Vaginal Hysterectomy for a Fallen Uterus

What is a vaginal hysterectomy?

A vaginal hysterectomy is surgery to remove the uterus through the vagina. It is a way to take the uterus out through the vagina rather than through a cut in your belly.

The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus.

When is it used?

Sometimes the uterus loses support and falls down through the vagina. The uterus may fall far enough to cause a lot of discomfort and may cause other problems. This problem is called uterine prolapse, or fallen uterus. If your vaginal walls are also dropping or sagging, your healthcare provider may repair them during the surgery. If the bladder is also dropped, then your provider may also repair your dropped bladder during the surgery.

Examples of alternatives are:

• using a pessary, which is a plastic or rubber device put in the vagina to push the uterus up into a better position
• having a surgical procedure called uterine suspension, which involves shortening and tying the ligaments that support the uterus to other ligaments and muscles in the pelvis (This procedure may be done if you plan to have more children.)
• having your uterus removed through a cut in your belly (abdominal hysterectomy)
• having your uterus removed with the help of a lighted tube with a camera put through a small cut in your belly (laparoscopic hysterectomy)
• choosing not to have treatment

You should ask your healthcare provider about these choices.

How do I prepare for this procedure?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Find someone to drive you home after the surgery. Allow for time to rest. Try to find other people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your healthcare provider if you need to stop taking it before your surgery. Be sure to tell your provider what medicines you are taking, including nonprescription drugs and herbal remedies.

Follow any other instructions your healthcare provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a regional or general anesthetic. A regional anesthetic numbs the lower part of your body while you stay awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles and causes a deep sleep. It will keep you from feeling pain during the procedure.

You will have an IV in your arm to give you fluids and medicines.

Your healthcare provider will cut through the vaginal wall to reach the ligaments and blood vessels that surround and support the uterus. Your provider will separate ligaments and blood vessels from the uterus and tie the blood vessels so they will heal and not bleed. Your provider will then cut the uterus off at the top of the vagina and remove it through the vagina.

Your healthcare provider will attach the uterine ligaments to the vagina to hold the vagina in place. If ligaments and other tissue around the vagina have stretched from aging or childbearing, your provider may repair the walls of the vagina by sewing the ligaments together. The vagina is then attached to the repaired ligaments and the top of the vagina is sewn closed.

What happens after the procedure?

You may stay in the hospital for 2 to 5 days. If the walls of your vagina were repaired, you may stay in the hospital longer while the bladder heals and starts working again. You may go home with a catheter in your bladder, which is a tube used to drain urine from the bladder until the bladder is working normally again. Your healthcare provider will check how your bladder is working at a follow-up visit.

After you go home, get plenty of rest. Do not do any heavy lifting or strain the stomach muscles in any other way for 4 to 6 weeks. Follow your healthcare provider's instructions for activity, pain relief, and preventing constipation. Ask your provider what other steps you should take and when you should come back for a checkup.

If you were having menstrual periods before the surgery, you will no longer have them after the operation. Without your uterus you will not be able to get pregnant. If you have concerns about this, discuss them with your healthcare provider before the surgery.

What are the benefits of this procedure?

• You will no longer have the discomfort of a fallen uterus.
• You will no longer have menstrual periods.
• You will not have to use birth control to prevent pregnancy.
• You will probably have less pain after this operation than if your uterus was removed through a cut in your belly.
• Recovery is usually faster when the uterus is removed through the vagina instead of through a cut in the belly.
• The vaginal procedure does not leave a visible scar.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. However, regional anesthesia is considered safer than general anesthesia.
• If your blood vessels leak or are injured, your healthcare provider may open your stitches to stop the bleeding.
• Your bladder or rectum might be injured and need repair.
• The tubes leading from your kidneys to your bladder (ureters) could be injured and need surgical repair.
• You may have an infection or bleeding.
• You may have nausea and vomiting.
• You may get a hernia, which is a weakness in the tissue in the top of the vagina that could bulge into the vagina long after the surgery.
• You may have a blood clot in your legs, pelvis, or lungs.

Your healthcare provider may give you medicine to help with these problems. Ask your provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever over 101.5°F (38.6°C).
• You cannot urinate or you have pain or burning when you urinate.
• You have pain in your belly or your belly gets swollen.
• You get dizzy or faint.
• You have nausea and vomiting.
• You get short of breath or have chest pain.
• You have a rash.
• You have a lot of bleeding from the vagina.
• You have swelling, redness, or pain in your leg.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.