Hysterectomy is the surgery performed to remove the uterus which results in ending up menstruation and ability to become pregnant for a woman.

Causes for the surgery:

• Abnormal vaginal bleeding
• Prolapse of the uterus
• Uterine fibroids
• Cancer ( Cervix , Uterus or Ovaries )
• Endometriosis

Different types in hysterectomy:

• Total hysterectomy = removal of uterus and cervix
• Partial hysterectomy = removal of only uterus leaving cervix intact
• Hysterectomy and salpingo oophorectomy = removal of uterus, one or both ovaries and fallopian tubes.
• Radical hysterectomy = removal of womb, cervix, fallopian ovaries and part of vagina.

Approaches through which hysterectomy is done:

• Abdominal approach
• Vaginal approach
• Laparoscopic approach

 Rehabilitation treatment slightly varies depending on the approach.

Signs and symptoms:

• Pain at the surgical site
• Scar
• Swelling ,redness around the site of incision

Preoperative and postoperative rehabilitation:

Preoperative exercises – Includes exercises which are done in the early postoperative period, so that the patient can cope-up with the exercises postoperatively.

• Breathing exercises
• Cough reflex includes huffing and coughing
• Aerobic exercises
• Upper limb and lower limb strengthening exercises
• Postural correction

Benefits of preoperative rehabilitation program:

• Systemic review concludes that preoperative exercises reduces the length of stay in the hospital
• Reduces the postoperative complications
• Helps in educating and training patient about the postoperative exercises

Postoperative rehabilitation aim:

• To avoid postoperative respiratory and circulatory complications
• To prevent muscles from wasting
• To prevent wound infection
• Scar management
• To prevent pressure sore
• Returning to daily living functional activities with minimal or no pain

Postoperative rehabilitation management:

• Deep breathing exercises
• Circulatory exercises initially when bed ridden
• Bracing exercises
• Mobility exercises like walking
• Pain management which includes electrotherapy modalities
• Scar mobilization
• Positioning – educating about comfort positions
• Pelvic floor strengthening exercises
• Lower abdominal muscle (transverse abdominis) activation exercises
• Upper and lower limb strengthening exercises

Recovery usually takes around 6 weeks to return to normal functional activities.

Benefits:

• Results in early recovery
• Reduces the length of hospital stay

Don’ts during first 6 weeks:

• Do not do heavy lifting and heavy activities like cooking large meals
• Avoid sudden movements
• Avoid sexual intercourse
• Avoid bending forward
• Avoid smoking
• Avoid sexual intercourse

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