Vaginal Hysterectomy For Uterine Fibroids

Definition of Vaginal Hysterectomy For Uterine Fibroids

A vaginal hysterectomy may be done to remove uterine fibroids. A fibroid is a noncancerous growth in the wall of the uterus. A vaginal hysterectomy involves the removal of the uterus and cervix through a small incision in the vagina. The ovaries and fallopian tubes may also be removed during the procedure.

Who is a candidate for the procedure?

Uterine fibroids do not usually produce symptoms. But sometimes, these problems may occur:

• bleeding or spotting between periods
• constipation
• the feeling that something is falling out of the vagina
• heavy or prolonged menstrual periods
• low backache
• more frequent urination
• pain with deep penetration during sexual intercourse
• pelvic pain or pressure
• rectal pressure

A vaginal hysterectomy for fibroids is best for women who do not want to bear children and have many symptoms. 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 anesthesiologist meets with the woman. He or she will discuss the anesthesia options and allergies to medicines.
• An intravenous line, or IV, is placed in a vein, usually in the hand or arm. The IV can be used to replace fluids and give medicine or a blood transfusion.
• Medicines, such as sedatives, are given.
• In the operating room, the woman is given either local or general anesthesia. The skin around the vagina is cleaned with a soapy solution to remove any bacteria.
• The abdomen and vulvar area, which is the area between the legs, are sometimes shaved.
• A urinary catheter is placed in the bladder to drain urine

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 before the uterus can be removed. Sutures 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. Other organs may be repaired or removed if necessary.

What happens right after the procedure?

The woman usually stays in the hospital for 1 to 3 days. She may be asked to sit up in bed and walk a short distance the first night after surgery. The urinary catheter is usually removed the next morning. The IV is usually removed if there is no evidence of fever or infection and the woman is drinking fluids.

What happens later at home?

Women having this surgery are advised to follow certain tips at home.

• Antibiotics and pain medicines should be taken as directed if needed.
• She should not drive until she is no longer taking strong pain medications.
• A balanced diet with iron replacement should be followed to promote healing.
• Exercise programs should be followed as directed.
• Intercourse should be avoided for 4 to 6 weeks after surgery to allow the vagina and internal structures to heal.
• Heavy lifting should be avoided for 4 to 6 weeks.
• Stool softeners, such as docusate, should be used. Eight glasses of fluids should be taken in each day. This helps prevent constipation and straining and damage to the incision.
• Walking every day is recommended.

After a hysterectomy, a woman cannot become pregnant. If the ovaries are removed along with the uterus and cervix, hormone replacement therapy with estrogen is often advised. This helps prevent symptoms and other health problems of menopause.

What are the potential complications after the procedure?

Surgery may cause bleeding, infection, or a reaction to anesthesia. Damage may happen to organs near the uterus such as the bladder and bowel. Any new or worsening symptoms should be reported to the healthcare provider.