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From the Woman's
Diagnostic Cyber - Frederick R. Jelovsek MD
Hysterectomy
and Postoperative Problems
Recovering post-hysterectomy - Am I doing too much?
People keep warning me over and over not to overdo after my
hysterectomy. How would I be able to tell if I was doing too
much? Could I do any serious damage and if so what kind of
symptoms would I have?
Any sudden increase in intraabdominal pressure can tear
stitches and cause a hernia in the incision or surgical site. As
you do more activity you run the risk of perhaps accidentally
causing a sudden increase. For example if you carry even light
grocery bags and the bag ripped, you might suddenly try to keep
the contents from falling and abdominally strain. It could be
vacuuming and knocking a vase off a "trying to save it". We see
all sorts of weird situations come from seemingly ok activities.
I had one patient who, about 4 weeks after a bladder suspension,
just plain "forgot" and lifted up the edge of the couch to move
it for cleaning. She felt a "pop" and at her next exam about half
of our suspension was "undone".
With respect to just overdoing it, if you have been at
decreased activity for awhile, feel good, and do two straight
hours of physical activity, all of a sudden you may sit down and
be exhausted. It can make you feel lousy for two or three more
days. A much better plan is frequent small amounts of activity
interspersed by frequent small periods of rest. Then steadily but
slowly increase the amount of activity and decrease the period of
rest but not the frequency of rest until you are feeling very
good.
If I have done any damage like you mentioned would I be able
to tell before my 6 week checkup? Would I feel different?
Probably not unless it was so much that you disrupted your
incisions and they opened up with some drainage. The first 6
weeks it's hard to tell from your point of view other than if you
get overly fatigued.
Post LAVH back pain and tissue in vaginal incision
Six months ago I had a complete LAVH hysterectomy. I started
having increased pain after recovery and attributed it to being
over active...well this week I went to the doctor and she told me
that I have tissue left over from the surgery caught in my
incision. I had the cervix and the ovaries and womb out and she
saw this when examing me for lower abominal and back pain. She
prescribed CataflamŽ, and is sending me to a GYN around here
for a second opinion. I had the hysterectomy for endometriosis
and cervical cancer cells. Can you tell me what this may be? I
have been having a lot of pain... and low grade temp. Also, I
have excruciating pain right between the buttocks at the base of
my spine, so I can't sit long and I can't stand to long...never
comfortable! My bowels are all messed up one day cramping and
hardly any movement and the next easy to go, so confusing!!
Please help....could it be cancer? could it be intestines caught
in my incision? Did my surgeon do a sloppy job?
The tissue that you mention remaining in the incision depends
upon which incision it is in. If it is in the abdominal
incisions, it may represent a hernia of the bowels through the
abdominal fascia. As you say, the bowels caught in the incision.
If it is in the vaginal incision, it could be bowel or
fallopian tube.
You do need to see the doctor who did the surgery. If there
is any suspicion that bowel has herniated, you may need further
surgery. It is possible that you are having complications from
adhesions inside and that can even give a partial bowel
obstruction with the symptoms you describe.
Any of the above complications can happen with any surgery,
not necessarily related to doing it wrong.
The second problem is estrogen replacement. It sounds as if
you are not on enough. What doses of estrogens are you taking?The
second problem is estrogen replacement. It sounds as if you are
not on enough. What doses of estrogens are you taking?
The incision that I was referring to was the vaginal
incision.
You need to return visit to the original or another
gynecologic surgeon.
Post hysterectomy stomach exercises
I am now 9 weeks post TAH with a midline incision. Can I
start to do some tummy exercises and if so what would be best? I
find I have no stomach tone at all and it is now starting to give
me back pain with "everything hanging in front".
You can resume stomach (rectus) muscle exercises at 6 weeks if
you did not have any "support work" done (like bladder
suspension) and at about 12 weeks with "support work" done. Start
gradually with leg lifts and knees-bent sit-ups, unless you get a
lot of back pain. If you do, just start with isometrics of
stomach muscle tightening.
Gradually, take at least 4 weeks to get up to the level you
might have been able to do before surgery.
Pre and post hysterectomy intense, burning leg and abdominal pain
I just had an total hysterectomy because of endometriosis.
I 'm 15 days post-op and I started getting an intense burning in
my legs and abdomen. The burning is so intense, continous and
painful that I can not sleep and need pain pills! I have had
this over and over. I never did track it in relation to my cycle,
I should have. I am in shock now that it started up several days
ago. I thought that the hysterectomy would have stopped it! Dr.s
always thought that it was an STD. In ten years, it never was!!!!
So I just stopped complaining because of ignorant Dr.s who just
don't listen! I have noticed a slight white discharge and I'm
wondering if it's a yeast and how that could be after a
hysterectomy?
Burning pain like you describe is either neurological in
origin (nerves, spinal cord) or vascular (blood vessel
tightening) in origin. We don't see it related to endometriosis
unless there is very very extensive pelvic disease.
Post operatively it can be aggravated by epidural or spinal
anesthesia. It sounds like this may be what we used to call
reflex symphathetic dystropy. Now it is a "regional pain
syndrome". You probably need to see a neurologist for this
problem initially. Sometimes it turns out to be vascular in which
there are Lupus like diseases that cause the blood vessels to
constrict or possibly even atherosclerosis of the larger blood
vessels of the aorta and pelvis. The neurologist will sometimes
have you see a vascular surgeon to seen if that's a problem.
If you are having severe pain now, I would ask your doctor if
you could see a neurologist fairly quickly.
Ovary removal at age 44
I am scheduled to undergo a hysterectomy and a bladder neck
suspension surgery next week. My doctor advises me to have my
uterus, cervix, ovaries and tubes all removed. He states that
there is a 1 in 70 chance in women over 40 getting cancer in
their ovaries and tubes. I have heard from other women that they
have multiple problems after having all of their organs removed
and that it would be best to leave the ovaries and tubes if
nothing is wrong with them. I have a prolapsed uterus and have
small cysts on my cervix which my doctor said was nothing to
worry about and that he would be removing my cervix anyway. There
will be another doctor performing the bladder part of the surgery
who is a urologist. I have had six children and had a tubal
ligation after my 6th child. I am 44 years old and have always
been an easy going person. My thoughts tend to lie with if there
is nothing wrong with my ovaries and tubes, I should not have
them removed and not have to be on the hormone therapy. My doctor
says that he recommends all of his patients over 40 to have
everything removed. He states that the one advantage to having
this done is that I will never go through menopause, unless I do
not take my hormones. Would you advise further?
Many women do have difficulty with hormone replacement after
removal of ovaries. Doctors usually recommend ovary removal at
age 45. Below 40 it's definitely best to leave them in. After 45,
the reduction in ovarian cancer outweighs the increase in heart
problems if you can't take HRT for 4-5 extra years, and the
possible increase in breast cancer.
I see many women deciding based on their medical and family
history at your age. If there is any colon cancer, breast cancer,
or uterine cancer, they choose to have the ovaries removed on the
slight chance they have a familial tendency to cancer. If heart
disease is more of a problem, then leaving the ovaries in until
natural menopause would decrease the number of years that you
might not be able to take HRT.
If the ovarian cysts give pain, then that is another reason to
add favoring removal.
I would say it's a neutral decision at your age and you should
do whatever you feel is best.
Recovery time from operative laparoscopy
I am having a laparoscopy done to repair one tube and remove
pelvic adhesions. The doctor estimates approximately 3 hrs of
surgery time. I was wondering what the recovery time is .
Recovery is usually a week after an operative laparoscopy like
this one.
Do they normally give pain meds for laps or should this be a
fairly non-invasive, non-painful procedure.
Pain meds are often needed the 1st 2-3 days but it's not as
bad as a full abdominal incision.
Cervix remaining after TAH
I am entering my 5th week after a total abdominal
hysterectomy (removal of the uterus and cervix).
In the 3rd week, I returned to the doctor's office
for an emergency appointment due to severe sharp
pains in my lower left side which extended to the
pelvic area. I am also experiencing a lot of
pressure at the end of urination, as well as a
loss of appetite, insomnia, night sweats and
extremely cold feet and hands during the day. The
doctor ordered a urinalysis to determine if I had
a urinary tract infection (the test was negative).
During the visit the doctor conducted a vaginal
examination, at which time she stated that it
"looked like my cervix was still there and she was
sure that it was removed." She then read the
pathology report and stated that the cervix was
removed, however, she still saw it during the
exam. She mentioned that "maybe they didn't get
it all." She also stated that the pain I was
having was "nerve degeneration" and was normal
after the surgery and suggested that I take
Motrin. She wanted to prescribe sleeping pills
for the insomnia but I refused, at which time she
told me take Benadryl.
Although I am concerned about the pain I am having
as well as the other symptoms described above, I
am more concerned about the comment regarding my
cervix. Am I at any risk if indeed parts of the
cervix was not removed and if so, what risks?
Also, is it unusual for only parts of the cervix
to be removed during a hysterectomy? In addition,
what could be causing the other symptoms I am
experiencing? I have my 6 week follow-up
appointment next week and would like suggestions
on what questions I should ask the doctor
regarding my symptoms and concerns.
The most common types of abdominal hysterectomy
are total (body of the uterus and cervix) and
subtotal (just the body of the uterus). Doctors
who recommend leaving the cervix feel that orgasm
during sexual response is better preserved as well
as future support of the end of the vagina. The
downside is that the junction of skin between the
glandular lining of the cervix and the flat skin
lining of the vagina is not removed and this is
where dysplasia and cancer can occur. Also the
glandular tissue remaining in the endocervix can
occasionally bleed or become infected (cervicitis).
Doctors who remove the entire cervix feel that the
need for future Pap smears and potential for
cancer of the cervix is almost totally prevented
in the future and that good support of the end of
the vagina can be accomplished surgically with the
correct technique. Orgasm may be slightly changed
but is not noted to be less pleasurable by most
women undergoing the procedure.
Sometimes, when doing a total hysterectomy (this
has nothing to do with the ovaries), in an effort
to make sure the vagina is not shortened and to
prevent injury to the bladder, a small amount of
the tip of the cervix is left. This would be like
removing the entire nose and nostrils but leaving
a small amount of the firm but moveable tip of the
nose. When looking straight on, it looks like the
entire cervix may still be present but in fact
only a slight external surface is still present.
It happens to all surgeons unintentionally
sometimes and some surgeons actually try to leave
this tissue intentionally. Almost always the
squamocolumnar junction is removed which gets rid
of the need for future Paps (or decreases the
frequency). It also means the vagina has not been
shortened at all which can happen sometimes.
When this happens to me either intentionally or
unintentionally, I look with a colposcope at about
3 months after the surgery to make sure there is
no endocervical tissue present. You might ask your
doctor about doing that.
As far as your other symptoms of night sweats and
insomnia, you did not mention if the ovaries were
removed or not and how old you are. These could be
symptoms of low estrogens. The pain you are having
needs to be evaluated by your surgeon. It sounds as
if your post operative exam was not by the same
person who did the surgery.
Nausea and gas pains persisting 6 wks after TAH
I was reading about the woman who had total
abdominal hysterectomy surgery who had some of the
same symptoms that I had. I also had a TAH
Surgery where my uterus, cervix, appendix,
ovaries, tubes, and a very large fibroid were
removed. My question is that since coming home
from the hospital 6 weeks ago, I have lost 17 lbs.
and I only weigh 103 lbs. My normal weight is 120
lbs, I am 5'4 and have a medium build. It seems
that I have a poor appetite and get full after a
few bites of food.If I try to eat all my portions
and get very full, I sometimes vomit up all the
food I just ate. I also experience some nausea
every day along with a lot of burping. I want to
gain back my weight but it seems like I can't eat
enough to gain it back. Frequent small meals have
not helped with weight gain. Is this normal after
surgery? My tests are normal and the post op
exams are normal. My doctor doesn't know what is
wrong and keeps telling me to continue to eat
small meals. Any comments?
Most of the time, nausea after gynecological
surgery subsides in the first week, or possibly
two. Occasionally it persists for a long time and
then we need to know if something is wrong or is
it just the body's response to the insult of
surgery and all of the perioperative bowel preps,
anesthesia, antibiotics, and other medications.
Nausea and loss of appetite can persist after two
weeks and when this happens, we honestly just do
not know why it takes so long for the bowel
function to return to normal. I suspect that
antibiotics during and possibly after surgery are
the main culprits that disturb the normal bacteria
of the gastrointestinal tract. Taking capsules
with live Acidophilus cultures may help this.
Sometimes you have just been eating different
foods than you normally did and the stomach is
sensitive to these.
You may have discontinued smoking or caffeine or a
medication you were on which increased bowel
motility and now the bowel is quite lazy and
produces an intermittent illeus (lack of bowel
muscle movement). Just being at home all day if
you were used to going out of the house for work
or leisure can lead to swallowing more saliva and
air which causes increased gas and nausea. Be sure
to try to restart all of your presurgical eating
and activity habits now that you are six weeks
out.
There are, however, conditions or complications of
surgery that your doctor should look for. A
chronic infection at the appendiceal stump can
cause these problems as can adhesions affecting
the bowel. A CAT scan may be needed to detect an
abscess; adhesions can only be suspected but not
confirmed short of repeat surgery. Injury at the
time of surgery to the bladder or ureter can also
cause this prolonged bowel problem. A kidney xray
(IVP) may be needed to see injury although a CAT
scan may also pick this up.
In summary I would say to use the Acidophilus
capsules, closely examine any food or medication
changes that have taken place and try to resume
your normal activities. If there is no explanation
there or if the nausea and loss of appetite
persists or seems to worsen, ask your doctor about
the possibility of further studies to look at the
gastrointestinal tract and kidneys.
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