A Hysterectomy Incision Sucks. But You Should Probably Know More About It Than That

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Obviously, you will be worried about the kind of hysterectomy incision they will make.

A lot will depend on how the surgery is performed. The location and nature of the incision can vary depending on whether your hysterectomy is performed via an abdominal incision, laparoscopic incision, or vaginal incision.

We will try to help you understand the most important things to know about the types of incisions that are typically made during a hysterectomy and how this affects recovery.

Read more about the different types of hysterectomy

Where Is a Hysterectomy Incision Located?

For an abdominal hysterectomy, they generally make the incision in the lower part of the abdomen and close to the pubic bone. For a laparoscopic hysterectomy, they make three or four smaller incisions, one of which is close to the belly button. A vaginal hysterectomy is quite different, as this incision is made internally in the vagina.

Abdominal hysterectomy Incisions can be either vertical (which starts in the center of the abdomen and ends just above the pubic bone) or horizontal bikini line (just above the pubic bone). Depending on the reason for your hysterectomy procedure, you may be more likely to have one type of incision over the other. For example, if you have large fibroids, endometriosis, or cancer, it is more likely that you will have a vertical incision.

Read also: Essential Advice for Husbands After a Hysterectomy – Practical Tips For Emotional Support.

The Vaginal Cuff

Whatever the type of hysterectomy, you will have an incision at the very top of the vagina. The place where they stitch the vagina together is the vaginal cuff. Only when they perform a partial hysterectomy (supracervical hysterectomy) will they leave the cervix and the top part of the vagina.

The appearance of a Hysterectomy Incision

One of the things that women are often concerned about regarding a hysterectomy involves scarring. They worry whether other people can tell that they have had the procedure.

With a vaginal hysterectomy, this is not a problem, given that the incision they make is inside the vagina and does not leave any visible signs on the outside. With an abdominal and laparoscopic hysterectomy, it can be a different story. It may be obvious to other people that you have had a hysterectomy or a cesarean section.

Abdominal hysterectomy incision

This is more than obvious, especially in the case of an abdominal hysterectomy. They make only one incision, which allows the surgeon to see all of your pelvic organs at once; unfortunately, it also means you will probably have a relatively large scar on your abdomen afterward. The appearance and location of this scar depend on which type of incision the surgeon makes.

Vertical incision scars usually run from the belly button to the pubic area but may sometimes be a bit more extensive than this, especially if you have a large uterus that requires a larger incision. Because the location of vertical incisions is on the abdomen itself, they are more exposed and are not easy to cover with underwear. This can make you self-conscious about your body, especially on vacations. For this reason, many women opt for a one-piece swimsuit rather than a bikini.

Horizontal incision scars generally run along the width of the pubic area and tend to be less obvious. A horizontal incision scar, or a bikini line incision, as some call it, can easily be covered with underwear or swimwear so it will be less visible to most people.

Laparoscopic hysterectomy incision

For both a laparoscopic hysterectomy and a robotic-assisted laparoscopic hysterectomy, they will make a series of small incisions.

These are around half an inch each in size, small enough to pass a tiny camera through the incision to see inside the pelvis. Laparoscopic incisions tend to heal more quickly than abdominal incisions.

But there will still be some scarring once the incision sites have healed. As these are located on the abdomen, it is likely that people will be able to see the scars.

Not everyone will experience the same type of scarring. You may have more or less scarring even compared to someone who has the same type of hysterectomy and incision. Deciding factors include the skill level of your surgeon, your body’s own healing ability, whether the incision gets an infection, and the method they use to close your incision(s).

What do they use to close a Hysterectomy Incision?

Sutures (stitches) and staples are most commonly used for larger hysterectomy incisions. However, many surgeons prefer to use glue or surgical tape (also known as Steristrips) for smaller incisions. It may also be the case that you have a combination of these to close your incision(s).

If they use stitches, they will use just a few per incision for most laparoscopic hysterectomies.

They often use dissolvable stitches as these have the advantage that you don’t have to remove them physically. If you need stitches removed, this usually happens a week or so after your surgery.

Vaginal hysterectomies use internal incisions to close the vaginal cuff, with the stitches being absorbed by the body. This takes away any need for the removal of stitches at a later date.

Potential Post-Incision Complications

Bleeding can sometimes affect the incision site and can be a sign of infection. Especially if you also develop redness and discharge in and around the incision area, and it feels warm to the touch.

Again, a delay in wound healing and a strange smell may also be signs of an infection.

The risk of infection is higher if you have had an abdominal hysterectomy. So, closely monitoring how the incision area recovers is important. Do seek medical advice if you suspect that it has become infected.

I can also recommend Iodosorb gel, which prevents post-hysterectomy wound infections. It is also the number one treatment for difficult healing wounds and for fluid reduction of weeping wounds.

Read also: Managing Hysterectomy Scar Tissue, 10 Effective Treatments and Techniques

Post-Incision Care

As aftercare can be a key factor for proper healing, be sure to follow any instructions you have from the hospital for taking care of the incision site once you get home.

With an abdominal or laparoscopic hysterectomy, they cover the wound with dressings in the early stages of your recovery. Generally, you need to keep these on for a few days while the wound starts to heal. You also need to change the dressings regularly in the early stages of recovery.

Initially, you must keep the wound and dressing as dry as possible. If the dressing does get damp, changing it as soon as possible reduces the risk of infection.

You can keep the wound clean by washing it with water and mild soap. It’s often fine to remove the dressing and have a shower once the wound starts healing. But check beforehand with your doctor if you are not sure. Having a bath (submerging the wound in water) is generally best to avoid until they advise you otherwise.

Some women report that their hysterectomy incision feels numb. This is normal as they damage superficial nerves during surgery, and the nerve tissue may take a few months to heal. Sometimes, wounds can become very itchy when they heal. It may be tempting, but applying creams or lotions directly on the incision is not recommended. This may delay the healing process of your wound. Rather, apply an ice pack for about 10 minutes, but never directly on the wound.

Reviewed by: Kimberly Langdon M.D. (OB/GYN)
Date reviewed: 18/3/2019

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