#78 What to Expect After a Hysterectomy

What people should expect in the immediate aftermath of a hysterectomy depends upon several factors. These include whether the hysterectomy is vaginal or abdominal and the reason for the hysterectomy.

If you are having an abdominal hysterectomy for cancer, your recovery has a lot to do with what kind of cancer you’ve had and what kind of abdominal hysterectomy you’ve had. For example, if you have endometrial or cervical cancer, you’ll probably have lymph nodes, portions of your bowel and the tissue beside your uterus removed. If, on the other hand, you had a vaginal hysterectomy or a laparoscopic hysterectomy (with or without robotic instrumentation), you will most likely have less pain and be able to move around after surgery with the aid of some pain medication.

You should be able to get up and walk around normally in 12 to 24 hours. If you have significant pain following one of these procedures, the pain is probably an indication that something is not going right. My first thought would be an infection and my second thought would be a bleed, making a hematoma, which is a large blood clot.

The most common side effect from the surgery would be pain, but you may also expect difficulty urinating, sometimes associated with painful urination and difficulty in passing stool. If you find that you have burning with urination, you will need to be checked for a bladder infection. If you have trouble with constipation, you need to take medication for that. While it is rare, post-op bleeding is a possibility either in the abdomen or in the abdominal wall.

Spotting is considered to be normal, whereas bleeding that is more than one pad per hour is definitely too much and requires an immediate visit to your doctor or to the emergency room.

Stitches can tear, or they can be ineffectively placed so that bleeding is not stopped. The return to the operating room to re-suture is sometimes necessary but shouldn’t occur with a surgeon more than once every decade or two. Before your surgery, you might ask your physician how many times his or her surgeries required a return to the operating room to stop the bleeding.

I have had some patients choose to go home the day of their hysterectomy, but I would recommend against doing that. Recovery from the surgery itself should be complete in about three months.

At home you should also check your temperature twice a day, 8 am and 8 pm. The 8 am temperature should be the lowest of the day. Your 8 pm temperature should be your highest temperature. Many people who run fevers will only run a fever for a few hours a day, so if you feel chilly after your surgery, that’s the time to check your temperature. The old rule about 98.6 degrees being the average temperature may not be your average temperature. A temperature of 100 degrees is probably not too high for some people, but for others it may be too high.

So, normally you could run somewhere between 98.0 and 96.6. A two-degree elevation of your normal temperature is a concern and should prompt a call to your doctor. You should also have a list of reasons to call your doctor before you leave the hospital.

The biggest problem with self-care after a hysterectomy includes a change in hormones and particularly estradiol, (estrogen). If you have had your ovaries removed and you find that you were dealing with hot flashes, anxiety, and depression, it is important to remember that hormone replacement could be indicated.

For hormone replacement, there’s been a lot of attention given to Premarin, which is manufactured from pregnant horse urine. I personally do not like this recommendation since pregnant mare’s urine is not something that ordinarily circulates in the blood of women. My favorite hormone replacement is the estradiol patch because the missing hormone after menopause, whether natural or surgical, is estradiol.