What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus (womb). There are a variety of conditions that may necessitate the removal of uterus such as uterine cancer and persistent abnormal vaginal bleeding, among other conditions.
In non-cancerous conditions, a doctor will first consider all other treatment approaches before considering a hysterectomy. Depending on the reason for a hysterectomy, a surgeon may decide to remove either a part of the uterus or the entire uterus.
Side Effects of Hysterectomy
Like other medical and surgical treatments, hysterectomy can also result in certain side-effects. A doctor should always discuss these side-effects with the patient, even when the underlying condition makes hysterectomy a necessity. It is imperative to get an informed consent before going ahead with the procedure.
A hysterectomy is a major surgical procedure. The operation is carried out under general anesthesia. The side-effects of hysterectomy can be attributed to either the surgical removal of the uterus or to the anesthesia given during the procedure. Side-effects caused by anesthesia are usually short-lived.
Modern developments in pharmacology and anesthetics have helped reduce these side-effects considerably. However, it is important that the patients are aware of the possibility of any side-effect before they give their consent for the surgery.
Certain predisposing factors may make a patient susceptible to certain complications caused by specific hysterectomy procedures. For this reason, only certain surgical techniques may be considered for certain patients. A doctor will usually discuss the risks of different hysterectomy procedures with a patient.
Complications during and after hysterectomy
Even though hysterectomy is generally a safe operation, there are certain complications that may arise due to the surgical procedures. These complications are usually common to all kinds of major surgeries. The following are some of the possible complications that may occur during or immediately after a hysterectomy:
- Bleeding is a possible complication of all surgeries. Excessive bleeding may occur either during surgery or just after surgery (postoperative hemorrhage).
- Infection is another complication that is common across all surgeries. Postoperative antibiotic prescription is routinely done in case of surgeries to minimize the risk of harmful infections.
- Injury to nearby organs such as the urinary bladder, bowels and other pelvic structures may also happen during a hysterectomy procedure.
- Complications due to general anesthesia are also common to many surgeries.
- Blood clots may develop within veins or lungs after a hysterectomy.
- Death is also a rare possibility of a hysterectomy operation. A fatal outcome could be due to infection, hemorrhage, pulmonary embolism, cardiac arrest, respiratory paralysis or coronary occlusion. A pre-existing disease condition may also contribute to a fatal outcome.
Long-term complications of hysterectomy
The following are some of the long-term complications and consequences of hysterectomy:
- If ovaries are also removed during a hysterectomy operation, menopause sets in immediately. Hormone replacement therapy (commonly abbreviated as HRT) can be commenced immediately after the surgery in order to avoid menopausal symptoms such as vaginal dryness, mood swings, hot flashes, and weight gain.
- Removal of the uterus means that future pregnancy will not be possible. This is especially a cause for concern in young women who are of a childbearing age.
- Sexual desire may wane. However, libido usually returns after a complete recovery from the effects of the surgery.
- Osteoporosis may set in early.
- Vaginal vault prolapse is a possible long-term complication.
- In addition to the physical complications, psychological problems such as depression may also occur. This is mostly caused by the loss of childbearing potential in women who were planning to get pregnant.
Side Effects of Anesthesia
Anesthesia is given during surgeries to inhibit any pain sensation during the procedure. An anesthesiologist is in charge of administering the anesthesia and monitoring the patient during the operation. In general, anesthesia is safe when administered by a good anesthesiologist. However, unforeseen and unavoidable complications may arise at times.
It is important for the patient to provide information regarding any allergies, medicines taken, and pre-existing medical conditions to the anesthesiologist. These types of information may have a bearing on how an individual responds to a particular anesthetic procedure.
For example, people who are heavy smokers, overweight, and suffer from lung and heart conditions have a relatively higher risk of suffering from adverse cardiovascular and respiratory complications as a result of anesthesia. Elderly people are also more prone to developing complications due to anesthesia than younger individuals.
Anesthesia can either be regional or general. Both types of anesthesia can cause side-effects such as weakness, nausea, vomiting, mood changes, fatigue, and allergic reactions. Regional (or spinal) anesthesia may cause headaches, numbness in the lower part of the body, impaired muscular coordination and control, infection at the site of injection, and pain around the shoulder or collarbone. Systemic toxicity can also develop if the anesthetic gets absorbed by the blood.
Side-effects of general anesthesia include hypothermia, rigor, laryngeal spasm, coughing, aspiration, damaged teeth and lips, and sore throat. Stroke, heart attack, and death are rare but possible complications of general anesthesia. Careful patient selection and pre-operative checkups can help in reducing the chances of complications due to anesthesia.
Vaginal Bleeding After Hysterectomy
Vaginal bleeding after hysterectomy is a potentially serious complication. Further surgery and blood transfusion may be required to treat this complication. Vaginal bleeding may occur either immediately after a hysterectomy procedure, or within a few days or few weeks of the operation. Vaginal hysterectomy has a higher incidence of postoperative vaginal bleeding than abdominal hysterectomy.
Vaginal bleeding can either be slight or profuse. Many women may experience only slight vaginal bleeding in the form of spotting within the first 4-6 weeks after operation. This slight bleeding is not a cause for concern since it will stop when the surgical wounds heal.
Vaginal bleeding that begins immediately after hysterectomy and continues for more than 6 weeks after surgery should be considered seriously. This type of vaginal bleeding is distinct from spotting or discharge. Other signs and symptoms such as vaginal discharge, vaginal pain, abdominal pain, and fainting may also be present in such situations.
Also read more on abnormal vaginal bleeding.
Causes of Vaginal Bleeding After Hysterectomy
The following are some of the potential causes of vaginal bleeding after hysterectomy:
- Improper ligation of a blood vessel during hysterectomy.
- Slipped ligature.
- Sloughing off of the granulation tissue that forms during wound healing.
- Re-opening of a wound after surgical closure (technically referred to as wound dehiscence).
- Pre-existing bleeding or coagulation disorder in a patient.
- Vaginal injury caused during or after the surgery.
- Non-effective suture material
- Subtotal hysterectomy
- Bladder infections
- Vaginal endometriosis
- Atrophic vaginitis