Life care after extensive hysterectomy

  Earlier stage cervical cancer is often treated surgically. The treatment of malignant tumors, in principle, requires complete removal of the tumor. The recurrence of the tumor can be reduced only by following the norms and removing a sufficient extent. Surgical treatment of cervical cancer requires at least a sufficient length of paracervical tissue and upper vaginal segment. This is known as extensive hysterectomy.  The parametrial tissue of the uterus is where the pelvic autonomic nerves pass through. What is the pelvic autonomic nerve? It is the vegetative nerve that controls bowel movements and urination. After damage to the autonomic nerve, it is easy to have difficulty in urination such as decreased sense of urination, weakness in urination, and urinary retention. Similarly, when the nerve that governs the rectum is damaged, there will be difficulty in defecation. In general, urinary retention is more common than difficulty in defecation. Difficulty in defecation is more common when the surgery is done more extensively.  Catheterization is usually required for 14 days after surgery to prevent urinary retention. This time allows the residual nerve to slowly regain function. However, in general, most patients still have relatively poor sensation of urinary distention after surgery. Even if the bladder is very distended, there is still no sensation of urination. Furthermore, urination is a complex process of coordination of multiple pelvic muscles and the organism needs to relearn the training. Normal urination requires contraction of the bladder forceps and relaxation and stretching of the urethral muscles. Therefore, we will let the patient distend the urine before removing the catheter and let the urine flow out while removing it, making the initial impression of coordinating different pelvic floor muscles for urination. Those who urinate successfully for the first time have less chance of urinary retention later on. In the latter stages of urine expulsion, the patient should urinate as forcefully as if he or she had a bowel movement. In this way, the urine is voided as cleanly as possible. Some patients who were unable to pass urine for several months after surgery miraculously passed urine after instructional training.  Postoperative constipation. Medications to soften the stool can be given, such as fluoride tablets and lactulose. You can also apply open cork softening stools and stimulate bowel movements. Commercially available 20ml of each opener, use 2 at a time and keep it for more than 30 minutes. If the above treatment is not effective, family members can put on gloves, lubricate the index finger, reach into the rectum, and then bend the index finger to dilate the anus and bring out the dry stool.  Our obstetrics department has a physiotherapy device for pelvic floor muscle training, which is also helpful to improve the difficulty of urination and defecation after surgery.