Adverse effects of any therapy should always be a consideration for a patient as part of informed consent for the procedure. A hysterectomy is no different and while the indications for a hysterectomy may make the procedure a necessity in order to avoid other complications, as is the case in dysfunctional uterine bleeding (refer to Abnormal Vaginal Bleeding), a patient has to be aware of the complications and adverse effects during and after a hysterectomy.
The “side effects” of a hysterectomy may not only be due to the surgical removal of the uterus itself but also as a result of anesthesia. The latter is usually short lived but is nevertheless an important consideration for the patient. A hysterectomy is a major surgical procedure that is usually conducted under general anesthesia. While modern anesthetics and pharmacology have drastically reduced adverse effects, it is still a concern for many patients.
Undergoing certain hysterectomy procedures may carry its own side effects and your doctor will discuss these risks with you. Other predisposing factors may only allow for certain techniques which could make you more prone to certain complications attributed with this specific procedure.
Complications During and Immediately After a Hysterectomy
Hysterectomy is a relatively safe operation but certain complications are possible which are common to most major surgeries. These may include :
- Excessive bleeding during surgery.
- Postoperative hemorrhage, which is one of the most serious complication.
- Infection, which is one the most common complication. Antibiotics are routinely prescribed post-operatively to minimize the risk of any infections.
- Bladder injury.
- Bowel injury, although this is rare.
- Injury to other pelvic structures.
- Complications of anesthesia.
- Blood clots in the veins (DVT) or lungs (pulmonary embolism).
- Death is a rare complication during or following a hysterectomy. It could be due to hemorrhage, infection, other pre-existing disease or pulmonary embolism resulting from DVT. During operation, death may occur as a result of cardiac arrest, coronary occlusion or respiratory paralysis.
Later Complications and Consequences of a Hysterectomy
- Immediate onset of menopause if the ovaries are removed. Refer to Causes of Secondary Amenorrhea. Menopausal symptoms like hot flashes, vaginal dryness, mood swings, weight gain and other symptoms can be avoided if hormone replacement therapy (HRT) is commenced immediately after the surgery.
- Pregnancy will not be a possibility and while this is obvious, the long term impact of being unable to fall pregnant has to be considered in younger women who fall within the childbearing age group.
- There may be an initial loss of sexual desire but it usually returns after complete recovery from the effects of surgery.
- Risk of early osteoporosis.
- Vault prolapse may be a long term complication.
- Psychological problems, including depression, may occur due to inability to bear children in women who were anxious to get pregnant.
Side Effects of Anesthesia during Hysterectomy
Anesthesia is necessary during surgery so that the patient does not feel any pain while the operation is taking place. A specialized doctor (anesthesiologist, sometimes referred to as an anesthetist) will administer the anesthesia and will decide on which form of anesthesia will be best for the patient. In the hands of a good anesthesiologist, the side effects of anesthesia may be minimal but there may be certain side effects which are unavoidable or unforeseen. In most cases, anesthesia is quite safe but in certain circumstances an individual’s reaction to an anesthetic agent may not be quite predictable.
It is important to let the anesthesiologist know about any allergies, medications taken regularly, or any medical conditions (such as hypertension or diabetes) that you may be suffering from as these may have a bearing on the effects of anesthesia.
People with heart or lung conditions, heavy smokers or those who are overweight may be more at risk of suffering from adverse reactions of anesthesia such as cardiovascular or respiratory problems.
Age is also a factor which may increase anesthetic risks. Elderly people may be more at risk of developing complications of anesthesia.
Either of the two forms of anesthesia may be used for hysterectomy :
1. General anesthesia (GA).
2. Regional anesthesia (epidural or spinal).
The side effects of either forms of anesthesia may include :
- Nausea or vomiting.
- Mood changes.
- Allergic reactions to anesthetic medicines.
With spinal anesthesia, a patient is more likely to suffer from :
- Some amount of pain, especially around the collar bone or shoulder.
- Numbness in lower part of the body.
- Rarely, nerve damage while administering spinal anesthesia can cause persistent weakness, numbness or pain.
- Infection, swelling or bruising at the injection site.
- If the anesthesia is absorbed through the blood stream, systemic toxicity might develop.
- Muscle control and coordination may be affected.
With GA, the side effects may be -
- Low body temperature (hypothermia) and rigor.
- Aspiration may be an uncommon side effect of GA. Being on an empty stomach before administration of anesthesia can prevent this complication.
- Coughing or gagging during insertion or removal of airway tubes.
- Laryngeal spasm.
- Sore throat or hoarseness.
- Damage to lips and teeth.
- Heart attack.
The latter 3 complications are rare with proper patient selection and thorough pre-operative check up.