Methods of performing hysterectomy surgery, adequate preparation and rehabilitation. Prevention of complications after surgery and rehabilitation - intensive care, nursing care and observation Removal of the uterus and appendages postoperative period

Resection of hemorrhoids does not yet make it possible to assume that everything is over. Following the recommendations of a proctologist in the postoperative period after removal of hemorrhoids is an important therapeutic stage, and the prognosis of treatment and the likelihood of developing complications depend on how well the rectum and anus function. To recover from the disease, you need to familiarize yourself with the basic principles of postoperative rehabilitation.

Duration of the postoperative period

The length of recovery time after hemorrhoid surgery depends on a number of factors:

• surgical techniques;
• type of hemorrhoidal lesion (internal, external or combined);
• age;
• existing intestinal diseases;
• functioning of the immune system (chronic diseases slow down postoperative treatment and increase the risk of complications).

How long does post-operative recovery last? On average, rehabilitation after removal of hemorrhoids lasts from 2 weeks to one and a half months, and the further prognosis of the disease depends on how well the patient follows medical recommendations during this time.

Main rules of rehabilitation

The recovery technique in the postoperative period is selected individually for each patient and is aimed at restoring the full functioning of the blood vessels. Treatment after hemorrhoidectomy should be comprehensive and include the following:

• Use of medications. To speed up the healing of postoperative sutures, ointments or suppositories are used topically after surgery with an analgesic, wound-healing, anti-inflammatory or hemostatic effect (medicines are selected taking into account the patient’s problem after resection of hemorrhoids). If the operation is successful, treatment with medications may not be required.
• Diet food. While scars are healing after excision of hemorrhoids, it is necessary to minimize the risk of injury to the mucous membrane of the rectum or anus from intestinal gases and dense feces. During the recovery period, food should be easily absorbed by the body and not linger in the intestines.
• Maintaining hygiene. It is necessary to wash the anus with cool water and baby soap. Failure to maintain hygiene in the postoperative period after removal of hemorrhoids often causes infection of the sutures with pathogenic microflora.
• Adequate physical activity. Despite the fact that approximately 4 days after surgery for hemorrhoids, many patients feel significantly better compared to the preoperative state, scar healing has not yet occurred and it is necessary to minimize physical stress on the pelvic area to prevent possible complications.

In order for recovery after hemorrhoid removal to proceed without complications, you must follow all points of medical recommendations. Failure to comply with the rules of rehabilitation may cause the recurrence of hemorrhoidal cones or the development of other problems in the patient.

Patient problems in the early period of rehabilitation

Removing hemorrhoids surgically does not always immediately relieve the patient of problems; early postoperative complications often occur. Most often, patients experience the following discomfort symptoms:

• Severe pain syndrome. After the anesthesia wears off, patients experience pain in the anus. Sometimes the pain is so unbearable that to alleviate a person’s condition, injections of non-narcotic (Nimesulide, Diclofenac) or narcotic (Promedol, Omnopon) analgesics are prescribed. Typically, severe pain lasts no more than 2-3 days and gradually subsides as postoperative scars heal.
• Urinary retention. Temporary difficulty urinating occurs more often in men after hemorrhoid surgery, when epidural anesthesia was used. The disorder is temporary and treatment is rarely required; usually normal urination is restored on its own within 24 hours after removal of hemorrhoids. In order to alleviate the condition, patients are shown catheterization of the bladder.
• Prolapse of a section of the rectum. Such consequences after removal of hemorrhoids do not occur often in patients and usually appear when the anal sphincter was damaged during the operation or the person has valve weakness. To eliminate the resulting disorder, depending on the severity of the condition, conservative or surgical treatment is used.
• Narrowing of the anus. This happens if the hemorrhoidectomy was done with improper suturing. In patients, the consequences of improper suturing of surgical wounds will be pain during bowel movements and a constant feeling of under-emptying of the intestines.

Surgery to remove hemorrhoids, other than pain in the operated area, may not cause any negative consequences, but a number of patients experience psychological problems associated with the act of defecation. A person is afraid of stool retention and at the same time experiences fear of going to the toilet. To eliminate the problem, laxatives and, for pain, mild analgesics are prescribed. In severe cases, patients need the help of a psychologist to combat fear.

A psychological problem with bowel movements, if not treated promptly, will eventually lead to constipation and injury to the anus.

Basics of therapeutic nutrition

Full recovery after surgery directly depends on what a person eats. Nutrition during the recovery period must comply with the following rules:

• Balance. Despite the exclusion of a number of foods from the diet, the body must receive the necessary vitamins and nutrients.
• Fractionality. It is recommended to eat in small portions, but often (up to 5-6 times a day).
• Cooking method. To reduce the risk of intestinal disorders, it is not recommended to fry food; it is advisable to prepare dishes by stewing, baking or boiling.
• Method of eating. Each piece should be chewed thoroughly before swallowing and avoid drinking various drinks while eating.

The suggested tips will help reduce the risk of constipation and flatulence, which can cause pain and discomfort to the patient during the rehabilitation period.

In addition to the rules of food intake, you should pay attention to the food set, because the proper functioning of the intestines depends on the type of food eaten.

Healthy food

The postoperative menu should include foods rich in fiber and moisture.

• porridge (except rice and semolina);
• vegetable soups;
• vegetable puree;
• omelettes;
• casseroles made from meat or cottage cheese;
• low-fat fermented milk products;
• fruits and berries without seeds;
• compotes and juices;
• ground or finely chopped meat and lean fish.

Prohibited Products

Rehabilitation after surgery requires minimizing the load on the intestines as much as possible. You need to remove from the menu:

• fresh milk;
• fatty fish and meat broths;
• seasonings;
• sauces;
• mayonnaise;
• vegetables with coarse fiber (onions, radishes, spinach, etc.);
• fatty fish and meat;
• rich fresh baked goods;
• any products with cocoa;
• fruits and berries containing small seeds (raspberries, kiwi);
• strong coffee and tea;
• alcoholic drinks;
• sparkling waters.

After the operation is performed, patients are not recommended to eat food during the first 24 hours, and after that they should eat in compliance with the above rules.

Many patients find it difficult to limit themselves in food and very often doctors hear the question: “After resection of hemorrhoids, how long should you follow a diet?” At least as long as the scars heal after surgery (on average, this happens within a month).

Those who are looking forward to finishing their diet so they can eat delicious food should think about the possible consequences: if you eat too much heavy and spicy food, hemorrhoids may reappear after surgery. Proctologists recommend that patients, even after the end of the rehabilitation stage, adhere to a milder version of the proposed diet and eat harmful foods in small quantities.

Physical activity after surgery

Treatment of hemorrhoids does not end with surgery; after removal of hemorrhoidal cones, to ensure full restoration of the body’s functioning, it is necessary to ensure a gentle load on the perineal area during the rehabilitation period. Depending on how much time has passed since the hemorrhoidectomy, doctors may recommend the following:

• In the first days there is complete rest. Patients must observe strict bed rest, and it is strictly forbidden to strain the abs or make sudden movements. During this period, tissues damaged by surgery actively heal and scars form.
• Physical exercises can only be done for 2-3 weeks. Proctologists recommend doing walking in place or breathing exercises. Physical activity that does not cause overstrain of the perineal muscles improves blood supply to the tissues, and scar healing takes less time.

Sexual contact is allowed only 2-3 weeks after hemorrhoidectomy, while anal sexual contact is strictly prohibited.

Postoperative recovery lasts up to 2 months and during this time the patients are considered disabled.

To reduce the risk of recurrence of hemorrhoids, it is recommended not to sit for long periods of time. For people whose work activity involves sitting at a desk or driving for a long time, doctors advise purchasing a special ring cushion for the seat.

• Wear soft underwear. It is unacceptable to wear panties made of coarse synthetic fabrics. And women are prohibited from wearing thongs.
• Wash the perineum with water and baby soap 2 times a day.
• Use only soft toilet paper (if possible, it is recommended to wash with cool water after each bowel movement).

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Possible postoperative complications

Removal of hemorrhoids can be successful, but due to patients’ violation of rehabilitation rules, complications sometimes arise:

• The appearance of suppuration. The most common problem is non-compliance with hygiene rules. If you do not start treating the resulting ulcers in a timely manner, then in the future this will lead to phlegmon or the formation of a rectal fistula.
• The appearance of bleeding. Such a complication becomes a consequence of injury to the areas of the anus and rectum that have not yet healed with feces or due to severe tension in the muscles of the perineum. Bleeding may be minor or profuse (if large vessels are damaged). For treatment, hemostatic sponges are used and, if necessary, injections of hemostatic agents are given.

In most cases, these phenomena can be avoided by following medical recommendations.

Signs of complications

Deviations in postoperative healing can be suspected based on the following signs:

• Prolonged severe pain. The normal duration of severe pain should not exceed 2-3 days; in most operated patients, the pain becomes moderately tolerable within a day after the operation.
• Fever. On the first day, a slight subfebrile rise in temperature is possible, but if hyperthermia lasts for several days, then this is a sign of an inflammatory process.
• The appearance of purulent discharge from the anus (occurs with feces during bowel movements).
• The appearance of blood stains on linen. A small amount of blood in the stool is acceptable, but if the bleeding is profuse and occurs not only when going to the toilet, but also at rest, then this is a dangerous sign.

The consequences accompanying operated hemorrhoids are always dangerous and require immediate treatment. If you ignore the signs that arise, life-threatening conditions may develop in the future.

The surgeon can perform an operation and remove the hemorrhoids, but further recovery depends not only on the doctor, but also on the patient. If the patient strictly follows medical recommendations regarding nutrition, hygiene and physical activity during rehabilitation, then the prognosis is favorable. During the healing period of postoperative scars, the risk of complications is minimal and there is almost no relapse of the disease.

After any surgical intervention, the patient cannot simply go back to normal life. The reason is simple - the body needs to get used to new anatomical and physiological relationships (after all, as a result of the operation, the anatomy and relative position of the organs, as well as their physiological activity, were changed).

A separate case is operations on the abdominal organs, in the first days after which the patient must especially strictly adhere to the instructions of the attending physician (in some cases, and related consultant specialists). Why does a patient need a certain regimen and diet after abdominal surgery? Why can’t you just go back to your old way of life instantly?

Mechanical factors that have a negative effect during surgery

The postoperative period is considered to be a period of time that lasts from the moment the surgical intervention is completed (the patient was taken from the operating room to the ward) until the disappearance of temporary disorders (inconveniences) that were provoked by the surgical injury.

Let's consider what happens during surgery, and how the patient's postoperative condition - and therefore his regimen - depends on these processes.

Normally, a typical condition for any organ of the abdominal cavity is:

• lie calmly in your rightful place;
• be in contact exclusively with neighboring bodies, which also occupy their rightful place;
• carry out tasks prescribed by nature.

During surgery, the stability of this system is disrupted. Whether removing an inflamed one, suturing a perforated one, or “repairing” an injured intestine, the surgeon cannot work only with the organ that is sick and requires repair. During surgery, the operating doctor is constantly in contact with other organs of the abdominal cavity: touching them with his hands and surgical instruments, moving them away, moving them. Even if such trauma is minimized as much as possible, even the slightest contact of the surgeon and his assistants with the internal organs is not physiological for the organs and tissues.

The mesentery, a thin connective tissue film through which the abdominal organs are connected to the inner surface of the abdominal wall and through which nerve branches and blood vessels approach them, is characterized by particular sensitivity. Trauma to the mesentery during surgery can lead to painful shock (despite the fact that the patient is in a state of medicated sleep and does not respond to irritation of his tissues). The expression “Pull the mesentery” in surgical slang has even acquired a figurative meaning - it means to cause significant inconvenience, cause suffering and pain (not only physical, but also moral).

Chemical factors that have a negative effect during surgery

Another factor that affects the patient’s condition after surgery is the medications used by anesthesiologists during operations to ensure. In most cases, abdominal operations on the abdominal organs are performed under anesthesia, a little less often - under spinal anesthesia.

At anesthesia Substances are injected into the bloodstream, the purpose of which is to induce a state of drug-induced sleep and relax the anterior abdominal wall so that it is convenient for surgeons to operate. But in addition to this valuable property for the operating team, such drugs also have “disadvantages” (side properties ). First of all, this is a depressive (depressing) effect on:

• central nervous system;
• intestinal muscle fibers;
• muscle fibers of the bladder.

Anesthetics that are administered during spinal anesthesia, act locally, without inhibiting the central nervous system, intestines and bladder - but their influence extends to a certain area of ​​the spinal cord and the nerve endings extending from it, which need some time to “get rid” of the action of anesthetics, return to their previous physiological state and provide innervation organs and tissues.

Postoperative changes in the intestines

As a result of the action of the drugs that anesthesiologists administered during surgery to provide anesthesia, the patient’s intestines stop working:

• muscle fibers do not provide peristalsis (normal contraction of the intestinal wall, as a result of which food masses move towards the anus);
• on the part of the mucous membrane, the secretion of mucus is inhibited, which facilitates the passage of food masses through the intestines;
• the anus is spasmodic.

As a result - the gastrointestinal tract seems to freeze after abdominal surgery. If at this moment the patient takes even a small amount of food or liquid, it will immediately be pushed out of the gastrointestinal tract as a result of a reflex.

Due to the fact that the drugs that caused short-term intestinal paresis will be eliminated (leave) from the bloodstream in a few days, the normal passage of nerve impulses along the nerve fibers of the intestinal wall will resume, and it will start working again. Normally, intestinal function resumes on its own, without external stimulation. In the vast majority of cases, this occurs 2-3 days after surgery. Timing may depend on:

• volume of the operation (how widely organs and tissues were involved in it);
• its duration;
• degree of intestinal injury during surgery.

A signal that the intestines have resumed is the release of gases from the patient. This is a very important point, indicating that the intestines have coped with the stress of surgery. It’s not for nothing that surgeons jokingly call passing gas the best postoperative music.

Postoperative changes in the central nervous system

Drugs administered to provide anesthesia are completely eliminated from the bloodstream after some time. However, during their stay in the body they manage to influence the structures of the central nervous system, affecting its tissues and inhibiting the passage of nerve impulses through neurons. As a result, a number of patients experience disorders of the central nervous system after surgery. The most common:

• sleep disturbance (the patient has difficulty falling asleep, sleeps lightly, wakes up from exposure to the slightest irritant);
• tearfulness;
• depressed state;
• irritability;
• violations from the outside (forgetting persons, events in the past, small details of some facts).

Postoperative changes in the skin

After surgery, the patient is forced to remain in a supine position for some time. In those places where the bone structures are covered with skin with virtually no layer of soft tissue between them, the bone presses on the skin, causing a disruption in its blood supply and innervation. As a result, necrosis of the skin occurs at the point of pressure - the so-called. In particular, they are formed in such areas of the body as:

Postoperative changes in the respiratory system

Often large abdominal operations are performed under endotracheal anesthesia. For this, the patient is intubated - that is, an endotracheal tube connected to an artificial respiration apparatus is inserted into the upper respiratory tract. Even with careful insertion, the tube irritates the mucous membrane of the respiratory tract, making it sensitive to the infectious agent. Another negative aspect of mechanical ventilation (artificial pulmonary ventilation) during surgery is some imperfection in the dosing of the gas mixture supplied from the ventilator into the respiratory tract, as well as the fact that normally a person does not breathe such a mixture.

In addition to factors that negatively affect the respiratory system: after surgery, the excursion (movement) of the chest is not yet complete, which leads to congestion in the lungs. All these factors together can provoke the occurrence of postoperative pain.

Postoperative changes in blood vessels

Patients who suffered from vascular and blood diseases are prone to formation and tearing in the postoperative period. This is facilitated by a change in blood rheology (its physical properties), which is observed in the postoperative period. A contributing factor is also that the patient is in a supine position for some time, and then begins physical activity - sometimes abruptly, as a result of which an existing blood clot may break off. They are mainly susceptible to thrombotic changes in the postoperative period.

Postoperative changes in the genitourinary system

Often after abdominal surgery, the patient is unable to urinate. There are several reasons:

• paresis of the muscle fibers of the bladder wall due to the effect on them of drugs that were administered during surgery to ensure medicated sleep;
• spasm of the bladder sphincter for the same reasons;
• difficulty urinating due to the fact that this is done in an unusual and unsuitable position for this - lying down.

Diet after abdominal surgery

Until the intestines have started working, the patient cannot eat or drink. Thirst is relieved by applying a piece of cotton wool or a piece of gauze moistened with water to the lips. In the vast majority of cases, intestinal function resumes on its own. If the process is difficult, drugs that stimulate peristalsis (Prozerin) are administered. From the moment peristalsis resumes, the patient can take water and food - but you need to start with small portions. If gases have accumulated in the intestines, but cannot escape, a gas outlet tube is installed.

The first dish that is given to the patient after the resumption of peristalsis is a lean thin soup with a very small amount of boiled cereals that do not provoke gas formation (buckwheat, rice), and mashed potatoes. The first meal should be two to three tablespoons. After half an hour, if the body has not rejected the food, you can give two or three more spoons - and so on, up to 5-6 small meals per day. The first meals are aimed not so much at satisfying hunger, but at “accustoming” the gastrointestinal tract to its traditional work.

You should not force the work of the gastrointestinal tract - it is better for the patient to be hungry. Even when the intestines have started working, a hasty expansion of the diet and the load on the gastrointestinal tract can lead to the fact that the stomach and intestines cannot cope, this will cause, due to the concussion of the anterior abdominal wall, a negative impact on the postoperative wound . The diet is gradually expanded in the following sequence:

• lean soups;
• mashed potatoes;
• creamy porridges;
• soft-boiled egg;
• soaked white bread crackers;
• vegetables cooked and pureed until pureed;
• steam cutlets;
• unsweetened tea.

• fat;
• acute;
• salty;
• sour;
• fried;
• sweet;
• fiber;
• legumes;
• coffee;
• alcohol.

Postoperative measures related to the work of the central nervous system

Changes in the central nervous system due to the use of anesthesia can disappear on their own in the period from 3 to 6 months after surgery. Longer-term disorders require consultation with a neurologist and neurological treatment(often outpatient, under the supervision of a doctor). Non-specialized events are:

• maintaining a friendly, calm, optimistic atmosphere around the patient;
• vitamin therapy;
• non-standard methods - dolphin therapy, art therapy, hippotherapy (the beneficial effects of communication with horses).

Prevention of bedsores after surgery

In the postoperative period, it is easier to prevent than to cure. Preventive measures should be carried out from the very first minute the patient is in a supine position. This:

• rubbing risk areas with alcohol (it must be diluted with water so as not to cause burns);
• circles for those places that are susceptible to pressure sores (sacrum, elbow joints, heels), so that the risk areas are as if in limbo - as a result of this, bone fragments will not put pressure on areas of the skin;
• massaging tissues in risk areas to improve their blood supply and innervation, and therefore trophism (local nutrition);
• vitamin therapy.

If bedsores do occur, they are dealt with using:

• drying agents (diamond green);
• drugs that improve tissue trophism;
• wound healing ointments, gels and creams (panthenol type);
• (to prevent infection).

Postoperative prevention

The most important prevention of congestion in the lungs is early activity:

• getting out of bed early if possible;
• regular walks (short but frequent);
• gymnastics.

If due to circumstances (large volume of surgery, slow healing of a postoperative wound, fear of a postoperative hernia) the patient is forced to remain in a supine position, measures are taken to prevent congestion in the respiratory organs:

Prevention of thrombus formation and blood clot separation

Before surgery, elderly patients or those who suffer from vascular diseases or changes in the blood coagulation system are carefully examined - they are given:

• rheovasography;
• determination of prothrombin index.

During surgery, as well as in the postoperative period, the legs of such patients are carefully bandaged. During bed rest, the lower limbs should be in an elevated state (at an angle of 20-30 degrees to the plane of the bed). Antithrombotic therapy is also used. Its course is prescribed before surgery and continues in the postoperative period.

Measures aimed at restoring normal urination

If in the postoperative period the patient cannot urinate, they resort to the good old reliable method of stimulating urination - the sound of water. To do this, simply open the water tap in the room so that water comes out of it. Some patients, having heard about the method, begin to talk about the dense shamanism of doctors - in fact, these are not miracles, but just a reflex response of the bladder.

In cases where the method does not help, bladder catheterization is performed.

After surgery on the abdominal organs, the patient is in a supine position in the first days. The time frame in which he can get out of bed and start walking is strictly individual and depends on:

• volume of operation;
• its duration;
• patient's age;
• his general condition;
• presence of concomitant diseases.

After uncomplicated and non-volume operations (hernia repair, appendectomy, etc.), patients can get up as early as 2-3 days after surgery. Volumetric surgical interventions (for a breakthrough ulcer, removal of an injured spleen, suturing of intestinal injuries, etc.) require a longer period of lying down for at least 5-6 days - first the patient may be allowed to sit in bed with his legs dangling, then stand and only then start taking the first steps.

To avoid the occurrence of postoperative hernias, it is recommended that patients wear a bandage:

• with a weak anterior abdominal wall (in particular, with untrained muscles, sagging muscle corset);
• obese;
• aged;
• those who have already been operated on for hernias;
• women who have recently given birth.

Proper attention should be paid to personal hygiene, water procedures, and room ventilation. Weakened patients who are allowed to get out of bed, but find it difficult to do so, are taken out into the fresh air in wheelchairs.

In the early postoperative period, intense pain may occur in the area of ​​the postoperative wound. They are stopped (relieved) with painkillers. It is not recommended for the patient to endure pain - pain impulses overstimulate the central nervous system and deplete it, which can lead to a variety of neurological diseases in the future (especially in old age).

The postoperative period begins immediately after the end of the operation and ends with the patient’s recovery. It is divided into 3 parts:

early - 3-5 days

late - 2-3 weeks

long-term (rehabilitation) - usually from 3 weeks to 2-3 months

Main taskspostoperative period are:

Prevention and treatment of postoperative complications.

Acceleration of regeneration processes.

Rehabilitation of patients.

The early postoperative period is the time when the patient’s body is primarily affected by surgical trauma, the effects of anesthesia and the forced position.

The early postoperative period may be uncomplicated And complicated.

In an uncomplicated course of the postoperative period, the reactive changes that occur in the body are usually moderate and last for 2-3 days. In this case, there is a fever of up to 37.0-37.5 ° C, inhibition of the central nervous system is observed, and there may be moderate leukocytosis and anemia. Therefore, the main task is to correct changes in the body, control the functional state of the main organs and systems.

Therapy for an uncomplicated postoperative period is as follows:

pain management;

correct position in bed (Fowler's position - the head end is raised);

wearing a bandage;

prevention and treatment of respiratory failure;

correction of water-electrolyte metabolism;

balanced diet;

control of the function of the excretory system.

The main complications of the early postoperative period.

I. Complications from the wound:

bleeding,

development of wound infection,

suture dehiscence (eventeration).

Bleeding- the most serious complication, sometimes threatening the patient’s life and requiring repeated surgery. In the postoperative period, to prevent bleeding, place an ice pack or a load of sand on the wound. For timely diagnosis, monitor pulse rate, blood pressure, and red blood counts.

Development of wound infection can occur in the form of the formation of infiltrates, wound suppuration, or the development of a more serious complication - sepsis. Therefore, it is imperative to bandage patients the next day after surgery. To remove the dressing material, always soak the wound with sanguineous discharge, treat the edges of the wound with an antiseptic and apply a protective aseptic bandage. After this, the bandage is changed every 3 days when it is wet. According to indications, UHF therapy is prescribed to the surgical site (infiltrates) or antibiotic therapy. It is necessary to monitor the portal functioning of drainages.

Suture dehiscence (eventeration) most dangerous after abdominal surgery. It may be associated with technical errors when suturing the wound (the edges of the peritoneum or aponeurosis are closely captured in the suture), as well as with a significant increase in intra-abdominal pressure (with peritonitis, pneumonia with severe cough syndrome) or with the development of infection in the wound. To prevent suture dehiscence during repeated operations and with a high risk of developing this complication, suturing the wound of the anterior abdominal wall with buttons or tubes is used.

II. The main complications of the nervous system: in the early postoperative period there are pain, shock, sleep and mental disorders.

Elimination of pain in the postoperative period is given exceptional importance. Painful sensations can reflexively lead to disruption of the cardiovascular system, respiratory system, gastrointestinal tract, and urinary organs.

Pain is controlled by prescribing analgesics (promedol, omnopon, morphine). It must be emphasized that unreasonable long-term use of drugs in this group can lead to the development of a painful addiction to them - drug addiction. This is especially true in our time. In addition to analgesics, the clinic uses long-term epidural anesthesia. It is especially effective after abdominal surgery; within 5-6 days makes it possible to sharply reduce pain in the area of ​​surgery and eliminate a pair of intestines in the shortest possible time (1% trimecaine solution, 2% lidocaine solution).

Eliminating pain, combating intoxication and excessive stimulation of the neuropsychic sphere are the prevention of such complications from the nervous system as postoperative sleep and mental disorders. Postoperative psychoses often develop in weakened, exhausted patients (homeless people, drug addicts). It must be emphasized that patients with postoperative psychosis require constant supervision. Treatment is carried out jointly with a psychiatrist.

Let's look at an example: A patient with destructive pancreatitis developed psychosis in the early postoperative period. He jumped out of the intensive care unit window.

III. Complications from the cardiovascular system can occur primarily as a result of weakness of cardiac activity, and secondarily as a result of the development of shock, anemia, severe intoxication.

The development of these complications is usually associated with concomitant diseases, so their prevention is largely determined by the treatment of concomitant pathology. The rational use of cardiac glycosides, glucocorticoids, sometimes vasopressants (dopamine), compensation of blood loss, complete oxygenation of the blood, combating intoxication and other measures taken taking into account the individual characteristics of each patient make it possible in most cases to cope with this severe complication of the postoperative period.

An important issue is the prevention of thromboembolic complications, the most common of which is pulmonary embolism- a serious complication, which is one of the common causes of death in the early postoperative period. The development of thrombosis after surgery is due to slow blood flow (especially in the veins of the lower extremities and pelvis), increased blood viscosity, water and electrolyte imbalance, unstable hemodynamics and activation of the coagulation system due to intraoperative tissue damage. The risk of pulmonary embolism is especially high in elderly obese patients with concomitant pathology of the cardiovascular system, the presence of varicose veins of the lower extremities and a history of thrombophlebitis.

Principles for the prevention of thromboembolic complications:

early activation of patients, active management in the postoperative period;

impact on a possible source (for example, treatment of thrombophlebitis);

ensuring stable dynamics (control of blood pressure, pulse);

correction of water and electrolyte balance with a tendency to hemodilution;

the use of disaggregants and other agents that improve the rheological properties of blood (reopolyglucin, trental, neoton);

the use of direct (heparin, fraxiparin, streptokinase) and indirect anticoagulants (syncumar, pelentan, aescusin, phenylin, dicoumarin, neodicoumarin);

bandaging the lower extremities in patients with varicose veins.

IV. Among the postoperative complications from the respiratory system the most common are tracheobronchitis, pneumonia, atelectasis, and pleurisy. But the most dangerous complication is development of acute respiratory failure, associated primarily with the consequences of anesthesia.

That's why the main measures for the prevention and treatment of respiratory complications are:

early activation of patients,

adequate position in bed with the head end elevated

(Fowler's position),

breathing exercises,

combating hypoventilation of the lungs and improving the drainage function of the tracheobronchial tree (inhalation of humidified oxygen,

cupping, mustard plasters, massage, physiotherapy),

thinning sputum and using expectorants,

prescribing antibiotics and sulfa drugs taking into account sensitivity,

sanitation of the tracheobronchial tree in seriously ill patients (through an endotracheal tube during prolonged mechanical ventilation or through a microtracheostomy during spontaneous breathing)

Analysis of inhalers and oxygen system.

V. Complications from the abdominal cavity in the postoperative period are quite severe and varied. Among them, peritonitis, adhesive intestinal obstruction, and gastrointestinal paresis occupy a special place. Attention is drawn to the collection of information when examining the abdominal cavity: examination of the tongue, examination, palpation, percussion, auscultation of the abdomen; digital examination of the rectum. The special importance in the diagnosis of peritonitis is emphasized in such symptoms as hiccups, vomiting, dry tongue, muscle tension in the anterior abdominal wall, bloating, weakened or absent peristalsis, the presence of free fluid in the abdominal cavity, and the appearance of the Shchetkin-Blumberg symptom.

The most common complication is the development paralytic obstruction (intestinal paresis). Intestinal paresis significantly disrupts the digestive processes, and not only them. An increase in intra-abdominal pressure leads to a high position of the diaphragm, impaired ventilation of the lungs and heart activity; In addition, there is a redistribution of fluid in the body, absorption of toxic substances from the intestinal lumen with the development of severe intoxication of the body.

Basics of preventing intestinal paresislaid down for operations:

careful handling of fabrics;

minimal infection of the abdominal cavity (use of tampons);

careful hemostasis;

novocaine blockade of the mesenteric root at the end of the operation.

Principles of prevention and control of paresis after surgery:

early activation of patients wearing a bandage;

rational diet (small convenient portions);

adequate gastric drainage;

insertion of a gas outlet tube;

stimulation of motility of the gastrointestinal tract (proserin 0.05% - 1.0 ml subcutaneously; 40-60 ml of hypertonic solution IV slowly drip; cerucal 2.0 ml IM; cleansing or hypertonic enema);

2-sided novocaine perinephric blockade or epidural blockade;

Surgical excision of a spinal hernia is considered the most extreme method of treating such a pathology, which is why many are interested in how long the postoperative period lasts after surgery for a spinal hernia and how complex and dangerous it is. The operation is indicated only if conservative methods do not bring the required result or if the patient has strict contraindications for taking medications.

In addition, there are certain indications for the operation, in particular the following:

• sharp and constant pain;
• compression of nerve endings;
• disruption of the spinal cord;
• risk of paralysis.

The operation to excise a herniated disc is quite complex and there is a high risk of complications, however, in some cases, only surgical removal of the bulging disc will help relieve pain and return full movements. The success of spinal surgery depends not only on the manipulations performed, but also on the correctness of the rehabilitation.

Cartilaginous discs running between the vertebrae allow movement. When there are problems and injuries to the discs, which often occurs with osteochondrosis, they burst and the central part goes beyond the intervertebral space. In this case, a hernia forms, which compresses the nerve endings and provokes severe pain and impaired movement.



If the changes that occur are quite pronounced and do not respond to conservative therapy, then surgical intervention is performed. A spinal hernia is removed using modern, low-traumatic techniques, without significant incisions or damage to soft tissue. In particular, the following is carried out:

• endoscopic excision;
• laser vaporization;
• plastic surgery to strengthen the vertebrae.

Laser therapy is considered the most preferred method, since it provides the most effective and gentle effect that helps eliminate the hernia. In addition, such surgical intervention has much less negative consequences. It is also possible to quickly restore damaged cartilage.

The main role of restorative procedures

Mandatory rehabilitation after removal of a hernia is indicated, which helps to quickly return to normal life and improve motor activity. After surgery, the height of the intervertebral disc decreases, thereby increasing the load on the joints and adjacent vertebrae.

The recovery period takes 4-7 months and during this period certain changes may occur in various parts of the spine, and there is also a high probability of relapses.

Important! The process of recovery and improvement of well-being largely depends on the correct approach to rehabilitation measures.

Rehabilitation after surgery to remove a hernia involves several stages and constant work to strengthen the muscles and improve the mobility of the spine.

Early postoperative period

The postoperative period after removal of a spinal hernia is divided into several different stages. The initial stage of recovery lasts literally 2 weeks from the date of surgery. During this time, the wounds heal completely, and painful manifestations and swelling disappear.

The patient is advised to use painkillers and anti-inflammatory medications, as well as moderate exercise. Usually, after the operation, patients begin to move independently on the 2nd day and do breathing exercises, as well as develop their limbs.

It is allowed to stand up only if the back muscles are supported by an elastic, durable corset. If necessary, drug therapy may be prescribed.

Important! After surgery, standing up without a corset is strictly prohibited, even for a short time, as awkward and sudden movements can lead to negative consequences.

Adaptation period after discharge

After surgery to remove a hernia, the patient is transferred to home treatment for literally 3-4 days. A sharp change in the situation certainly requires compliance with certain restrictions and rules, namely:

• You must wear a corset;
• avoid sudden movements;
• do not sit down for 2 months.

A month after the operation, you need to add a set of special restorative and strengthening exercises for the back muscle corset to the exercises. If necessary, physical therapy can be performed, but only as prescribed by a doctor.

Important! During this period, it is strictly forbidden to be excessively active and use gymnastics on your own without consulting a doctor.

A full course of rehabilitation measures can begin as early as 2 months after the operation, and it implies a complex that includes gymnastics, physiotherapy, massage and sanatorium treatment.

Physiotherapy

Even if no negative consequences are observed after the hernia excision operation, and the recovery period is actively underway, exercise therapy can be performed no earlier than 2 months later. The set of exercises must be selected by the doctor, taking into account all available indications and contraindications.

Basically, during this period, many exercises to strengthen the back muscles are performed while lying on the floor, so you first need to prepare a fairly soft mat. Classes must be done daily, as this is the only way to achieve good results.

Massage

Massage is included in the complex of therapy no earlier than 2 months after discharge from the hospital, and the type of massage procedures must be gentle, warm the muscles and improve blood circulation in the back area. Massage should only be performed by a highly qualified specialist.

When performing a massage, forceful techniques are contraindicated, since there will be no benefit from manual therapy, but rather bad consequences may occur.

Physiotherapy

Spinal surgery to remove a hernia is quite complex, which is why it takes quite a long time for a complete recovery. Physiotherapy helps to cope with pain and promotes faster recovery. Physiotherapeutic procedures can be prescribed at any time at the discretion of the doctor.

Physiotherapy helps:

• eliminate swelling;
• improve blood circulation;
• relieve spasm;
• reduce swelling.

When conducting physiotherapy, a variety of procedures are used, in particular, such as ultrasound, laser exposure, iontophoresis with medications, pulsed currents and much more. All physiotherapeutic procedures are carried out only after a doctor’s prescription.

Diet therapy

After hernia surgery, following a special diet is indicated. In the first days, consumption of easily digestible foods containing a large amount of fiber is indicated.

Subsequently, you need to follow a low-calorie diet. You can consume any food, however, in moderation, so as not to provoke weight gain, as this can be an additional burden on the spine.

A well-chosen program of rehabilitation therapy, carried out for at least six months, will consolidate the results of a successful operation.

Update: October 2018

Hysterectomy or removal of the uterus is a fairly common operation that is performed for certain indications. According to statistics, approximately a third of women who have crossed the 45-year mark have undergone this operation.

And, of course, the main question that concerns patients who have undergone surgery or are preparing for surgery is: “What consequences can there be after removal of the uterus”?

Postoperative period

As you know, the period of time that lasts from the date of surgical intervention to restoration of ability to work and good health is called the postoperative period. Hysterectomy is no exception. The period after surgery is divided into 2 “sub-periods”:

• early
• late postoperative periods

During the early postoperative period, the patient is in the hospital under the supervision of doctors. Its duration depends on the surgical approach and the general condition of the patient after surgery.

• After surgery to remove the uterus and/or appendages, which was carried out either vaginally or through an incision in the anterior wall of the abdomen, the patient remains in the gynecological department for 8 - 10 days, and it is at the end of the agreed period that the sutures are removed.
• After laparoscopic hysterectomy the patient is discharged after 3–5 days.

The first day after surgery

The first postoperative days are especially difficult.

Pain - during this period, the woman feels significant pain both inside the abdomen and in the area of ​​the sutures, which is not surprising, since there is a wound both outside and inside (just remember how painful it is when you accidentally cut your finger). To relieve pain, non-narcotic and narcotic painkillers are prescribed.

Lower limbs remain, as before the operation, in or bandaged with elastic bandages (prevention of thrombophlebitis).

Activity - surgeons adhere to active management of the patient after surgery, which means getting out of bed early (after laparoscopy in a few hours, after laparotomy in a day). Physical activity “accelerates the blood” and stimulates intestinal function.

Diet - the first day after a hysterectomy, a gentle diet is prescribed, which contains broths, pureed food and liquids (weak tea, still mineral water, fruit drinks). Such a treatment table gently stimulates intestinal motility and promotes early (1–2 days) spontaneous bowel movement. Independent stool indicates the normalization of intestinal function, which requires a transition to regular food.

Belly after hysterectomy remains painful or sensitive for 3–10 days, which depends on the patient’s pain sensitivity threshold. It should be noted that the more active the patient is after surgery, the faster her condition recovers and the lower the risk of possible complications.

Treatment after surgery

• Antibiotics - usually antibacterial therapy is prescribed for prophylactic purposes, since the patient’s internal organs came into contact with air during the operation, and therefore with various infectious agents. The course of antibiotics lasts an average of 7 days.
• Anticoagulants - also in the first 2 - 3 days, anticoagulants (blood thinning drugs) are prescribed, which are designed to protect against thrombosis and the development of thrombophlebitis.
• Intravenous infusions- in the first 24 hours after hysterectomy, infusion therapy (intravenous drip infusion of solutions) is carried out in order to replenish the volume of circulating blood, since the operation is almost always accompanied by significant blood loss (the volume of blood loss during an uncomplicated hysterectomy is 400 - 500 ml).

The course of the early postoperative period is considered smooth if there are no complications.

Early postoperative complications include:

• inflammation of the postoperative scar on the skin (redness, swelling, purulent discharge from the wound and even dehiscence);
• problems with urination(pain or pain when urinating) caused by traumatic urethritis (damage to the mucous membrane of the urethra);
• bleeding of varying intensity, both external (from the genital tract) and internal, which indicates insufficiently well-performed hemostasis during surgery (discharge may be dark or scarlet, blood clots are present);
• pulmonary embolism- a dangerous complication that leads to blockage of the branches or the pulmonary artery itself, which is fraught with pulmonary hypertension in the future, the development of pneumonia and even death;
• peritonitis - inflammation of the peritoneum, which spreads to other internal organs, dangerous for the development of sepsis;
• hematomas (bruises) in the area of ​​the sutures.

Bloody discharge after removal of the uterus, like a “daub,” is always observed, especially in the first 10–14 days after the operation. This symptom is explained by the healing of sutures in the area of ​​the uterine stump or in the vaginal area. If a woman’s discharge pattern changes after surgery:

• accompanied by an unpleasant, putrid odor
• the color resembles meat slop

You should consult a doctor immediately. It is possible that inflammation of the sutures in the vagina has occurred (after hysterectomy or vaginal hysterectomy), which is fraught with the development of peritonitis and sepsis. Bleeding from the genital tract after surgery is a very alarming signal and requires repeat laparotomy.

Suture infection

If a postoperative suture becomes infected, the general body temperature rises, usually not higher than 38 degrees. The patient’s condition, as a rule, does not suffer. Prescribed antibiotics and treatment of sutures are quite enough to relieve this complication. The first time the postoperative dressing is changed and the wound is treated the next day after the operation, then the dressing is carried out every other day. It is advisable to treat the sutures with a solution of Curiosin (10 ml, 350-500 rubles), which ensures gentle healing and prevents the formation of a keloid scar.

Peritonitis

The development of peritonitis more often occurs after a hysterectomy performed for emergency reasons, for example, necrosis of a myomatous node.

• The patient's condition deteriorates sharply
• The temperature “jumps” to 39 – 40 degrees
• Pronounced pain syndrome
• Signs of peritoneal irritation are positive
• In this situation, massive antibiotic therapy is carried out (prescription of 2 - 3 drugs) and infusion of saline and colloid solutions
• If there is no effect from conservative treatment, surgeons perform a relaparotomy, remove the uterine stump (in case of uterine amputation), wash the abdominal cavity with antiseptic solutions and install drainages

The hysterectomy slightly changes the patient’s usual lifestyle. For a quick and successful recovery after surgery, doctors give patients a number of specific recommendations. If the early postoperative period proceeded smoothly, then after the woman’s stay in the hospital expires, she should immediately take care of her health and the prevention of long-term consequences.

• Bandage

A good help in the late postoperative period is wearing a bandage. It is especially recommended for premenopausal women who have had a history of multiple births or for patients with weakened abdominal muscles. There are several models of such a supportive corset; you should choose the model in which the woman does not feel discomfort. The main condition when choosing a bandage is that its width must exceed the scar by at least 1 cm above and below (if an inferomedial laparotomy was performed).

• Sex life, weight lifting

Discharge after surgery continues for 4 to 6 weeks. For one and a half, and preferably two months after a hysterectomy, a woman should not lift weights of more than 3 kg and perform heavy physical work, otherwise this could lead to the rupture of internal sutures and abdominal bleeding. Sexual activity during the specified period is also prohibited.

• Special exercises and sports

To strengthen the vaginal and pelvic muscles, it is recommended to perform special exercises using an appropriate simulator (perineal gauge). It is the simulator that creates resistance and ensures the effectiveness of such intimate gymnastics.

The described exercises (Kegel exercises) got their name from a gynecologist and developer of intimate gymnastics. You must perform at least 300 exercises per day. Good tone of the vaginal and pelvic floor muscles prevents prolapse of the vaginal walls, prolapse of the uterine stump in the future, as well as the occurrence of such an unpleasant condition as urinary incontinence, which almost all women in menopause face.

Sports after a hysterectomy are easy physical activity in the form of yoga, Bodyflex, Pilates, shaping, dancing, swimming. You can start classes only 3 months after the operation (if it was successful, without complications). It is important that physical education during the recovery period brings pleasure and does not exhaust the woman.

• About baths, saunas, and the use of tampons

For 1.5 months after surgery, it is prohibited to take baths, visit saunas, steam baths and swim in open water. While there is spotting, you should use sanitary pads, but not tampons.

• Nutrition, diet

Proper nutrition is of no small importance in the postoperative period. To prevent constipation and gas formation, you should consume more liquid and fiber (vegetables, fruits in any form, wholemeal bread). It is recommended to give up coffee and strong tea, and, of course, alcohol. Food should not only be fortified, but contain the required amount of proteins, fats and carbohydrates. A woman should consume most of her calories in the first half of the day. You will have to give up your favorite fried, fatty and smoked foods.

• Sick leave

The total period of incapacity for work (counting the time spent in the hospital) ranges from 30 to 45 days. If any complications arise, the sick leave is naturally extended.

Hysterectomy: what then?

In most cases, women after surgery face psycho-emotional problems. This is due to the existing stereotype: there is no uterus, which means there is no main female distinctive feature, and accordingly, I am not a woman.

In reality, this is not the case. After all, it is not only the presence of a uterus that determines a woman’s essence. To prevent the development of depression after surgery, you should study the issue regarding removal of the uterus and life after it as carefully as possible. After the operation, the husband can provide significant support, because outwardly the woman has not changed.

Fears regarding changes in appearance:

• increased facial hair growth
• decreased sex drive
• weight gain
• changing voice timbre, etc.

are far-fetched and therefore easily overcome.

Sex after hysterectomy

Sexual intercourse will give the woman the same pleasures as before, since all sensitive areas are located not in the uterus, but in the vagina and external genitalia. If the ovaries are preserved, then they continue to function as before, that is, they secrete the necessary hormones, especially testosterone, which is responsible for sexual desire.

In some cases, women even note an increase in libido, which is facilitated by relief from pain and other problems associated with the uterus, as well as a psychological moment - the fear of unwanted pregnancy disappears. Orgasm will not disappear after amputation of the uterus, and some patients experience it more vividly. But the occurrence of discomfort and even...

This point applies to those women who have had a hysterectomy (a scar in the vagina) or a radical hysterectomy (Wertheim operation), in which part of the vagina is excised. But this problem is completely solvable and depends on the degree of trust and mutual understanding of the partners.

One of the positive aspects of the operation is the absence of menstruation: no uterus - no endometrium - no menstruation. This means goodbye to critical days and the troubles associated with them. But it’s worth mentioning that, rarely, women who have undergone uterine amputation while preserving the ovaries may experience slight spotting on menstruation. This fact is explained simply: after amputation, a uterine stump remains, and therefore a little endometrium. Therefore, you should not be afraid of such discharges.

Loss of fertility

The issue of loss of reproductive function deserves special attention. Naturally, since there is no uterus - the place of fruit, pregnancy is impossible. Many women list this fact as a plus for having a hysterectomy, but if the woman is young, this is definitely a minus. Before suggesting removal of the uterus, doctors carefully assess all risk factors, study the medical history (in particular the presence of children) and, if possible, try to preserve the organ.

If the situation allows, the woman either has myomatous nodes excised (conservative myomectomy) or the ovaries are left behind. Even with an absent uterus, but preserved ovaries, a woman can become a mother. IVF and surrogacy are a real way to solve the problem.

Suture after hysterectomy

The suture on the anterior abdominal wall worries women no less than other problems associated with hysterectomy. Laparoscopic surgery or a transverse incision in the lower abdomen will help to avoid this cosmetic defect.

Adhesive process

Any surgical intervention in the abdominal cavity is accompanied by the formation of adhesions. Adhesions are connective tissue cords that form between the peritoneum and internal organs, or between organs. Almost 90% of women suffer from adhesive disease after a hysterectomy.

Forced penetration into the abdominal cavity is accompanied by damage (dissection of the peritoneum), which has fibrinolytic activity and ensures lysis of fibrinous exudate, gluing the edges of the dissected peritoneum.

An attempt to close the area of ​​the peritoneal wound (suturing) disrupts the process of melting of early fibrinous deposits and promotes increased adhesions. The process of formation of adhesions after surgery depends on many factors:

• duration of the operation;
• volume of surgical intervention (the more traumatic the operation, the higher the risk of adhesions);
• blood loss;
• internal bleeding, even leakage of blood after surgery (resorption of blood provokes adhesions);
• infection (development of infectious complications in the postoperative period);
• genetic predisposition (the more the genetically determined enzyme N-acetyltransferase, which dissolves fibrin deposits, is produced, the lower the risk of adhesive disease);
• asthenic physique.
• pain (constant or intermittent)
• urination and defecation disorders
• , dyspeptic symptoms.

To prevent the formation of adhesions in the early postoperative period, the following are prescribed:

• antibiotics (suppress inflammatory reactions in the abdominal cavity)
• anticoagulants (thin the blood and prevent the formation of adhesions)
• motor activity already on the first day (turning on its side)
• early start of physiotherapy (ultrasound or, Hyaluronidase, and others).

Properly carried out rehabilitation after a hysterectomy will prevent not only the formation of adhesions, but also other consequences of the operation.

Menopause after hysterectomy

One of the long-term consequences of hysterectomy surgery is menopause. Although, of course, any woman sooner or later approaches this milestone. If during the operation only the uterus was removed, but the appendages (tubes with ovaries) were preserved, then the onset of menopause will occur naturally, that is, at the age for which the woman’s body is “programmed” genetically.

However, many doctors are of the opinion that after surgical menopause, menopausal symptoms develop on average 5 years earlier than expected. There are no exact explanations for this phenomenon yet; it is believed that the blood supply to the ovaries after a hysterectomy somewhat deteriorates, which affects their hormonal function.

Indeed, if we recall the anatomy of the female reproductive system, the ovaries are mostly supplied with blood from the uterine vessels (and, as is known, quite large vessels pass through the uterus - the uterine arteries).

To understand the problems of menopause after surgery, it is worth defining the medical terms:

• natural menopause - cessation of menstruation due to the gradual fading of the hormonal function of the gonads (see)
• artificial menopause - cessation of menstruation (surgical - removal of the uterus, medication - suppression of ovarian function with hormonal drugs, radiation)
• surgical menopause – removal of both the uterus and ovaries

Women endure surgical menopause more severely than natural menopause, this is due to the fact that when natural menopause occurs, the ovaries do not immediately stop producing hormones; their production decreases gradually, over several years, and eventually stops.

After removal of the uterus and appendages, the body undergoes a sharp hormonal change, since the synthesis of sex hormones suddenly stopped. Therefore, surgical menopause is much more difficult, especially if a woman is of childbearing age.

Symptoms of surgical menopause appear within 2–3 weeks after surgery and are not much different from the signs of natural menopause. Women are concerned about:

• tides (see)
• sweating ()
• emotional lability
• Depressive states often occur (see and)
• later dryness and aging of the skin occur
• brittleness of hair and nails ()
• urinary incontinence when coughing or laughing ()
• Vaginal dryness and related sexual problems
• decreased sex drive

In case of removal of both the uterus and ovaries, hormone replacement therapy is necessary, especially for women under 50 years of age. For this purpose, both gestagens and testosterone are used, which is mostly produced in the ovaries and a decrease in its level leads to a weakening of libido.

If the uterus and appendages were removed due to large myomatous nodes, then the following is prescribed:

• continuous estrogen monotherapy, used as oral tablets (Ovestin, Livial, Proginova and others),
• products in the form of suppositories and ointments for the treatment of atrophic colpitis (Ovestin),
• as well as preparations for external use (Estrogel, Divigel).

If a hysterectomy with adnexa was performed for internal endometriosis:

• treatment with estrogens (Kliane, Progynova)
• together with gestagens (suppression of the activity of dormant foci of endometriosis)

Hormone replacement therapy should be started as early as possible, 1 to 2 months after the hysterectomy. Hormone treatment significantly reduces the risk of cardiovascular disease, osteoporosis and Alzheimer's disease. However, hormone replacement therapy may not be prescribed in all cases.

Contraindications to treatment with hormones are:

• surgery for ;
• pathology of the veins of the lower extremities (thrombophlebitis, thromboembolism);
• severe pathology of the liver and kidneys;
• meningioma.

The duration of treatment ranges from 2 to 5 or more years. You should not expect immediate improvement and disappearance of menopausal symptoms immediately after starting treatment. The longer hormone replacement therapy is carried out, the less pronounced the clinical manifestations are.

Other long-term consequences

One of the long-term consequences of hysterovariectomy is the development of osteoporosis. Men are also susceptible to this disease, but the fairer sex suffers from it more often (see). This pathology is associated with a decrease in estrogen production, so in women osteoporosis is more often diagnosed during pre- and postmenopausal periods (see).

Osteoporosis is a chronic disease that is prone to progression and is caused by a metabolic disorder of the skeleton such as the leaching of calcium from the bones. As a result, the bones become thinner and brittle, which increases the risk of fractures. Osteoporosis is a very insidious disease; it occurs latently for a long time and is detected in an advanced stage.

The most common fractures occur in the vertebral bodies. Moreover, if one vertebra is damaged, there is no pain as such; severe pain is typical for simultaneous fractures of several vertebrae. Spinal compression and increased bone fragility lead to spinal curvature, changes in posture and decreased height. Women with osteoporosis are susceptible to traumatic fractures.

The disease is easier to prevent than to treat (see), therefore, after amputation of the uterus and ovaries, hormone replacement therapy is prescribed, which inhibits the leaching of calcium salts from the bones.

Nutrition and exercise

You also need to follow a certain diet. The diet should contain:

• dairy products
• all varieties of cabbage, nuts, dried fruits (dried apricots, prunes)
• legumes, fresh vegetables and fruits, greens
• You should limit your salt intake (promotes the excretion of calcium by the kidneys), caffeine (coffee, Coca-Cola, strong tea) and avoid alcoholic beverages.

To prevent osteoporosis, it is useful to exercise. Physical exercise improves muscle tone and increases joint mobility, which reduces the risk of fractures. Vitamin D plays an important role in the prevention of osteoporosis. Consuming fish oil and ultraviolet irradiation will help compensate for its deficiency. The use of calcium-D3 Nycomed in courses of 4 to 6 weeks replenishes the lack of calcium and vitamin D3 and increases bone density.

Vaginal prolapse

Another long-term consequence of hysterectomy is prolapse of the vagina.

• Firstly, prolapse is associated with trauma to the pelvic tissue and supporting (ligament) apparatus of the uterus. Moreover, the wider the scope of the operation, the higher the risk of prolapse of the vaginal walls.
• Secondly, prolapse of the vaginal canal is caused by the prolapse of neighboring organs into the freed pelvis, which leads to cystocele (prolapse of the bladder) and rectocele (prolapse of the rectum).

To prevent this complication, women are advised to perform Kegel exercises and limit heavy lifting, especially in the first 2 months after hysterectomy. In advanced cases, surgery is performed (vaginoplasty and its fixation in the pelvis by strengthening the ligamentous apparatus).

Forecast

Hysterectomy not only does not affect life expectancy, but even improves its quality. Having gotten rid of the problems associated with diseases of the uterus and/or appendages, forever forgetting about the issues of contraception, many women literally blossom. More than half of the patients note liberation and increased libido.

Disability after removal of the uterus is not granted, since the operation does not reduce the woman’s ability to work. A disability group is assigned only in cases of severe uterine pathology, when hysterectomy entailed radiation or chemotherapy, which significantly affected not only the ability to work, but also the patient’s health.