Hysterectomy Complications

From the Woman's Diagnostic Cyber - Frederick R. Jelovsek MD
Hysterectomy
and Postoperative Problems

• Recovering post-hysterectomy - Am I doing too much?
• Post LAVH back pain and tissue in vaginal incision
• Post hysterectomy stomach exercises
• Pre and post hysterectomy intense, burning leg and abdominal pain
• Ovary removal at age 44
• Recovery time from operative laparoscopy
• Cervix remaining after TAH
• Nausea and gas pains persisting 6 wks after TAH

 

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 Cataflam®, 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.