Who is this information for?

This information is for you if you are about to have, or you are recovering from, a laparoscopic hysterectomy

• an operation to remove your uterus (womb) by keyhole surgery. You might also find it useful to share this information with your family and friends.

There are several different types of hysterectomy including:

• hysterectomy alone or with salpingo-oophorectomy (removal of one or both or your ovaries and fallopian tubes) at the same time.

Some laparoscopic hysterectomies are done entirely by keyhole surgery. Others are done partially through your vagina (sometimes called a laparoscopy-assisted vaginal hysterectomy or LAVH).
The type of hysterectomy you have will depend on your personal circumstances and will be discussed with you before your operation.

About this information

You should read this information along with any other information you have been given about your choices and the operation itself. This information gives general advice based on women’s experiences and expert opinion. Every woman has different needs and recovers in different ways. Your own recovery will depend upon:

• how fit and well you are before your operation
• the reason you are having a hysterectomy
• the exact type of hysterectomy that you have
• how smoothly everything goes and whether there are any complications.

What can I expect after a laparoscopic hysterectomy?

Usual length of stay in hospital

In most instances you will be admitted to hospital on the day of your operation. You may be able to go home within 24 hours or, depending on your circumstances, you may need to stay in hospital for 1 to 3 days.

After-effects of general anaesthesia

Most modern anaesthetics are short-lasting. You should not have, or suffer from, any after-effects for more than a day after your operation. During the first 24 hours you may feel more sleepy than usual and your judgement may be impaired. You are likely to be in hospital during the first 24 hours but, if not, you should have an adult with you during this time and should not drive or make any important decisions.

Cuts

You will have between two and four small cuts on different parts of your abdomen. Each scar will be between 0.5 cm and 1 cm long. If you have had your cervix removed, you will also have a scar at the top of your vagina which will be out of sight.

Dressings and Stitches

Your cuts will be held together with glue, which will eventually dissolve. Any stitches in your vagina will not need to be removed as they are dissolvable. You may notice a stitch or part of a stitch coming away after a few days or maybe after a few weeks. This is normal and nothing to worry about. It usually occurs with the stitches on the surface of your skin.

Catheter

You may have a catheter (tube) in your bladder to allow drainage of your urine. This may be for up to 24 hours after your operation until you are easily able to walk to the toilet to empty your bladder. If you have problems passing urine, you may need to have a catheter for a few days.

Packs

You may have a pack (a length of gauze like a large tampon) in your vagina after the operation to reduce the risk of bleeding. This is normally removed by a nurse after your operation while you are still in hospital.

Vaginal bleeding

You can expect to have some vaginal bleeding for 3 to 4 weeks after your operation. This is like a light period and is red or brown in colour. Some women have little or no bleeding initially and have a sudden gush of old blood or fluid about 10 days later. This usually stops quickly. You should use sanitary towels rather than tampons, as using tampons could increase the risk of infection.

Pain and discomfort

You can expect pain and discomfort in your lower abdomen for at least the first few days after your operation. You may also have some pain in your shoulder. This is a common side-effect of laparoscopic surgery. When leaving hospital, you should be provided with painkillers for the pain you are experiencing. If you are prescribed painkillers which contain codeine or dihydrocodeine, these can make you sleepy, slightly sick and constipated. If you do need to take these medications, try to eat extra fruit and fibre to reduce the chances of becoming constipated.

Taking painkillers as prescribed to reduce your pain will enable you to get out of bed sooner, stand up straight and move around – all of which will speed up your recovery and help to prevent the formation of blood clots in your legs or your lung

Trapped wind

Following your operation your bowel may temporarily slow down causing air or ‘wind’ to be trapped. This can cause some pain or discomfort until it is passed. Getting out of bed and walking around will help. Peppermint water may also ease your discomfort. Once your bowels start to move, the trapped wind will ease.

Starting to eat and drink

After your operation you may have a drip in your arm to provide you with fluids. When you are able to drink again the drip will be removed. You will be offered a drink of water or cup of tea and something light to eat. This may be the evening after your surgery. If you are not hungry initially, you should drink fluid. Try eating something later on.

Washing and showering

You should be able to have a shower the day after your operation. Don’t worry about getting your scars wet – just ensure that you pat them dry with clean disposable tissues or let them dry in the air. Keeping scars clean and dry helps healing.

Formation of blood clots & how to reduce the risk

There is a small risk of blood clots forming in the veins in your legs and pelvis (deep vein thrombosis) after any operation. Thee clots can travel to the lungs (pulmonary embolism) which could be serious. You can reduce the risk of clots by:

• being as mobile as you can as early as you can after your operation
• doing exercises when you are resting, for example:
• pump each foot up and down briskly for 30 seconds by moving your ankle
• move each foot in a circular motion for 30 seconds
• bend and straighten your legs – one at a time

You may also be given other measures to reduce the risk of a clot developing, particularly if you are overweight or have other health issues. These may include:

• a daily injection of a blood thinning agent; your doctor will advise you on the length of time you should take this for
• graduated compression stockings; the stockings should be worn day and night until your movement has improved and your mobility is no longer significantly reduced
• Special boots that inflate and deflate.

Physiotherapy

The ward physiotherapist willl visit you after your operation to show you some exercises and have a discussion with you about how to progress with getting out of bed and mobilising. The physiotherapist will also advise you on how to do pelvic-floor muscle exercises.

Starting HRT (hormone replacement therapy)
If your ovaries have been removed during your operation you may be offered HRT. This will be discussed with you by your gynaecologist and together you can decide the best way forward.

Cervical screening (smears)
Some women who have had a laparoscopic hysterectomy will need to continue to have screening (smears). Check with your Consultant if this applies to you.

Tiredness and feeling emotional
You may feel much more tired than usual after your operation as your body is using a lot of energy to heal itself. You may need to take a nap for the first few days. A hysterectomy can also be emotionally stressful and many women feel tearful and emotional at first – when you are tired these feelings can seem worse. For many women this is often the last symptom to improve

What can help me recover?
It takes time for your body to heal and for you to get fit and well again after a laparoscopic hysterectomy. There are a number of positive steps you can take at this time. The following will help you recover:

Rest
Rest as much as you need to for the first few days after you get home. It is good to relax, but avoid crossing your legs for too long when you are lying down. Rest doesn’t mean doing nothing at all throughout the day, as it is important to start exercising and doing light activities around the house within the first few days.

A daily routine
Establish a daily routine and keep it up. For example, try to get up at your usual time, have a wash and get dressed, move about and so on. Sleeping in and staying in bed can make you feel depressed. Try to complete your routine and rest later if you need to.

Eat a healthy balanced diet
Ensure your body has all the nutrients it needs by eating a healthy balanced diet. A healthy diet is a high fibre diet (fruit, vegetables, wholegrain bread and cereal) with up to 2 litres a day of fluid intake, mainly water. Remember to eat at least five portions of fruit and vegetables each day. You will only gain weight if you eat more than you need to

Keep your bowels working
Your bowels may take time to return to normal after your operation. Your motions should be soft and easy to pass. You may initially need to take laxatives to avoid straining and constipation. You may find it more comfortable to hold your abdomen (provide support) the first one or two times your bowels move.
If you do have problems opening your bowels, it may help to place a small footstool under your feet when you are sitting on the toilet so your knees are higher than your hips. If possible, lean forwards and rest your arms on top of your legs to avoid straining.

Stop smoking
Stopping smoking will benefit your health in all sorts of ways such as lessening the risk of a wound infection or chest problems after your anaesthetic. By not smoking – even if it is just while you are recovering – you will bring immediate benefits to your health. If you are unable to stop smoking before your operation, you may need to bring nicotine replacements for use during your hospital stay. You will not be able to smoke in hospital. If you would like information about a smoking cessation clinic in your area speak with the nurse in your GP surgery.

Support from your family and friends
You may be offered support from your family and friends in lots of different ways. It could be practical support with things like shopping, housework or preparing meals. Most people are only too happy to help – even if it means you having to ask them! Having company when you are recovering gives you a chance to say how you are feeling after your operation and can help to lift your mood. If you live alone, it will help to plan in advance for such things as having your shopping delivered.

A positive outlook
Your attitude towards how you are recovering is an important factor in determining how your body heals and how you feel in yourself. You may want to use your recovery time as a chance to make some longer term positive lifestyle choices such as:
• starting to exercise regularly if you are not doing so already and gradually building up the levels of exercise that you take
• eating a healthy diet: if you are overweight it is best to eat healthily without trying to lose weight for the first couple of weeks after the operation. After that you may want to lose weight by combining a healthy diet with exercise.
Whatever your situation and however you are feeling, try to continue to do the things that are helpful to your long-term recovery.

What can slow down my recovery?

It can take longer to recover from a hysterectomy if you had health problems before your operation; for example, women with diabetes may heal more slowly and may be more prone to infection

• you smoke; some women who smoke are at increased risk of getting a chest or wound infection during their recovery: smoking can delay the healing process
• you were overweight at the time of your operation; if you are overweight it can take longer to recover from the effects of anaesthesia and there can be a higher risk of complications such as infection and thrombosis
• There were any complications during your Recovering after an operation is a very personal experience. If you are following all the advice you have been given but do not think you are at the stage you ought to be, talk with your GP.

When should I seek medical advice after a laparoscopic hysterectomy?

While most women recover well after a laparoscopic hysterectomy, complications can occur – as with any operation. You should seek medical advice from your Consultant, the hospital where you had your operation:

• Burning and stinging when you pass urine or pass urine frequently: this may be due to a urine infection. Treatment is with a course of antibiotics.
• Heavy or smelly vaginal bleeding or bleeding which starts again: if you are also feeling unwell and have a temperature (fever), this may be because of an infection or a small collection of blood at the top of the vagina, called a vault haematoma. Treatment is usually with a course of antibiotics. Occasionally you may need to be admitted to hospital for the antibiotics to be administered intravenously (into a vein). Rarely, this may need to be drained.
• Red and painful skin around your scars: this may be caused by a wound infection. Treatment is with a course of antibiotics.
• Increasing abdominal pain: if you also have a temperature (fever), have lost your appetite and are vomiting, this may be because of damage to your bowel or bladder, in which case you will need to be admitted to hospital.
• A painful, red, swollen, hot leg or difficulty bearing weight on your legs: this may be caused by a deep vein thrombosis (DVT). If you have shortness of breath, chest pain or cough up blood, it could be a sign that a blood clot has travelled to the lungs (pulmonary embolus). If you have these symptoms, you should seek medical help immediately.

Getting back to normal

Around the house

While it is important to take enough rest, you should start some of your normal daily activities when you get home and build up slowly. You will find you are able to do more as the days and weeks pass.

It is helpful to break jobs up into smaller parts, such as ironing a couple of items of clothing at a time and taking rests regularly. You can also try sitting down while preparing food or sorting laundry. For the first 1 to 2 weeks you should restrict lifting to light loads such as a 1 litre bottle of water, kettles or small saucepans.

You should not lift heavy objects, such as full shopping bags or children, or do any strenuous housework like vacuuming, until 3 to 4 weeks after your operation, as this may affect how you heal internally. Try getting down to your children rather than lifting them up to you. If you feel pain you should try doing a little less for another few days.

Remember to lift correctly by having your feet slightly apart, bending your knees, keeping your back straight and bracing (tightening or strengthening) your pelvic floor and stomach muscles as you lift. Hold the object close to you and lift by straightening your knees.

Exercise

While everyone will recover at a different rate, there is no reason why you should not start walking on the day you return home. You should be able to increase your activity levels quite rapidly over the first few weeks. There is no evidence that normal physical activity levels are in any way harmful and a regular and gradual build-up of activity will assist your recovery. If you are unsure, start with short steady walks close to your home a couple of times a day for the first few days. When this is comfortable you can gradually increase the time while walking at a relaxed steady pace. Many women should be able to walk for 30 to 60 minutes after 2 or 3 weeks

Swimming is an ideal exercise that can usually be resumed within 2 to 3 weeks as long as vaginal bleeding and discharge has stopped. If you build up gradually the majority of women should be back to previous activity levels within 4 to 6 weeks.
Contact sports and power sports should be avoided for at least 6 weeks, although this will depend on your level of fitness before your surgery.

Driving

You should not drive for 24 hours after a general anaesthetic. Each insurance company will have its own conditions for when you are insured to start driving again. Check your policy.
Before you drive you should be:

• free from the sedative effects of any painkillers
• able to sit in the car comfortably and work the controls
• able to wear the seatbelt comfortably
• able to make an emergency stop
• able to comfortably look over your shoulder to manoeuvre.

In general, it can take 2 to 4 weeks before you are able to do all of the above. It is a good idea to practise without the keys in the ignition. See if you can do the movements you would need for an emergency stop and a three-point turn without causing yourself any discomfort or pain. When you are ready to start driving again, build up gradually, starting with a short journey

Travel plans

If you are considering travelling during your recovery, it is helpful to think about:

• The length of your journey: journeys over 4 hours where you are not able to move around (in a car, coach, train or plane) can increase your risk of deep vein thrombosis (DVT). This is especially so if you are travelling soon after your operation.
• How comfortable you will be during your journey, particularly if you are wearing a seatbelt.
• Overseas travel:
• Would you have access to appropriate medical advice at your destination if you were to have a problem after your operation?
• Does your travel insurance policy cover any necessary medical treatment in the event of a problem after your operation?
• Are your plans in line with the levels of activity recommended in this information?
  If you have concerns about your travel plans, it is important to discuss these with your Counsultant or the hospital where you have your operation before travelling.

Having sex

You should usually allow 4 to 6 weeks after your operation to allow your scars to heal. It is then safe to have sex – as long as you feel comfortable. If you experience any discomfort or dryness (which is more common if your ovaries have been removed at the time of the hysterectomy) you may wish to try a vaginal lubricant. You can buy this from your local pharmacy.

Returning to work

Everyone recovers at a different rate, so when you are ready to return to work will depend on the type of work you do, the number of hours you work and how you get to and from work

You may experience more tiredness than normal after any operation, so your return to work should be like your return to physical activity, with a gradual increase in the hours and activities at work. If you have an occupational health department they will advise on this.

Some women are fit to work after 2 to 3 weeks and will not be harmed by this if there are no complications from surgery.
Many women are able to go back to normal work after 4 to 6 weeks if they have been building up their levels of physical activity at home.

Returning to work can help your recovery by getting you back into your normal routine again. Some women who are off work for longer periods start to feel isolated and depressed. You do not have to be symptom free before you go back to work. It is normal to have some discomfort as you are adjusting to working life.

It might be possible for you to return to work by doing shorter hours or lighter duties and building up gradually over a period of time. Consider starting partway through your normal working week so you have a planned break quite soon.
You might also wish to see your GP or your occupational health department before you go back and do certain jobs – discuss this with them before your operation. You should not feel pressurised by family, friends or your employer to return to work before you feel ready. You do not need your GP’s permission to go back to work. The decision is yours.