Vaginal Hysterectomy

WHAT YOU SHOULD KNOW:

• A hysterectomy (hiss-ter-ek-tuh-mee) is surgery to take out your uterus (womb). This surgery is also called a "TVH" (total vaginal hysterectomy). This is because caregivers remove your uterus through an incision (cut) in your vagina. The uterus is a hollow, round organ in your lower abdomen (belly). It is where your baby grows when you are pregnant. You cannot have children after your uterus has been removed. You will also not have monthly periods.
  
  
• A fallopian (fuh-low-p-un) tube is attached to each side of your uterus. The ovaries are below and behind the fallopian tubes. If your tubes and ovaries are also removed it is called "BSO." If your tubes and ovaries are not removed, you will have menopause (change of life) at the normal time. This is usually between 40 to 50 years of age. If your tubes and ovaries are removed, you may need to take hormone medicine. This medicine helps your body wait to go through menopause at the regular time. You can start normal activities 4 to 8 weeks after your hysterectomy.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

There are always risks with having a hysterectomy. You may bleed more than usual or get an infection. Caregivers will watch you closely for these problems. If you don't have a hysterectomy, your problems may get worse. And without a hysterectomy, there may be no other way to treat your problem. Call your caregiver if you are worried or have questions about your health problem or care.

WHILE YOU ARE HERE:

Before Surgery:

• Blood Tests: You may need blood taken for tests. The blood can be taken from a vein in your hand, arm, or the bend in your elbow. It is tested to see how your body is before the hysterectomy and will let caregivers know if you are pregnant. You may need to have blood drawn more than once.
  
  
• Call Button: You can use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call.
  
  
• Chest X-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing before your hysterectomy. Caregivers may also use the x-ray to look for signs of infection like pneumonia (new-moan-yuh).
  
  
• Douche: Liquid with medicine in it may be put into your vagina to lessen the chance of infection.
  
  
• Enema: Liquid may be put into your anus (rear end) through a soft rubber tube. It may be done to empty your bowel before surgery.
  
  
• Gown: A hospital gown is needed so that caregivers can easily check and treat you. Put your gown on so it opens in the back. You may not be allowed to wear pajama bottoms to the operating room. This is because you may need monitors on your skin during the hysterectomy.
  
  
• Informed Consent: You have the right to understand your health problem in words you can understand. You should be told what tests, treatments, or procedures may be done to treat your problem. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Pre-Op Care: You may be given medicine right before the hysterectomy, which makes you feel sleepy and more relaxed. You are taken on a cart to the room where your hysterectomy will be done. Caregivers help you get comfortable on the bed. A belt may be put over your legs for safety. If you get cold, ask for more blankets.

• Anesthesia (an-iss-thee-zuh): This is medicine to make you comfortable during the hysterectomy. Caregivers work with you to decide which anesthesia is best and whether you will be awake or completely asleep. Do not sign legal documents for 24 hours after having anesthesia. Also, do not drive or use heavy equipment. The medicine may make you drowsy and your thinking unclear. An adult may need to drive you home and stay with you for 24 hours after your hysterectomy. Ask your caregiver for the CareNotes™ handout about the following types of anesthesia if you want more information.
  
  
  • General Anesthesia: This is medicine given as a liquid in your IV. Or, it is given as a gas through a facemask or a tube placed in your mouth and throat. This tube is called an endotracheal (end-o-tra-kee-ull) tube or "ET" tube. Usually you are asleep before caregivers put the tube into your throat. And, the ET tube is usually removed before you wake up. You are completely asleep and free from pain during the hysterectomy.
    
    
  • Spinal or epidural anesthesia: This is medicine put into your back to numb you below the waist. With spinal anesthesia, the medicine is given through a shot. Feeling returns in about two hours. Epidural anesthesia is put into your back through a tiny tube. The tube may be left in place to give you more medicine later if needed. After epidural anesthesia, feeling returns to your legs when the medicine wears off.
  
  
• Heart Monitor: This is also called an EKG or an electrocardiogram (e-lek-tro-kar-d-o-gram). It is a painless test to see how your heart is working. Sticky pads (3 or 5) are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This screen shows a tracing of each heartbeat. Your heart is being watched all the time to make sure your body is handling surgery well.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

During Surgery:

• Your legs are put up in stirrups (leg holders). A caregiver cleans your vagina with soap and water. This soap may make your skin yellow, but is cleaned off later. Sheets are put over you to keep the surgery area clean.
  
  
• An incision (cut) is made in your vagina and caregivers remove your uterus through this incision. Your tubes and ovaries also may be removed. The incision is closed with stitches (thread). Caregivers may pack your vagina with a gauze sponge that may be soaked with medicine. This helps the incision heal faster and also helps prevent infection.

After Surgery: You are taken to a room where you can rest until you either wake up or feeling returns to the numbed area. You are then allowed to go home. Or, if you are staying in the hospital you may be taken back to your room. Do not get out of bed until your caregiver says it is OK. You will have a sanitary pad on after your surgery. Caregivers may check it to make sure you are not bleeding too heavily. Change the pad often to keep from getting an infection.

• Activity:
  
  
  • You may need to rest in bed. You may be allowed out of bed once you are feeling better usually the day of surgery. If you are not allowed out of bed for awhile, you should exercise your legs in bed. When your caregiver says it's OK, do leg exercises in bed. You can lift one leg off the bed and draw big circles with your toes. This will help make your legs strong and help you from getting blood clots. Stop if you become tired.
    
    
  • Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.
  
  
• Bowel movements: Exercise such as walking can help you have regular bowel movements. Including foods such as fruit, bran, and prune juice, and drinking enough water can also help. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular.
  
  
• Deep Breathing and Coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (spit) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
  
  
  • Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • You may be asked to use an incentive (in-sen-tiv) spirometer (sper-om-ih-ter). This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Eating: You may be able to eat when bowel sounds (stomach growling) are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. Ice chips are usually given first and then liquids (water, broth, apple juice, or 7-up). If you don't have problems after drinking liquids, caregivers may then let you eat soft foods. Some examples of soft foods are ice cream, applesauce, or custard. If you do OK with soft food, you may begin eating a regular diet.
  
  
• Foley Catheter (kath-uh-ter): This is a tube that may be put into your bladder to drain your urine. The bladder is an organ where urine is kept. The catheter may make you feel like you have to urinate. Relax and the catheter will drain the urine for you. When the catheter is taken out, you can urinate on your own.
  
  
  • Don't pull on the catheter because this will make you hurt or bleed.
    
    
  • Don't kink the catheter because the urine cannot drain.
    
    
  • Don't lift the bag of urine above the catheter. If you do this, the urine will flow back into your bladder. This can cause an infection.
  
  
• Intake/Output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Caregivers often call this "I&O."
  
  
  • When you are allowed, drink 6 to 8 (soda pop can size) glasses of water each day. Or, follow your caregivers advice if you must limit the amount of liquid you drink. If you are on I&O, tell your caregiver how much liquid you drink.
    
    
  • Ask your caregiver if it is OK to flush your urine down the toilet. It may need to be measured before it is thrown away.
  
  
• Medicines:
  
  
  • Antibiotics(an-ti-bi-ah-tiks): This medicine may be given to help you fight infection caused by a germ called bacteria (bak-teer-e-uh). Antibiotics may be given by IV, as a shot, or by mouth.
    
    
  • Pain Medicine: Caregivers may give you medicine to lessen your pain. This medicine may be given as a shot, by mouth, or through your IV or epidural catheter in your back. Tell caregivers if the pain does not go away or comes back. A special pump may be used that allows you to push a button and give yourself the medicine through your IV or the epidural catheter. This is called patient-controlled analgesia (ah-null-g-z-uh) and is set up so you cannot accidentally give yourself too much medicine.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Stool Softeners: You may be given stool softeners to keep you from getting constipated (kon-stih-pa-ted). Constipated means it is hard have a BM. Stool softeners make your BM softer so you do not need to strain when having a BM.
  
  
• Oxygen: You may need extra oxygen for a day or two after surgery. It may be given through a plastic mask over your mouth and nose. Or, it may be given through nasal prongs (short, thin tubes in your nose). Tell your caregiver if the oxygen is drying out your nose or if the nasal prongs bother you. Don't take off your oxygen without asking your caregiver. If you do, your body may not have enough oxygen.
  
  
• Pressure Stockings: Tight elastic stockings may be put on your legs to help keep blood from staying in your legs and causing clots. The stockings may also be called Ted Hose® or Jobst Stockings®.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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