Hysterectomy- By Physioscare| 2021

Hysterectomy- By Physioscare| 2021
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Hysterectomy

– The surgical removal of uterus is called as hysterectomy.

– Total hysterectomy  refers to the removal  of the uterus along with one or both fallopian tubes and ovary depending on the condition.

 

Indications

Prolapsed uterus

Menorrhagia

Fibroids

Carcinoma

Dysfunctional uterine bleeding

Uterine  ir ovarian cyst

Benign tumors  of myometrium

 

Types

– Vaginal hysterectomy

– Abdominal hysterectomy

 

1. Vaginal hysterectomy

– When child bearing is complete and the condition of uterus  is  malignant a vagiinal hysterectomy  is done in caseof uterine prolapse.

– Under general anesthesia,  the cervix is drwan down and an incision is made in the anterior wall of vagina.

– Transverse cervical and uterosacral ligaments are divided from the cervix and the uterine blood vessels are ligated and cut.

– Once the fallopian tubes, round ligament and ovarian ligament are tied, and divided, the uterus and cervix can be removed.

 

Schauta’s hysterectomy

It is a radical vagina hysterectomy in which the ovarian, tubes, most of vagina and pelvic cellular tissues are also removed vaginally.

Complications

Hematoma of vaginal vault.

Infection

 

2. Abdominal hysterectomy

Either pfannenstiel incision or paramedian incision is used.

 

Wertheim’s hysterectomy

It is done for carcinoma

It involves removal of uterus, fallopian, ovaries,  most of vagina, pelvic lymph nodes.

 

Subtotal  hysterectomy

It involves removal of funds and body of  uterus.

 

Total hysterectomy

It involves removed of uterus, fallopian tubes and ovaries.

 

Extend hysterectomy

It involves total hysterectomy along with removal of cuff if vaginal and pelvic lymph nodes or biopsy.

 

Complications

Backache

Stress incontinence

Dyspareunia

Reduced bowel frequency

Increased urine frequency

Urinary incontinence

 

Physiotherapy management

 

Assessment

1. Patient profile

2. Chief complaints

3. History

  • Present
  • Past medical surgery
  • Surgical history

 

4. Obstetic notes

– Any secretions

– Indications

– Types of surgery

– Vaginal hysterectomy

– Abdominal hysterectomy

– Types of incision

– Post menopausal bleeding

– 3 point scale

– Duration

– Texture

– Pressure

– Grading of pelvic floor muscles

 

5. Musculoskeletal examination

6. Cardiorespiratory assessments

 

Physiotherapy aims

 

Prevention of circulatory and respiratory complication

To strengthen pelvic floor, back and abdominal muscles.

To teach postural correction exercise

Advise on backache

Functional training

 

Physiotherapy means of treatment

 

A. Day of operation

– Adequate assesment with proper gynecological and surgical notes are taken

– Assistive deep breathing exercises with inspiratory holds.

– Huffing technique with incisional support.

– Removal of airways secretions

– Active cycle of breathing techniques.

– Ankle/ foot exercise

– Repeat these exercise 3-4 times/day

 

B. Day 1 post- operatively

– Bed mobility exercise

– Sitting out of bed for 10 mins

– Rolling side to side

– Supine to sitting exercise

– Calf muscle stretching

– Pelvc tilting exercise

– Exercise to prevent DVT and circulatory complications

– Unilateral upper limb movemet and chest expansion exercises.

 

C. Day 2 post-operatively

– Short  distance walking

– Pelvic rocking

– Abdominal strengthening

– Incentive spirometry

 

D. Day 3 onwards

– Pelvic floor contractions

– Ambulatory exercise

– Functinal training

– Postural correction exercises

 

E. Post- opertaively radiotherapy

– It is mainly for patient with malignant disease

 

F. Home Exercise

– Avoid lifting heavy weight for 4 weeks

– Start short distance walking 2nd week

– By 6 week can resume driving

 

Post operative complication

DVT

Bleeding

Respiratory

UTI

Chest infection

Wound infection

Incontinence

Dyspareunia

 


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