The Dame’s Guide to Uterus Removal: So You’re Having a Hysterectomy

When you first decide to have a hysterectomy, one of the most astonishing things you discover is just how common it is. In the great tradition of soldiering on, most women schedule life-altering surgery in between the school lunches and the afternoon laundry.

When I wrote my original blog post about needing to have the operation, I was stunned by how many women – both in real life and online – responded with a story about their hysterectomy. For whatever reason, this major surgery is extremely common. Almost 30,000 women a year have one and I can guarantee that several women around you right now have quietly had one too. They just didn’t speak of it because, well, we don’t.

Hysterectomies can be many things – liberating, terrifying, painful, stressful and a relief from years of pain. But they can also be lonely and confusing, no matter how prepared and supported you are.

This blog post contains some advice I’ve gleaned from my own operation. Unfortunately, every hysterectomy is different so there are no rules. But there are stories you can learn from. This is mine.

I had a Total Abdominal Hysterectomy. Vaginal hysterectomies will be different, as will more extensive hysterectomies involving the removal of ovaries and/or surgery to repair internal damage or cancer.

So you’re thinking about having a hysterectomy?

The first thing you need to know is that this operation is not as easy as your surgeon will make out. He or she probably does several hysterectomies a week. You will have one in your entire life. So when your surgeon tells you that you’ll be out of bed the next day, driving in 10 days, back at work after 4 weeks, they are trying to be comforting but simultaneously failing to understand what it’s like being a patient.

So let’s have a look at the real timelines involved.

1. “Out of bed the next day”
   is code for “walk around your room once and then sleep for three hours”. Recovering from a hysterectomy involves a delicate balance of rest and mobility; sleep and movement. You should get out of bed every day for every meal, a shower and a short, gentle walk around your living room. But other than that, you will be resting.
   Rest. Rest. Rest.
   You should prepare a stack of books, DVDs, Netflix and a computer in arm’s reach. Mostly you should be prepared to sleep.
2. Two nights in hospital
   Shoot for four. You won’t regret any time with nursing staff taking care of you. I was offered a fourth night and didn’t take it and my first day at home was HELL.
3. Driving.
   I’ll deal more with driving below but “10 days” is the time it takes before you can legally drive after an anaesthetic. Should you actually drive 10 days after abdominal surgery? Hell no.
4. “Recovery time of 4-6 weeks”.
   The complete recovery time for a hysterectomy is a year. That’s right, an entire year. Six weeks is a good guide for when you can start to get back to your normal routine. Until then you’ll be tired, sore and struggling with normal activities. If you can’t put your life on hold for six weeks then you need to seriously reconsider the operation. The initial recovery time is really 6-8 weeks and 3 months is better estimate for getting things back to “normal”.
5. Back to work
   You should not be thinking of work until 6 weeks. Ask your surgeon for a medical certificate for that period upfront. That way, you won’t be stressing about your four-week recovery progress. It would be better for you to have a complete post-op checkup at 6 weeks before returning to work.
6. Pain
   When I woke up from my surgery, I was in AGONY. This was a surprise to me. Pain killers can cause constipation and that is not advisable for abdominal surgery so I was quite under-medicated. In fact, the overall level of pain for this surgery was unexpected and it lasted far longer than I thought it would.

Rule 1 – No lifting.

Did I say there are no rules? That’s not entirely true. The 2kg rule is the one true rule. No stretching, no bending, no straining and NO LIFTING for a full month. Then only go to 5kg. I personally didn’t lift anything over that for three months. Vaginal prolapse is not fun.

Rule 2 – Rest, rest, rest.

You will need rest. Lots of it for several weeks. With that kind of rest, you need support. Lots of it for several weeks. Lay down the law with your carer before your operation. They will need to handle everything – meals, cleaning, kids, bills and taking care of you. If you have any doubts about your carer before the operation, then don’t go through with it.

Rule 3 – Walk, walk, walk. But also listen to your body

Recovering from abdominal surgery takes exercise. But “exercise” is not a session at a gym or a jog in the park. “Exercise” is mild, gentle walking. Start with short walks around your living room and then slowly make them longer. To give you some idea, I walked 200 metres between week 2 and week 3 and was exhausted afterward.

Walking helps to strengthen and to stretch the abdominal muscles that hold your organs in place. But walking is also tiring and, more than anything, you should listen to your body. If you feel like staying in bed, do it. If you feel up to walking then do that too but make sure you don’t walk so far that you can’t get back.
I had my carer drive me to a coffee shop for a beverage and then wait while I walked home (about 300m). At 200 metres, when I realised I wasn’t going any further, I rang them to pick me up.

Listen to your body. For the first 4 weeks you should be resting or walking. Try to avoid sitting and standing. After 4 weeks, you might find you have muscular pain in your abdomen where the muscles are weak. Walking will help your recovery significantly at this stage.

Rule 4 – Avoid constipation with a good diet.

Straining to go to the toilet can cause a prolapse and constipation is also extremely painful when you’ve just had abdominal surgery. Your doctor will give you instructions on the correct way to move your bowels to stop straining on your internal organs. But there are simple steps you can take to avoid constipation after surgery

1. No codeine or any painkiller that causes constipation. If this means you have to limit yourself to ibuprofen and paracetamol then so be it. Discuss better pain medication with your doctor if you need it. I personally hate taking ibuprofen as it is a terribly harmful drug with horrible side effects so I stopped taking it a week after the surgery. Then two weeks after the surgery. Then four weeks after the surgery. Then six weeks after the surgery. You’re getting the picture. Pain killers help you recover more quickly. Take them. I finally stopped needing them 10 weeks out.
2. Diet is the best way to avoid constipation. Eat two serves of fruit a day as well as yoghurt, lean meats and lots of vegetables. If you have chocolate cravings, take magnesium tablets.
3. Drink loads of water. Between the surgery and the anaesthetic and the drugs and the healing, your body need water and water is the best way to avoid constipation. I drank four to six litres a day in the first few weeks after my surgery. Water is the best and only thing you should be drinking. I love coffee but couldn’t stomach it for about two weeks post-op.
4. No alcohol for four weeks. Yeah, I just made that up. But this is peak healing and alcohol is not good for healing or with painkillers. Give your body a break. I didn’t miss it anyway
5. Mobility. Making sure you get out of bed for your shower, meals and a short walk every day is enough mobility to keep your bowels moving. A walk, combined with a diet full of roughage, will be enough to keep things moving.

Hysterectomy FAQ

1. When will I feel better?

About three weeks. Do not overdo it. Enjoy feeling vaguely human. Keep resting and walking and not doing anything but healing.
Stay in your pyjamas. Getting dressed in the morning sends a signal that you’re “better” and people will start asking you to do things. Nothing says “still healing” like sleepwear.

2. When will I start to feel normal?

About four weeks. Do not overdo it. Just because you’re starting to feel human, doesn’t mean you’re not still healing. But if you want to start doing laundry and stacking the dishwasher, that’s ok at this stage. Four weeks is usually when somebody grabs a vacuum cleaner or picks up their two-year-old and finds it was a mistake.

3. When do I get my energy back?

From 5 to 12 weeks depending on the surgery and how well you’re recovering. You’ll certainly start getting back to normal activities in week 5 and 6. Do not overdo it. If you return to work after week 6 make sure people know you’re still recovering.

4. It’s been 4/5/6 weeks and I feel normal but I’m still in pain. Should I be worried?

Your body is still healing and will be for a long time. Increase your walking to loosen and strengthen your abdominal muscles. No intensive exercise. Don’t overdo it. Never be afraid to text your surgeon or to insist on a checkup if you’re concerned. Making sure you recover is his/her job.

5. Seriously, it’s a lot of pain

It’s very easy to do something about week 4 or 5 to bruise the organs that are healing. Driving too far, doing housework, that sort of thing. As long as you’re not spotting or bleeding, you’re probably fine but REST. And always call your doctor if you need to put your mind at rest.

For me, there was a progression to the pain that I wasn’t expecting. At first, it was about the incision. Then it was abdominal (the pain also coalesced into two hard lumps under my incision that I was worried might be hernias). Then it was vaginal. The latter was a surprise and very concerning. Remember, your vagina is also healing. It will be inflamed and, if the cervix was removed, you’ll have a cuff. Sitting and standing for long periods can “pull” on the cuff. It can feel like there is a great pressure in your vagina, like you have a tampon stuck in there or even like it’s falling out. This is actually quite normal but, as always, speak to your surgeon if you’re worried.

6. What about sex?

A lot of women find this difficult to ask or talk about. The rule is rather euphemistically “nothing in your vagina for six weeks”. I have heard of (a) woman having sex at 11 weeks and tearing her vaginal cuff. But that was unusual. After 6 weeks is normal but my advice is to just wait till you feel ready. If that’s after your 6-week check up, great. If it’s 12 weeks, that’s your call. If you need to lie to your partner that your doctor hasn’t cleared it yet, go ahead. This time is all about you.

7. What’s the best advice you got before your hysterectomy?

You only have one chance to heal properly so if you’re worried about anything then err on the side of caution. You may be bored lying in bed around week 4 but that’s better than a torn cuff, a vaginal prolapse or adhesions.

And buy giant granny panties that won’t rub against your scar. I bought size 20 underwear and think I may wear them permanently. They’re super comfortable and they never work their way down to my scar. I know, super sexy right?

8. Swelly belly?

Is a thing. I’m writing this at week 12 and I have swelly belly after a big day. It’s generally a sign to lie down and rest. Swelly belly can last for a full year. So, yeah, granny pants. They are awesome.

9. I thought you were going to talk more about driving?

Yes I was! Sorry. Anaesthetic affects your reaction times so your insurer won’t cover you for about 10 days post-surgery. After that, you’re legally able to drive. Should you? Hell no. Nobody should drive any further than the local shops or a school drop off for 6 weeks after abdominal surgery. And if you can avoid that, do it. Driving puts a great deal of pressure on your abdominal muscles. Even if it does no damage, driving too far can hurt like hell. Try to avoid it till week 6 as much as possible and, my advice, don’t get into that car at all till week 4 (if possible).

10. What haven’t I thought of?

Probably a thousand things. Send me a message on Twitter if you have any questions at all. Hopefully I can help. Find at least one woman around you who’s had the surgery to talk to.

There is a very good forum of other women going through this. It’s HysterSisters. I found this very helpful to about week 6 and then less so. After that stage, I found the posts were dominated by women with serious complications from their hysterectomy and this was unnecessarily scary.

So, there it is. Every hysterectomy is different but hopefully this helps.

To summarise, for those who have made it this far:

1. Get six weeks off work upfront
2. Granny panties!
3. Take your pain meds and avoid constipation
4. Walk, walk, walk. Rest, rest, rest.
5. Expect a recovery time of at least 3 months. Understand you’re still healing up till a year.
6. Always call your surgeon if you have any concerns. Or me! I’m here if you need me.

It’s been a hard road but I can honestly say that I’m happy with my hysterectomy so far. I feel much better (at 12 weeks, finally!) and have less pain and more energy than before I went under the knife.

But before I go, one more word of caution. Fibroids, endometriosis, heavy periods and chronic anaemia can make you feel like crap. But no operation cures stress. If you need a counsellor as well as a hysterectomy, then talk to somebody. Removing your uterus will not automatically make life better if there’s other stressors. That’s too much to ask of surgery, even one as major as this one.

Good luck!