaginal mucosa in its upper sections (at the level of the arches) - posterior and, possibly, anterior colpotomy.

The undeniable advantages of this access are:

significantly less trauma and the number of complications during surgery, compared with the abdominal method;
minimal blood loss;
short duration of pain and better health after surgery;
rapid activation of a woman and rapid restoration of bowel function;
short period of stay in the hospital (3-5 days);
a good cosmetic result, due to the absence of an incision in the skin of the anterior abdominal wall, which allows a woman to hide the fact of surgical intervention from her partner.

The terms of the rehabilitation period with the vaginal method are much shorter. In addition, the frequency of complications in the immediate and their absence in the late postoperative periods is low, and mortality is on average 3 times less than with abdominal access.

At the same time, vaginal hysterectomy also has a number of significant disadvantages:

the lack of a sufficient area of the surgical field for visual revision of the abdominal cavity and manipulations, which greatly complicates the complete removal of the uterus in endometriosis and cancer, due to the technical difficulty of detecting endometrioid foci and tumor boundaries;
high risk of intraoperative complications in terms of injury to blood vessels, bladder and rectum;
difficulty in stopping bleeding;
the presence of relative contraindications, which include, in addition to endometriosis and cancer, a significant size of the tumor-like formation and previous operations on the abdominal organs, especially on the organs of the lower floor, which can lead to changes in the anatomical location of the pelvic organs;
technical difficulties associated with lowering the uterus in obesity, adhesions and nulliparous women.

Due to such limitations, in Russia, vaginal access is used mainly in operations for omission or prolapse of an organ, as well as in case of a sex change.

Laparoscopic access

In recent years, it has become increasingly popular for any gynecological operations in the small pelvis, including hysterectomy. Its benefits are largely identical to the vaginal access. These include a low degree of trauma with a satisfactory cosmetic effect, the possibility of dissecting adhesions under visual control, a short recovery period in a hospital (no more than 5 days), a low incidence of complications in the immediate and their absence in the long-term postoperative period.

However, the risks of such intraoperative complications as the possibility of damage to the ureters and bladder, blood vessels and large intestine remain. The disadvantage is the limitations associated with the oncological process and the large size of the tumor formation, as well as extragenital pathology in the form of even compensated heart and respiratory failure.

Combined or assisted vaginal hysterectomy

It consists in the simultaneous use of vaginal and laparoscopic accesses. The method allows to eliminate the important disadvantages of each of these two methods and to perform surgical intervention in women with the presence of:

endometriosis;
adhesions in the pelvis;
pathological processes in the fallopian tubes and ovaries;
myoma nodes of considerable size;
in the anamnesis of surgical interventions on the abdominal organs, especially the small pelvis;
difficulty bringing down the uterus, including nulliparous women.

The main relative contraindications that force preference for laparotomy access are:

Common foci of endometriosis, especially retrocervical with germination in the wall of the rectum.
Pronounced adhesive process, causing difficulties in dissection of adhesions when using a laparoscopic technique.
Volumetric formations of the ovaries, the malignant nature of which cannot be reliably excluded.

Preparing for the operation

The preparatory period for a planned surgical intervention consists in conducting possible examinations at the prehospital stage - clinical and biochemical blood tests, urinalysis, coagulogram, determination of the blood group and Rh factor, tests for the presence of antibodies to hepatitis viruses and sexually transmitted infectious agents, including including syphilis and HIV infection, ultrasound, chest fluorography and ECG, bacteriological and cytological examination of smears from the genital tract, extended colposcopy.

In the hospital, if necessary, additionally carried out with a separate, repeated ultrasound, MRI, sigmoidoscopy and other studies.

1-2 weeks before surgery, if there is a risk of complications in the form of thrombosis and thromboembolism (varicose veins, pulmonary and cardiovascular diseases, overweight, etc.), a consultation of specialized specialists and the administration of appropriate drugs, as well as rheological agents and antiplatelet agents.

In addition, in order to prevent or reduce the severity of symptoms of posthysterectomy syndrome, which develops after removal of the uterus in an average of 90% of women under 60 years of age (mostly) and has varying degrees of severity, surgery is planned for the first phase of the menstrual cycle (if any) .

1-2 weeks before the removal of the uterus, psychotherapeutic procedures are carried out in the form of 5-6 conversations with a psychotherapist or psychologist, aimed at reducing the feeling of uncertainty, uncertainty and fear of the operation and its consequences. Phytotherapeutic, homeopathic and other sedatives are prescribed, concomitant gynecological pathology is treated, and it is recommended to stop smoking and taking alcoholic beverages.

These measures can significantly facilitate the course of the postoperative period and reduce the severity of psychosomatic and vegetative manifestations provoked by the operation.

In the hospital on the evening before the operation, food should be excluded, only liquids are allowed - loosely brewed tea and still water. In the evening, a laxative and a cleansing enema are prescribed, before going to bed - a sedative. On the morning of the operation, it is forbidden to take any liquid, the intake of any drugs is canceled and the cleansing enema is repeated.

Before the operation, compression tights, stockings are put on or the lower extremities are bandaged with elastic bandages, which remain until the woman is fully activated after the operation. This is necessary in order to improve the outflow of venous blood from the veins of the lower extremities and prevent thrombophlebitis and thromboembolism.

Equally important is the provision of adequate anesthesia during the operation. The choice of the type of anesthesia is carried out by the anesthesiologist, depending on the expected volume of the operation, its duration, concomitant diseases, the possibility of bleeding, etc., as well as in agreement with the operating surgeon and taking into account the wishes of the patient.

Anesthesia during removal of the uterus can be general endotracheal combined with the use of muscle relaxants, as well as its combination (at the discretion of the anesthesiologist) with epidural analgesia. In addition, it is possible to use epidural anesthesia (without general anesthesia) in combination with intravenous medical sedation. Insertion of a catheter into the epidural space can be prolonged and used for postoperative analgesia and faster recovery of bowel function.

The principle of the operation technique

Preference is given to laparoscopic or assisted vaginal subtotal or total hysterectomy with preservation of the appendages on at least one side (if possible), which, among other advantages, helps to reduce the severity of post-hysterectomy syndrome.

How is the operation going?

Surgical intervention with combined access consists of 3 stages - two laparoscopic and vaginal.

The first stage is:

introduction into the abdominal cavity (after gas insufflation into it) through small incisions of manipulators and a laparoscope containing a lighting system and a video camera;
carrying out laparoscopic diagnostics;
separation of existing adhesions and isolation of the ureters, if necessary;
the imposition of ligatures and the intersection of round uterine ligaments;
mobilization (isolation) of the bladder;
the imposition of ligatures and the intersection of the fallopian tubes and own ligaments of the uterus or in the removal of the ovaries and fallopian tubes.

The second stage consists of:

dissection of the anterior wall of the vagina;
intersection of the vesicouterine ligaments after displacement of the bladder;
an incision in the mucous membrane of the posterior wall of the vagina and the imposition of hemostatic sutures on it and on the peritoneum;
the imposition of ligatures on the sacro-uterine and cardinal ligaments, as well as on the vessels of the uterus, followed by the intersection of these structures;
removing the uterus to the wound area and cutting it off or dividing it into fragments (with a large volume) and removing them.
suturing on the stump and on the mucous membrane of the vagina.

At the third stage, laparoscopic control is again carried out, during which small bleeding vessels (if any) are ligated and the pelvic cavity is drained.

How long does a uterus removal surgery take?

It depends on the access method, the type of hysterectomy and the extent of the surgical intervention, the presence of adhesions, the size of the uterus, and many other factors. But the average duration of the entire operation is usually 1-3 hours.

The main technical principles of hysterectomy for laparotomy and laparoscopic approaches are the same. The main difference is that in the first case, the uterus with or without appendages is removed through an incision in the abdominal wall, and in the second case, the uterus is divided into fragments in the abdominal cavity using an electromechanical instrument (morcellator), which are then removed through a laparoscopic tube (tube). ).

rehabilitation period

Moderate and slight spotting after removal of the uterus is possible for no more than 2 weeks. In order to prevent infectious complications, antibiotics are prescribed.

In the first days after surgery, bowel dysfunction almost always develops, mainly associated with pain and low physical activity. Therefore, the fight against pain is of great importance, especially in the first day. For this purpose, injectable non-narcotic analgesics are regularly administered. Prolonged epidural analgesia has a good analgesic and intestinal motility-improving effect.

In the first 1-1.5 days, physiotherapeutic procedures, physiotherapy exercises and early activation of women are carried out - by the end of the first or at the beginning of the second day they are recommended to get out of bed and move around the department. 3-4 hours after the operation, in the absence of nausea and vomiting, it is allowed to drink non-carbonated water and "weak" tea in a small amount, and from the second day - to eat.

The diet should include easily digestible foods and dishes - soups with chopped vegetables and grated cereals, dairy products, boiled low-fat varieties of fish and meat. Foods and dishes rich in fiber, fatty fish and meat (pork, lamb), flour and confectionery products, including rye bread (wheat bread is allowed on the 3rd - 4th day in limited quantities), chocolate are excluded. From the 5th - 6th day, the 15th (general) table is allowed.

One of the negative consequences of any operation on the abdominal cavity is the adhesive process. It most often proceeds without any clinical manifestations, but sometimes it can cause serious complications. The main pathological symptoms of adhesion formation after hysterectomy are chronic pelvic pain and, more seriously, adhesive disease.

The latter can occur in the form of chronic or acute adhesive intestinal obstruction due to impaired passage of feces through the large intestine. In the first case, it is manifested by periodic cramping pains, gas retention and frequent constipation, moderate bloating. This condition can be resolved conservatively, but often requires surgical treatment in a planned manner.

Acute intestinal obstruction is accompanied by cramping pain and bloating, lack of stool and flatus, nausea and repeated vomiting, dehydration, tachycardia and, first, an increase and then a decrease in blood pressure, a decrease in the amount of urine, etc. In acute adhesive intestinal obstruction, its urgent resolution is necessary through surgical treatment and intensive care. Surgical treatment consists in dissection of adhesions and, often, in resection of the intestine.

Due to the weakening of the muscles of the anterior abdominal wall after any surgical intervention on the abdominal cavity, it is recommended to use a special gynecological bandage.

How long to wear a bandage after removal of the uterus?

Wearing a bandage at a young age is necessary for 2-3 weeks, and after 45-50 years and with poorly developed abdominal muscles - up to 2 months.

It contributes to faster healing of wounds, reducing pain, improving bowel function, and reducing the likelihood of hernia formation. The bandage is used only in the daytime, and in the future - with long walking or moderate physical exertion.

Since the anatomical location of the pelvic organs changes after the operation, and the tone and elasticity of the pelvic floor muscles are lost, consequences such as prolapse of the pelvic organs are possible. This leads to constant constipation, urinary incontinence, deterioration of sexual life, vaginal prolapse and also to the development of adhesions.

In order to prevent these phenomena, it is recommended to strengthen and increase the tone of the muscles of the pelvic floor. You can feel them by stopping the started urination or the act of defecation, or by trying to squeeze the finger inserted into the vagina with its walls. The exercises are based on a similar contraction of the pelvic floor muscles for 5-30 seconds, followed by relaxation for the same duration. Each of the exercises is repeated in 3 sets of 10 times each.

A set of exercises is performed in different starting positions:

The legs are set shoulder-width apart, and the hands are on the buttocks, as if supporting the latter.
In the kneeling position, tilt the body to the floor and put the head on the arms bent at the elbows.
Lie on your stomach, put your head on bent arms and bend one leg at the knee joint.
Lie on your back, bend your legs at the knee joints and spread your knees to the sides so that the heels rest on the floor. Put one hand under the buttock, the other - on the lower abdomen. While compressing the pelvic floor muscles, pull the arms up a little.
Position - sitting on the floor with crossed legs.
Put your feet slightly wider than your shoulders and rest your knees with straightened arms. The back is straight.

The muscles of the pelvic floor in all starting positions are compressed inward and upward with their subsequent relaxation.

Sex life after hysterectomy

In the first two months, abstinence from sexual intercourse is recommended to avoid infection and other postoperative complications. At the same time, regardless of them, removal of the uterus, especially at reproductive age, in itself very often causes a significant decrease in the quality of life due to the development of hormonal, metabolic, psychoneurotic, vegetative and vascular disorders. They are interconnected, exacerbate each other and are reflected directly in the sexual life, which, in turn, increases the degree of their severity.

The frequency of these disorders especially depends on the volume of the performed operation and, last but not least, on the quality of the preparation for it, the management of the postoperative period and treatment in a longer period of time. Anxiety-depressive syndrome, which proceeds in stages, was noted in every third woman who underwent hysterectomy. The terms of its maximum manifestation are the early postoperative period, the next 3 months after it and 12 months after the operation.

Removal of the uterus, especially total with unilateral, and even more so with bilateral removal of the appendages, as well as carried out in the second phase of the menstrual cycle, leads to a significant and rapid decrease in the content of progesterone and estradiol in the blood in more than 65% of women. The most pronounced disorders of the synthesis and secretion of sex hormones are detected by the seventh day after the operation. The restoration of these disorders, if at least one ovary was preserved, is noted only after 3 or more months.

In addition, due to hormonal disorders, not only libido decreases, but many women (every 4-6th) develop atrophy processes in the vaginal mucosa, which leads to their dryness and urogenital disorders. It also adversely affects sexual life.

What drugs should be taken to reduce the severity of negative consequences and improve the quality of life?

Given the staging nature of the disorders, it is advisable to use sedatives, neuroleptics, and antidepressants in the first six months. In the future, their reception should be continued, but in intermittent courses.

With a preventive purpose, they must be prescribed during the most likely periods of the year of exacerbations of the course of the pathological process - in autumn and spring. In addition, in order to prevent manifestations or reduce the severity of post-hysterectomy syndrome in many cases, especially after hysterectomy with the ovaries, it is necessary to use hormone replacement therapy.

All drugs, their dosages and duration of treatment courses should be determined only by a doctor of the appropriate profile (gynecologist, psychotherapist, therapist) or together with other specialists.