Hi everyone. I'm back with my VLOG and this week i'm going to talk to you about
hysterectomy. So we're back to women's problems at the moment! So what is it?
Hysterectomy is a surgical operation where a woman has her uterus or womb
removed. So it's a big piece of surgery. So why is it carried out? So there are
lots of different reasons for carrying it out. One of them is Uterine Fibroids.
So these are benign growths in the uterus that can get very big and
they bleed and they can be very painful. And sometimes hysterectomy is the only
answer. Endometriosis is another cause. Uterine
prolapse, where the uterus slides into the vagina, and can be really
uncomfortable and beyond repair. Abnormal vaginal bleeding. Chronic pelvic pain.
Thickening of the uterus wall; so this is called adenomyosis. And finally cancer. So
if there's cancer of the ovaries, the fallopian tubes, the uterus or the cervix,
a hysterectomy is the answer. So what type of hysterectomy would you have if
you had one? Well there are different types, depending on what's going on and
what the reason that the surgery is. So there is a subtotal hysterectomy which
is where the upper part of the womb is taken away. Then there's a total hysterectomy,
where the entire womb and the cervix is taken away. And then there is a radical.
In a radical you will lose the uterus, the surrounding tissues, some lymph nodes
the cervix, the upper part of the vagina, and possibly the ovaries and fallopian
tubes. In any hysterectomy the ovaries and fallopian tubes may also be taken
and taking away the ovaries is called an oophorectomy and taking away the
fallopian tubes is called a salpingectomy. So if you were to have a hysterectomy
where you lost everything that would be called a hysterectomy with a salpingectomy plus
oophorectomy. So lots of massive words but basically it means a
hysterectomy plus the ovaries and fallopian tubes. So the questions to ask
your surgeon when they're choosing what type of hysterectomy for
you are: Why are you choosing this particular type? What are the benefits
versus risks for me in particular? Can I keep my ovaries? And this is really
critical, because although hysterectomy some more often carried out in slightly
older women, they can be carried out in younger women too. And if you take the
ovaries you will go immediately into menopause whatever age you are. Even if
you leave the ovaries after a hysterectomy, because there's an
interruption to the blood supply, there's quite a high chance that you
will go into menopause within five years, again regardless of what age you are. So
this is a really important thing. And then of course is this the most minimal
surgery that you could do for me? Because you always want the most minimal surgery,
for your health, for the length of the anaesthetics. So then what surgical
technique will the surgeon use. Well that really depends on the reasons for doing
the hysterectomy, your history, what their experience is, what your overall health
is and also what your weight is. So those things will come into play when making
that decision and there are three different ways of carrying out this
surgery. So there is laprascopic surgery. There's vaginal surgery and
there is abdominal surgery. So laprascopic surgery
is the gold standard it's the preferred method. And this is where small
incisions, three or four are made in the tummy wall,
and a camera goes into one of them (that one usually goes through your belly button)
and then tools goes through the others. So gas is inserted into your abdomen and
the surgery is all carried out through these tiny holes. So it's minimally
invasive and you do need a general anaesthetic for it, usually. Then there's the
vaginal method and this is where the womb and the cervix are removed via the
vagina. So like when I have an a speculum exam at the GP, all of the surgery is done
that way. Small holes are made at the top of the vagina, so that the surgeon can
get access to the different ligaments and make the incisions that he needs. And
then afterwards these are just sutured (stitched) up. This can be done under
general or local anaesthetic and sometimes even a spinal anaesthetic so
like when you're having a cesarean section and you have a spinal anaesthetic. And then finally
there's the abdominal hysterectomy. Now this is the biggest surgery and has the
longest recovery time as a result, but we'll talk about that
So it's an incision that's made in your abdomen. It can either be done at the
bikini line like a cesarean or it can actually done up the middle. So a line
that goes this way. And that would depend very much on the reason for you having
the hysterectomy and whether you have big fibroids etc. You will need a
general anaesthetic for this without a shadow of a doubt. So the questions to
ask once the decision has been made are: What kind of preparation do I need? Do I
need to start medications/stop medications, lose weight, stop smoking?
All of those kind of things. What type of anaesthetic will be used?
How long will the surgery last? How long is the waiting list to have this surgery?
How long will I be in hospital? How long will it take me to recover?
When can I go back to work, drive, have sex? Will I need to smear tests afterwards? And if so, when/how many?
And will I have scars? So those are all the questions and write them down and go
through them one by one, don't be rushed. This is your life, your body, your surgery.
It's really important. So before any surgery, what can you do to make it go as
smoothly as possible? Well, be in the best of health:
eat a really healthy balanced diet, stop smoking, exercise regularly, and if you
need to lose weight, try and lose some weight. You'll probably have a
pre-assessment at the hospital, where you'll go and they will check all of
these things for you, do an ECG of your heart if needed, speak to the surgeon if
needed. You need to think about travel arrangements to and from the hospital,
before and after surgery. Who's going to help you? And what support you can have
in place at home. And then after surgery, what to expect. Well immediately when you
come around from the anaesthtic you'll possibly be in
pain. You could have a catheter, that's a tube into your bladder.
You could have drains in place to take away fluid and blood from the surgery
site. You'll feel a bit groggy. You could have a headache. You'll possibly have a guaze
pack inside your vagina and your wounds will have dressings on them. And all of
these things will gradually be taken away over the next few days. And the
nursing staff will talk to you about them and help you with them. In the few
days after the surgery you'll be encouraged to mobilise as soon as
possible to prevent any blood clots. And you need to be sensible; don't do
anything that hurts. If it causes pain don't do it, it's your body telling you
to stop. And then prior to discharge you will have a list of all your medicines
and a prescription for them supplied. You'll need to know what the rules are;
what you can and can't do, and what to expect. You'll possibly have some physio
follow-up booked and you need to know when that is. And you'll need to have
your support at home, especially if you've had an abdominal surgery because
you will be able to do very little for a while. So to give you an idea of the timings
on these: if you have a vaginal or a laparoscopic surgery you should start
feeling back to normalish within about four days, and your GP follow-up will be
in four to six weeks. If you have an abdominal surgery you're going to need
six to eight weeks recovery time and you will need that, it's a big surgery. And
you will have follow-up at the hospital at the end of that period, with the
consultant, to check how things are going. So again, questions to ask before you
leave? And again, write them down and take your time, don't don't be rushed!
So who should you contact if you're worried, it's really important ? What am I allowed
to do on my own? What will I need help with? What can't I
do be? Be very clear so that you know. How much pain, bruising and swelling is
normal? What should I expect? And when should I worry? When should I contact
someone because I think it's more than that?
Do I have any stitches that need removing? And when do they need removing?
And your GP/nurse can do that for you but
we need to know when and where! When can I get back to work? When can I
drive? When is my follow up and who is it with? And if you've had your ovaries
taken away: Will I be starting HRT? When will I be starting it?
what will I expect? So lots of questions. So write those down and take them with
you and don't be rushed. And then at home - what to expect? So you can expect vagina
bleeding or discharge for up to six weeks. It won't be as heavy as a period
but it will be there. You might have some bladder or bowel issues. So because
you've had a catheter in you might start getting the symptoms of a urine
infection; so pain when you pee, pain in the tummy, fever. And if you get any of
these speak to a GP immediately because you will need treatment. Your Bowel might
have shut down a little bit so you might be constipated, because when the bowel
was touched during the surgery that often happens and obviously you've got
pain medication which could also be making you constipated. And it's really
important that you don't strain when you're going to the toilet because you
don't want to undo anything that's been done down there. So take laxatives and
make sure you're not straining. And another tip I can give you is when you
do go to open your bowels just use your hands across your abdomen to give
yourself some support, to just make it feel that much easier. You might be going
into menopause if you've lost your ovaries so you could be experiencing hot
flushes, night sweats, mood changes, anxiety. So all of those things are
really important and if you are experiencing them and you haven't got a
plan in place, see your GP. And emotionally you might feel a bit wrung out.
It's a big surgery and also it's a big change in your life. You've lost your womb,
you've lost your ability to carry a child. Some women find that really
difficult to cope with. They feel less womanly as a result, their mood swings
can be massive. You can be tearful and you can be depressed and this is all
understandable, but please speak to your GP ASAP, because we can put in place
counselling for you and if necessary tackle the depression as well.
It's really important and it's completely understandable, completely.
So when can you get back to normal?
As soon as possible obviously, but there are some rules! So people ask when they
can exercise again, and we do want you to get back to
exercise, because exercise is good for you all around you, mentally and
physically. So what we say is, once the wounds have healed, get into walking
and swimming to start with. And then gently ease back. Obviously if you've had
an abdominal hysterectomy you need to take it easy for six to eight weeks,
before you do that, but you could swim or walk. Lifting: again be careful, be
sensible, don't do anything that hurts. And if you've had an abdominal
hysterectomy, don't lift anything heavier than a full kettle for six to eight
weeks. Driving? And this is the question we get more often than than not. So what we say
is that when you can comfortably wear a seat belt across your tummy and you can
do an emergency stop, so slam that right foot down hard, then you're ready
to drive. (excuse me) Don't drive before then because your
insurance will be invalidated, and that's really important. When can you have sex
again? Well, wait till your wounds have healed and your vaginal discharge has
stopped. And then go back to sex, be gentle at first because obviously you
might be a bit sore, but after that it's back to normal. And you don't need
contraception anymore, so there's a plus side!! And working? See how you feel,
judge it yourself and be guided by your body. If you're in pain, have some time
off and relax. Don't do anything that hurts and if you have a job with heavy
lifting, you will need six to eight weeks off because you won't be able to do that.
But if you've got a sedentary job you can go back to work once you feel well enough.
So complications. So obviously because
you have an anaesthetic, there is always risks that come with that and these will
all be explained to you before you have your anaesthetic and surgery. But those
risks include things like nerve damage, allergic reactions and in severe cases
even death, but that really is very very rare. Ureter damage, so that's damage
to the tube that comes from your bladder to your kidney, and that's usually been
repaired at the time, and the risk is about one in a hundred.
Bowel or bladder damage, is also possible. And this can lead to things
like urine infections, incontinence, frequency and in really rare cases (but
at the severe end) you could need a catheter or colostomy bag.
Bleeding that needs a blood transfusion can happen. Infections of your wound or
obviously your bladder and if you get these will need to be treated with
antibiotics. Blood clots, because you're having surgery and you're immobile and that's
why we get you up as soon as we can. Slow healing or vaginal prolapse is rare
but they do happen. And then obviously, as I said before, there's a
risk of going into menopause within five years because of the blood supply to the
ovaries being interrupted. Or if your ovaries have been taken, going into
menopause, which is a dead cert if they have. So those are the complications.
Now what about smear tests? Now this is a complicated area, so I'm going to try to
give you a quick overview. But I'm going to put a link in the details afterwards
so that you can have a look for yourself, because it really does depend on what
your smear history is, and what kind of surgery you've had done. So if you still
have a cervix you will need to have your smears as normal for the rest of your
your screening life, so up to 65, at the recall that you would normally have had.
So that one's quite simple. If you don't have a cervix left anymore and you've
never had history of what we call CIN (so those are a particular grade of
precancerous cells) on your cervix and that your smears have always been normal
in the past - you don't need some years anymore. If however your smears have been
abnormal in the past, but you didn't have CIN, you'll need what we call a vault
smear at six months and if that's normal then no more smears!
If however you've got a previous history of CIN and
you've had your cervix completely taken away, you'll need a vault smear at 6
months and 18 months. Then if those are normal your go to no smears. If however
you had CIN in the past but the excision of those cells was incomplete or uncertain
you'll continue to have smears. And depending on
whether that was CIN 1 or 2/3, depends on how often. So these will be
vault smears at 6, 12, 24 months if there was incomplete excision or
uncertainty. And if it was CIN 2/3, six twelve at nine months and then
annually. So as you can see it's really complicated and there is a link in the
notes afterwards. I hope I haven't confused you there, hopefully I've given you an
overview. So, it's a big surgery for sure, and it needs thinking about before you
have it. But for some women it's just absolutely necessary. Everything else has
been tried and there is no other solution. So it's important and it
changes your life, because on the plus side for most women, as I said, this is
life-changing surgery, where the terrible pain, bleeding, bloating, feeling unwell,
goes away because the cause of it it's been taken away!
So that's the most brilliant thing about it. I speak to women, who after their
hysterectomy almost started life all over. Also it enables you to have oestrogen-
only HRT, which is also life-saving. It takes away the menopausal symptoms,
keeps your bones healthy and strong and doesn't come with the risks that
progesterone brings, so that's another plus side. And then (excuse me I had a
cold as you can tell) then it also prevents uterine cancer, and if you have
your ovaries taken away, ovarian cancer. So you never have to worry about that
cancer that all women you know reasonably high risk of in their
lifetime. So it's life-changing and sometimes
life-saving surgery. So although it's complicated, and there's loads of things
to think about, for many women it's a no brainer; it's their last opportunity to
get rid of everything that's been driving them absolutely crazy. So
hopefully today I've given you the questions to ask before, during and after
the surgery. Given you an idea of what to expect
and what to do. I'll put some links to useful sites afterwards, including the
smear one. And ask me any questions you've got and I'll try and answer them.
And I hope that's been useful as ever. Thanks for watching and have a really
brilliant 2018!!
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