Coping after a hysterectomy
Having a hysterectomy is very traumatic, both physically and emotionally. To ensure a full recovery, it is essential to accept help and take it easy for a while. Elaine Larkin gets some good medical advice
According to Dr Martine Millett-Johnston, consultant gynaecologist and medical director of the Kilkenny Clinic: “No matter who has had the hysterectomy, the first two weeks require a lot of care, rest and minding.” To fully recover emotionally, physically, psychologically and sexually, she adds, takes 12 weeks.
“The post-op care depends on the type of hysterectomy a woman has had and the reason for her hysterectomy,” she continues.
There is the “total hysterectomy” – where the womb and the cervix are removed or the womb, cervix and ovaries are removed – so a woman goes into a menopause.
“This would always be an abdominal procedure with an abdominal scar, which may be like a bikini scar or it could be an up-and-down incision. If it’s for cancer, it’s an up-and-down incision, which is a large wound,” explains Millett-Johnston.
Following this operation, women tend to be in hospital for seven days and are slower to recover because they have big wounds, she adds.
There is also the laparoscopic or keyhole hysterectomy: a total hysterectomy where the womb and cervix are removed or a sub-total hysterectomy where the womb is taken but the cervix is left.
“With keyhole surgery, they are mobile quicker and have a two- to three-day stay in hospital,” she explains.
A keyhole hysterectomy involves three tiny incisions on the abdomen and patients are mobile and walking around the day after surgery. However, keyhole surgery can also take the ovaries.
“That must be taken into consideration because, when a woman goes home, she will need more care. It’s like taking the petrol out of the engine of a car. She will be more tired, have hot flushes and will have to go on HRT.”
Another type of hysterectomy is where the uterus is removed vaginally. The womb and the cervix go and the ovaries are usually conserved. There are no visible abdominal wounds with the vaginal approach and patients recover very quickly.
“In that type of hysterectomy, patients tend to be more mobile quickly; they are mobile from the very beginning. They have a shorter stay in hospital – about four to five days,” says Millett-Johnston.
However, patients who have a vaginal hysterectomy may require a bladder repair. They can’t lift, drag, pull or do any heavy-duty work for eight to 12 weeks.
Women who have had a major hysterectomy with a big incision and women who have had a vaginal hysterectomy should not lift anything heavy, drag or pull (for example files or boxes) for 10 to 12 weeks, she adds. The former group shouldn’t drive for four to six weeks. Those who have had keyhole or vaginal surgery, however, can drive after two weeks. For the first two weeks, this group should not do tasks such as vacuuming, running up or down stairs, or carrying heavy shopping bags.
There are other factors to consider as well. Depression can occur after any hysterectomy. “It’s very important that patients address this,” says Millett-Johnston. “Sometimes partners are reluctant to see the patient go on anti-depressants but it’s important to recognise this may only be in the short term and that patients don’t go into what they call a black hole, that they tackle this immediately.”
Partners need to be aware that sexual activity for all hysterectomies can’t be commenced for about six to eight weeks, she adds. “Sometimes, with a sub-total hysterectomy, where the cervix is left, intercourse can resume earlier, say at four weeks, but it needs to be very gentle. We adopt the approach of the ‘quiet vagina’, where the partner will just place the penis in the vagina and do nothing else. On the second go, have some thrusting with ejaculation so that there is care and consideration given to the partner.”
She concludes: “Before patients have a hysterectomy, it’s very important to discuss psychological, sexual, emotional and physical situations that can arise following a hysterectomy. That’s not always done.”