Alternative Names vaginal hysterectomy for leiomyomata or bleeding
Definition This is a surgery to remove the uterus and cervix through a cut in the vagina. This procedure may be needed when fibroids or abnormal vaginal bleeding are present. Sometimes the ovaries and fallopian tubes are also removed.
Who is a candidate for the procedure? Fibroids are noncancerous tumours that grow in the walls of the uterus. The fibroids grow slowly and may cause the uterus to become enlarged. They can also cause bleeding problems. It is not known what causes these tumours.
Fibroids:
often grow when the body increases its production of oestrogen, the main female hormone, such as during pregnancy
are often multiple, meaning there is more than one fibroid
are usually less than an inch in size
have a marbled, dense appearance
may change the shape of the uterus
Usually fibroids do not produce symptoms. But sometimes, these problems may occur:
heavy menstrual periods
prolonged menstrual periods of more than 5 to 7 days
clotting with menstruation
bleeding or spotting between periods
pelvic pain
pelvic pressure or a heavy feeling, especially with walking or exercise
more frequent urination
rectal pressure
pain with deep penetration during sexual intercourse
constipation
low backache
infertility, or an inability to get pregnant
miscarriage
the feeling of something "falling out" of the vagina
This surgery is best for women who do not want to bear children and have many symptoms. It can greatly improve the quality of a woman's life in this situation.
If the bladder or rectum is protruding through a tear in a muscle or tissue, it can be fixed during the surgery. The ovaries and tubes may also be removed if there is no scarring or enlargement that would prevent their removal through the vagina.
How is the procedure performed? Before surgery, several things are usually done.
An IV is placed in a vein, usually in the hand or arm. This is a tube that can be used to replace fluids and give medication or a blood transfusion, if needed.
A catheter, or tube, is placed in the bladder so the doctors can see how much urine the body is making. It also drains the bladder through the night so that a woman does not have to get up to go to the bathroom.
Blood tests may be done to check for any common problems, such as a full blood count, to check for anaemia, or a low blood count.
An anaesthetist, or a doctor trained to give pain medication during surgery, meets with the woman. He or she will discuss the type of pain control, any allergies to medications and other possible disorders.
The belly and vulva area, which is the area between the legs, are sometimes shaved.
Medications needed before surgery are given.
In the operating room, the woman is either given local pain control or is put completely to sleep, which is called general anaesthesia, to prevent pain. The skin around the vagina is cleaned with a soapy solution to remove any bacteria. A cut is then made in the upper part of the vagina to expose the tissue, such as blood vessels, that surrounds the uterus and cervix. These tissues must be cut and tied off to remove the uterus. Stitches are placed in these deep structures. These will heal during the weeks following surgery and do not need to be removed. The uterus is removed from the top of the vagina, and the vagina is closed at the top.
The surgery usually takes 60 to 90 minutes. At times, the ovaries and tubes may be removed, and other organs may be repaired or removed if needed for other reasons. All tissue is sent to a laboratory to be analysed.
What happens right after the procedure? The woman usually stays in the hospital for 1 to 3 days. She is often asked to sit up in bed and walk a short distance the day after surgery. The catheter is usually removed the following morning if no bladder repair or trauma occurred. Pain relievers may be given through the IV, by an injection or orally for any pain or discomfort. The IV is usually removed if there is no evidence of fever or infection, and the woman is able to drink fluids without getting nauseous or vomiting.
After this operation, a woman does not need to use birth control since she cannot become pregnant. Sexually active women, especially those with several partners, should still use condoms to avoid the risk of sexually transmitted diseases. If the ovaries are removed along with the uterus and cervix, hormone replacement therapy, or oestrogen, may be advised to prevent symptoms and other health problems of the menopause.
What happens later at home? Women having this surgery are advised to follow these tips at home:
A balanced diet with iron replacement should be followed to promote healing.
Stool softeners, such as docusate, should be used and 8 glasses of fluids should be taken in each day. This helps prevent constipation and straining during bowel movements, which may disturb the healing wounds.
Heavy lifting should be avoided for 4 to 6 weeks.
Walking is advised every day.
Antibiotics and pain relievers should be taken as directed if needed.
Exercise programs should be followed as directed.
Sex should be avoided for 6 weeks after surgery to allow the vagina and internal structures to heal.
What are the potential complications after the procedure? There are always problems that can occur during surgery. The risks and benefits of any surgery should be discussed before the operation. Possible problems include:
infection
those caused by anaesthesia, such as breathing trouble, reactions to drugs and poor pain relief
internal bleeding
mild nausea and vomiting
trauma to the bladder or ureter, the tube that carries urine from the kidney to the bladder
bowel trauma
fistula formation, which occurs when a hole forms between the bladder, intestines and vagina
pelvic scar formation
prolonged paralysis of the bowels
allergic reactions to antibiotics or pain medication
bleeding, which may require blood transfusions
stitches breaking apart
blood collecting below the cut
blood clots in the legs, lungs, heart or brain
death
Most women, however, have few or no complications.
Author: Eva Martin, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 12/06/2005 Contributors Potential conflict of interest information for reviewers available on request
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