Hysterectomy Complications: Everything You Need to Know

What Is Hysterectomy?

Hysterectomy is a surgical procedure in which a woman's uterus is removed. The term "hysterectomy" is derived from the Greek word "hysteria," which means uterus, and "ectomy," which means removal. Every surgery has its own complications, and hysterectomy is no exception. Complications in hysterectomy depend on the type of hysterectomy and the procedure followed during hysterectomy. Hysterectomy is often performed to treat various medical conditions, including:

• Uterine Fibroids: Uterine fibroids are non-cancerous growths that develop within the muscular wall of the uterus or on its surface. These growths can vary in size, from small and undetectable to large and bulky masses. While some women with fibroids may not experience any symptoms, others may suffer from heavy and prolonged menstrual bleeding, pelvic pain or pressure, frequent urination, and even reproductive problems, such as infertility or recurrent miscarriages. When fibroids cause severe and debilitating symptoms, and other conservative treatment options (such as medications, hormonal therapies, or minimally invasive procedures) fail to provide relief, a hysterectomy may be considered as a definitive treatment option. Removing the uterus eliminates the source of fibroids and, consequently, the symptoms associated with them.

• Endometriosis: A condition where the tissue that lines the uterus grows outside of it, leading to pain and inflammation.

• Uterine Prolapse: Uterine prolapse occurs when the pelvic floor muscles and ligaments become weak, causing the uterus to descend into the vaginal canal. This condition is more common in women who have experienced multiple childbirths, have had difficult deliveries, or have a history of chronic conditions that strain the pelvic floor, such as obesity and chronic cough.

• Chronic Pelvic Pain: Chronic pelvic pain is persistent and severe pain in the lower abdomen or pelvis that lasts for six months or longer and does not respond to other treatments. The causes of chronic pelvic pain can be complex and multifactorial, including conditions like endometriosis, fibroids, pelvic inflammatory disease (PID), irritable bowel syndrome (IBS), and others. A hysterectomy for chronic pelvic pain is considered a last resort when all other potential causes have been ruled out, and other treatment options have been unsuccessful.

• Gynecologic Cancer: In cases of gynecologic cancers, such as uterine, cervical, or ovarian cancer, a hysterectomy is often part of the treatment plan. The extent of the surgery depends on the type and stage of cancer. For early-stage cancers confined to the uterus or cervix, a total hysterectomy (removal of the uterus and cervix) may be performed to remove the primary tumor. In more advanced cases, additional procedures, such as removal of nearby lymph nodes or the ovaries, may be necessary. For some gynecologic cancers, a hysterectomy may be the primary treatment, particularly when the cancer is limited to the reproductive organs and has not spread to other parts of the body. In other cases, hysterectomy may be combined with radiation therapy, chemotherapy, or both to provide comprehensive cancer treatment.

What Are the Types of Hysterectomy?

• Complete/Total Hysterectomy: Involves complete removal of uterus along with cervix.

• Partial Hysterectomy: Also called supra-cervical hysterectomy, where only the top portion of the uterus is removed.

• Radical Hysterectomy: Includes removal of the complete uterus, cervix along with the upper part of vagina.

• Complete Hysterectomy With Salpingo Oophorectomy: In this procedure, the surgeon completely removes the uterus, cervix, vagina, along with ovaries and fallopian tubules. It is the choice of the surgeon to remove unilateral or bilateral ovaries.

What Are the Different Procedures Followed During Hysterectomy?

Surgical removal of the uterus can be done in the following ways:

• Hysterectomy Through Abdomen: Surgical removal of the uterus through the abdomen by making a small cut over the abdomen. The main disadvantage is scar formation and a longer recovery time compared to a vaginal hysterectomy.

• Hysterectomy Through Vagina: Most doctors recommend this type of hysterectomy, where the uterus is removed through the vagina. Advantages include no scarring, no incisions, and early recovery time.

• Hysterectomy Through Laparoscopy: The surgeon uses a laparoscope which is an instrument consisting of a small hollow tube with a camera and light at its end, and this instrument is inserted by making a small hole in the abdominal region. The uterus is cut into small pieces once it is located, and the small pieces are removed either through the vagina or by making small cuts on the abdomen. This procedure favors discharge from the hospital on the same day. It is a completely painless process, and the patients recover within a short duration.

• Hysterectomy Through Robots: It is similar to laparoscopy, where the robots perform the surgery, and the robotic machinery is under the control of the surgeon.

What Are the Complications of Hysterectomy?

Complications of hysterectomy can be categorized into long-term and short-term complications.

1. Long Term Complications Include:

• Menopause: It is of two types, namely:

• Immediate Menopause: This is seen when the patient has undergone total hysterectomy along with bilateral salpingo-oophorectomy, where the uterus, along with fallopian tubes, and ovaries, are completely removed. Removal of ovaries permanently leads to the stoppage of the menstrual cycle, and the woman enters menopause.

• Premature Menopause: When the surgeon retains the ovaries during hysterectomy, menopause cannot be attained immediately, but over a period of time, the blood supply to the ovaries is disturbed as a result of hysterectomy and thereby, menopause is achieved. Early menopause usually affects women who have undergone a hysterectomy in their early 30s or 40s. In women who have already reached menopause or who are about to reach menopause does not make any difference. Symptoms of menopause include hot flushes, dryness of the vagina, profuse sweating especially seen during night times, and osteoporosis.

• Decreased Sexual Desire: Sexual life after hysterectomy cannot be anticipated in women. Women who are undergoing excessive bleeding and painful menstrual cramps can get relief after the removal of the uterus. Hence these women can love their sexual life. Women who have sufficient children live in fear of becoming pregnant again. Hysterectomy could relieve their fear and help them enjoy sex. But some women lose their desire for sex after hysterectomy. This can be mainly because of dryness of the vagina and the absence of uterine contractions. The dryness of the vagina causes friction during intercourse leading to pain and a burning sensation. This can be reduced by using vaginal lubricants such as gels, sprays, and ointments.

• Depression: Menstrual periods and becoming pregnant is considered a sign of femininity, but by undergoing a hysterectomy, both are lost. This causes depression in women, especially those who are under the reproductive age group (15-45 years). The symptoms include dropping of interest in doing things, permanent loss of femininity, and lethargy (weakness). These symptoms are temporary, and counseling helps to cope with the situation.

• Gastrointestinal Injury: Usually leads to bowel upset; the symptoms include constipation. This is temporary and can be reduced by the intake of foods containing fiber. Initially, to overcome the problem, laxatives are advised to prevent stress on the abdomen during the excretion of fecal matter. Diet modifications are majorly suggested by the nutritionist after the surgery to overcome the problem.

• Genitourinary Tract Injury: During a hysterectomy, bladder disturbances can occur, leakage of urine, or incontinence (capacity to hold the urine is lost), leading to random passing of urine.

• Abdominal Prolapse: It is one of the long-term side effects of hysterectomy, where the abdominal organs would stretch and descend into the pelvic area.

• Osteoporosis: This is a condition where the bones become fragile and are prone to fractures easily. Women who undergo hysterectomy face the problems of osteoporosis. This is mainly because of the decreased production of estrogen after hysterectomy.

• Heart Problems: Women who have undergone hysterectomy are more prone to coronary artery disease (CAD). CAD is a condition in which arteries supplying blood to the heart are blocked due to cholesterol deposits alongside the walls of the arterial blood vessels. The gynecologist must clearly explain the situation of CAD to the patient and also discuss the preventive features.

• Venous Thromboembolism: Blood clot formation is seen after the surgery. This is mainly because of the lack of movement after the surgery. These blood clots, also called thrombus, are mostly formed in the legs and especially in the veins. To prevent this patient is kept on blood thinners and suggested to start walking as early as possible after the hysterectomy.

2. Short-Term Complications: They are usually mild and nominal and occur within the first thirty days after surgery. They include:

• Bleeding: This is common during any surgery and has only a minor risk in a hysterectomy. This can be treated by blood transmission.

• Infections: When surgeries are performed under a sterile environment, there are chances of infections, like infections are the site of incisions, which can simply be treated by advising antibiotics.

• Anesthetic Complications: These are very rare and might include nerve damage and mild allergies. Pre-anesthetic evaluation is recommended before every surgery to avoid complications.

Conclusion:

If a gynecologist advises to undergo a hysterectomy, the patient should clearly discuss the types of hysterectomy, procedures of hysterectomy, and the complications of hysterectomy with the doctor. Complications in the hysterectomy can be dealt with by using medications, counseling, and making the required lifestyle changes.