Vaginal hysterectomy

A vaginal hysterectomy is an operation performed under a general, spinal or epidural anaesthesia to remove the womb (uterus) through the vagina.

It is a common surgical procedure to cure or alleviate a number of gynaecological complaints. The cervix is also removed so there is no longer any need for cervical screening.

A vaginal hysterectomy is considered after other treatments have failed. The decision to have a hysterectomy should be shared between you and your doctor. In most cases a vaginal hysterectomy is needed to relieve either acute or chronic painful or distressing symptoms.

Heavy or very painful periods: When all other treatment options have been explored some women whose quality of life is unduly affected by heavy or very painful periods will benefit from having a vaginal  hysterectomy. Sometimes the heavy bleeding can also cause anaemia.

Prolapse: This is where the uterus or parts of the vaginal wall drop down. This may happen after the menopause when the tissues that support the uterus tend to become thinner and weaker

• Vaginal Hysterectomy (VH): This is when the uterus and cervix are both removed through the vagina.
• Total Laparoscopic Hysterectomy (TLH): Is a keyhole procedure to provide access for a laparoscope (telescope) to help remove the womb and sometimes remove the fallopian tubes, ovaries and cervix.

At your pre-op assessment and on your admission day the nurse will go through your hospital stay and explain your operation. Please do let us know about any concerns you have or if there is any information you think we should know about, that will make your stay with us more comfortable. A variety of simple tests will be done to ensure you are fit for surgery.

Smoking increases the risk of complications so, if possible, please try to stop smoking a month before the operation.

You will need to make arrangements for your family, children or any other commitments you have prior to coming in to hospital and to cover the length of your recovery. You will be seen by the anaesthetist who
will discuss with you the options of a general anaesthetic (induced sleep) or regional anaesthesia (like an epidural). The doctor performing the surgery will answer any questions and address any concern that
you might have before you go to theatre. It is not unusual to feel anxious: the nursing staff will gladly discuss how you are feeling and to talk you through your emotions.

The operation usually takes about an hour. Your surgeon will pass a specially designed instruments through your vagina to remove your womb. The surgeon will then close the top of your vagina using dissolvable stitches and may place a tampon-shaped dressing (known as a pack) in your vagina. The vaginal pack will stay in for 24 hours before it is removed. You won’t have any visible cuts or scars.

There are risks with any operation but these are small. The main risks associated with a vaginal hysterectomy are:

Common risks:

• Post-operative pain
• Swelling and bruising
• Urinary infection, retention and/or frequency
• Blood-stained vaginal discharge
• Feeling emotional.

Uncommon risks:

• Damage to the bladder
• Damage to the bowel
• Pelvic abscess or infection
• Venous thrombosis and pulmonary embolism (clot in leg/lung)
• Haemorrhage requiring blood transfusion
• Return to theatre i.e. because of bleeding
• Vaginal vault dehiscence (opening) requiring re-stitching.

As you come round from the anaesthetic you may experience pain and/or nausea. Please inform the nursing staff and they will assess you and take appropriate action.

We will use a pain score to assess your pain:

0-10: 0 = No Pain, 10 = Very Strong Pain.

You may have a PCA pump (patient controlled analgesia) to control your pain.

Your nurse will be checking your blood pressure, pulse, breathing and temperature and will monitor any vaginal bleeding. The nurse will also ask you to move from side to side and to do leg and breathing exercises once you are able, this will help prevent any pressure damage, a DVT (Deep Vein Thrombosis) or chest infection.

The first 12 hours after the operation
You will have a drip attached in your arm (intravenous infusion);
once you are fully awake you will be able to start drinking and eating.
Your drip will then be discontinued. You may also have a urinary
catheter to drain your urine. You can expect pain or discomfort in your
lower abdomen. You will be given painkillers to alleviate this.

Day 1: after the operation
The nursing staff will assist you with washing or to shower as necessary. We encourage early mobilisation. We would normally expect you to sit out of bed and walk around the day after surgery. Often you will be able
to go home the next day.

If you have a vaginal pack and a catheter, it will usually be removed on the morning after your surgery. We will monitor your urine output to make sure you are emptying your bladder properly after the catheter has been removed. You may experience trapped wind which may cause discomfort. Peppermint water and getting up and walking will help this. You may also find it difficult to open your bowels at first - you will be given mild laxatives to soften your stools and prevent constipation and straining.

Occasionally, a drain (small tube) will be inserted through your vagina to drain off any blood or fluid that may collect immediately after the operation. This will be removed by a nurse after your surgery while you are still in hospital.