Best Questions to Ask Before A Hysterectomy
Hearing the words “you need a hysterectomy” is scary. It is overwhelming. Things often move very fast, and people faced with this surgical procedure sometimes don’t know what questions they can, and indeed should, ask. So here is a list of key questions to discuss with your surgeon.
List of Key Questions to Ask Before (or after) a Hysterectomy:
- Why do I need this procedure?
- What is the evidence supporting this procedure for my condition?
- How do you plan to support the remaining vagina?
- After the incisions and tissues heal, where will I be referred for post-operative physical therapy?
What is the rationale for those specific questions?
1. Why do I need this procedure?
“Just because you have a prolapse” is not an adequate response. 50-80% of people with pelvic organ prolapse report full resolution of pain, pressure and leakage complaints associated with the prolapse after a course of physical therapy.
references: Marian Wiegersma, Chantal M C R Panman, Liesbeth C Hesselink, Alec G A Malmberg, Marjolein Y Berger, Boudewijn J Kollen, Janny H Dekker, Predictors of Success for Pelvic Floor Muscle Training in Pelvic Organ Prolapse, Physical Therapy, Volume 99, Issue 1, January 2019, Pages 109–117, https://doi.org/10.1093/ptj/pzy114
Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training
in women with pelvic organ prolapse (POPPY): a multicentre randomised
controlled trial. Lancet 2014; 383:796–806.
2. What is the evidence supporting this procedure for my condition?
This goes along with #1.
Are you having unexplained pelvic pain? Success rates for hysterectomy to address primary pelvic pain have been reported as high as 70%, with pain persisting, at various levels, in 20-40% of individuals. (PMID: 7501344DOI: 10.1016/0029-7844(95)00304-a).
That means that about 3 out of 4 women who undergo this procedure will have a significant reduction in pain. And 1 out of 4 will not.
Are you having this procedure due to cancer? Well, then you have no choice. You have to get the cancer out.
If there is a choice, have you exhausted all other interventions? More specifically, have you tried pelvic floor physical therapy? As mentioned, Pelvic PT has a high success rate of treating complaints such as incontinence, prolapse pressure, and pelvic pain, and even if it doesn’t fully resolve your complaint, and you still end up needing surgery, you will be better connected with your body pre-surgically, which is a very good thing.
There is a reported complication rate of 20% of individuals post hysterectomy (https://doi.org/10.1111/j.1479-828X.1998.tb02963.x), and while most complications are mild and short-term, it is still prudent to be aware of them.
3. How do you plan to support the remaining vagina?
This is important. The uterus, and it’s connective tissues, help to stabilize the vagina.
If we remove the uterus, the remaining vagina needs to be stabilized, or you could have a prolapse post-hysterectomy. A recent study indicated a post-hysterectomy vaginal prolpase rate of 12%, or a bit more than 1 in 10 women.
Sacrocolpoplexy (posterior support) and Sacrospinous fixation (posterior support) are two options (I discuss them in this post).
Your surgeon may need to make this decision during the surgery, based on the quality of the tissues that will remain, but it is important to have this discussion, so that some type of fixation occurs.
4. After my tissues have healed, where will you be referring me for physical therapy?
Muy importante. Would you ever have a knee replaced, or rotator cuff repaired, and not do rehabilitation afterwards? NO!
So why would you literally slice through the definition of someone’s core (arthroscopic or open, it’s still a slice), remove a key organ, and then just ‘stitch them up and send them home’ and expect them to recover full function.
And you wonder why older physicians and people think it is ‘normal’ for women to leak and have pelvic pain…it’s because we’ve been neglecting to offer them basic rehabilitative care for centuries.
The studies mentioned above, as well as others, support the use of pre- and post-operative PT in improving patient outcomes as far as pain, improved sexual function, improved continence function of urine and bowels, and overall improved quality of life.
If your surgeon says “you don’t need PT”, kindly ask them to document in your chart that you requested the service, and they declined to provide you with a script for it. It’s one thing if they want you to wait 4-6 weeks (although you can start earlier with basic relaxation techniques and breathing techniques to manage pain), but another thing if they deny you a script entirely. The above ‘trick’ usually results in you obtaining an order.
*Oooh, another fun fact–As a Doctorate Level Profession, PTs are now a “Direct Access” medical service in most states and most insurances do not even ‘require’ a physical order. The exceptions are Medicare, Medicaid services, and certain Christian Medishare plans. But if you are unsure, call your local PT office, and they will tell you if a script is required.
5. What if there isn’t a Pelvic PT near me?
Check out this blog post to help you find a PT near you. There are also PTs that offer online consults, or online programs (like mine!)
I hope this helped you identify the key questions to ask before your hysterectomy.
Thanks for Reading!
This post was intended to empower you to know more about what is happening to your body, and the body of your loved ones.
Check out my Pelvic Floored Signature Lecture Series for in-depth training of how your current pelvic floor muscle status could be contributing to your pain, incontinence, constipation, pelvic organ pressure, or sexual dysfunction complaints, and how home treatments could improve your quality of life pre- or post-hysterectomy. The program includes 12 mini lectures, and 12 progressive exercise programs that I developed based upon current research, as well as my 16 years of experience in pelvic health. You can stream them as often as you’d like from the privacy of your home.
A full pelvic floor physical therapy program, for less than the price of one standard in person PT evaluation!
What other motivation do you need? Did I mention that for every 4 courses I sell, I will donate one to a person in need, through my People Before Profits Program. I am so proud of this. By buying my program you are not only helping yourself (or your loved one), but also someone in need.
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