Hysterectomy
Original Editor - Erika Rodrigues
Top Contributors - Erika Rodrigues, Khloud Shreif, Vidya Acharya and Alexandra Stead
Introduction
The uterus is a pear-shaped, hollow central landmark organ of the pelvic anatomy and internal genitalia, located anatomically in anteversion anteflexion position anterior to the rectum and posterior and superior to the bladder. It is divided into fundus, body, and cervix. The uterus, vagina, ovaries, and fallopian tubes are part of the internal reproductive system
Hysterectomy is the surgical removal of the uterus,[1] which can be performed through the abdominal route, vaginal route, laparoscopically, or a combined method.[2] It is one of the most common gynaecological surgeries worldwide, conducted mainly to treat fibroids, prolapse, or malignancy. Whilst this surgery has many benefits, there are some associated risks and side effects that can occur following, including some women who may suffer from pain, prolapse (eg, vaginal fault prolapse), dyspareunia[3], or urinary incontinence post surgery.[4]
Indication
- Uterine Leiomyomas[5]
- Uterine Bleeding[5]
- Endometriosis[5]
- Adenomyosis[5]
- Endometrial hyperplasia[5]
- Uterine Cancer[5]
- Pelvic Inflammatory Disease[5]
- Massive Postpartum Hemorrhage [5]
Types of Hysterectomies
- Supracervical Hysterectomy - Removal of the fundus and body of the uterus but excludes the cervix [6]
- Total Abdominal Hysterectomy - Removal of the uterine body and the cervix[6]
- Hysterectomies are associated with the removal of the ovaries and fallopian tubes ( Bilateral salphingo-oophorectomy)[6]
- Radical Hysterectomy- removal of uterus, cervix, and the upper part of the vagina.
Surgical Approaches for hysterectomy
- Abdominal Hysterectomy[7] - This route allows inspection of other pelvic organs and surrounding tissue. This route is used for carcinoma or to remove a large fibroid uterus. The uterus is accessed through a Pfannenstiel( Bikini-line) incision.
- Vaginal Hysterectomy[7]- An incision is made in the anterior vaginal wall to access the uterus and cervix. This approach is usually used for non-malignant conditions of the uterus, particularly in cases of uterine prolapse.
- Laparoscopic Hysterectomy[7] - The laparoscope is inserted through a small incision in the abdomen to help surgeons view internal organs during the procedure. This helps to guide them to remove the uterus through small cuts in the abdomen or vagina.
- Robotic-assisted Hysterectomy[7]- they use robotic arms to do the surgery through incisions in the abdomen[8].
Complications
- Vaginal Cuff Cellulitis[9]
- Infected Pelvic Hematoma or Abscess[9]
- Wound Infection[9]
- Urinary Tract Infection[9]
- Venous thromboembolism[9]
Physiotherapy Management
Short Term Goals:
- Patient education
- Pain reduction
- Improve the strength of abdominal muscles
- Improve respiratory efficiency
- Bed Mobility
Long Term Goals:
- Maintain the strength of abdominal muscles
- Maintain the strength of pelvic floor muscles
- Make patient functionally independent
Pre-Operative Physiotherapy:
- Patient Education- Education regarding the route of surgery, prognosis, post-surgical complications, the importance of physiotherapy
- To prevent respiratory complications- Active Cycle Breathing Technique (ACBT), Supported coughing
- To increase the strength of pelvic floor muscles - Pelvic floor exercises
- To increase strength in the abdominals
- Mobility - Early ambulation, Bed mobility
Post Operative Physiotherapy
Early movement and mobilisation, including circulatory, breathing exercises, upper and lower limb movements, walking, core strengthening, and pelvic floor muscle training, helps to speed the recovery period, decrease pain, and avoid complications that may happen with immobility.[10]
Certain types of exercise can be initiated from day 1 post surgery. This includes breathing exercises (pursed lip breathing and huffing in some cases), to help with phlegm management.
Core strengthening exercises can commence from week 2 post-surgery, including progressive abdominal and pelvic floor exercises ( pelvic tilting, and Kegel exercise) and back extensors exercises[11] [12].
The patient should be advised to avoid heavy lifting and straining or bearing down for about 6 weeks.
Resources
NHS: Physiotherapy advice following hysterotomy
References
- ↑ Papadopoulos MS, Tolikas AC, Miliaras DE. Hysterectomy—Current Methods and Alternatives for Benign Indications. Obstetrics and Gynecology International. 2010 Jan 1;2010(1):356740.
- ↑ Anbreen F, Qadir S, Naeem H, Farhat N, Ghafoor M, Hassan S. Type, time-trend and indications of hysterectomy. Gomal Journal of Medical Sciences. 2018 Dec 31;16(4):92-6.
- ↑ Forsgren C, Johannesson U. Sexual function and pelvic floor function five years after hysterectomy. Acta Obstetricia et Gynecologica Scandinavica. 2025 May;104(5):948-57.
- ↑ Chang OH, Saldanha IJ, Encalada-Soto D, Jalloul RJ, Rozycki S, Orlando M, White A, Yang LC, Thompson JC, Nihira M, Bretschneider CE. Associations between hysterectomy and pelvic floor disorders: a systematic review and meta-analysis. American journal of obstetrics and gynecology. 2025 Mar 20.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Carlson KJ, Nichols DH, Schiff I. Indications for hysterectomy. New England Journal of Medicine. 1993 Mar 25;328(12):856-60.
- ↑ 6.0 6.1 6.2 Kives S, Lefebvre G, Wolfman W, Leyland N, Allaire C, Awadalla A, Best C, Leroux N, Potestio F, Rittenberg D, Soucy R. Supracervical hysterectomy. Journal of Obstetrics and Gynaecology Canada. 2010 Jan 1;32(1):62-8.
- ↑ 7.0 7.1 7.2 7.3 Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane database of systematic reviews. 2015(8).
- ↑ Carbonnel M, Moawad GN, Tarazi MM, Revaux A, Kennel T, Favre-Inhofer A, Ayoubi JM. Robotic hysterectomy for benign indications: what have we learned from a decade?. JSLS: Journal of the Society of Laparoscopic & Robotic Surgeons. 2021 Jan;25(1):e2020-00091.
- ↑ 9.0 9.1 9.2 9.3 9.4 Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstetrics & Gynecology. 2013 Mar 1;121(3):654-73.
- ↑ Ingale G, Patil S, Thorat R. Physiotherapy Intervention in Post-Hysterectomy Patient with Urinary Incontinence: A Case Report. Journal of Pharmaceutical Research International. 2021 Dec 23;33(60B):1652-8.
- ↑ Aghamkar J, Perita CJ, Yangad S, Jamadar K, Sabde S, Dhir S, Arokiaswamy ST. A Study to Evaluate the Effect of Back Muscle Strengthening Exercises on Pain Among Post-Hysterectomy Women Admitted in Tertiary Care Hospitals. Journal of Pharmacy and Bioallied Sciences. 2025 Sep 1;17(Suppl 3):S2551-3.
- ↑ Waghe VR, Athawale V. Physiotherapeutic Approach in Enhancing Recovery and Quality of Life After Vaginal Hysterectomy: A Case Report. Cureus. 2024 Mar 12;16(3).