A hysterectomy is a common surgical procedure involving the removal of the uterus, performed for various gynecologic conditions. While modern surgical techniques and preventative measures have made this operation very safe, post-operative infection is a recognized complication. Understanding the potential sites of infection and the signs to watch for is instrumental in ensuring a swift and uncomplicated recovery. Being informed about post-operative care allows patients to partner effectively with their healthcare team to manage any issues that arise.
Where Infections Occur
Infections following a hysterectomy are generally categorized by their location within the surgical field, which includes the external incision and the deeper pelvic spaces. The most common type of post-operative infection is a Surgical Site Infection (SSI), which can manifest at the external incision used for abdominal or laparoscopic approaches. These infections typically involve the skin and underlying subcutaneous tissue near the scar.
A specific infection unique to hysterectomy is vaginal cuff cellulitis, or a vaginal cuff infection. This occurs at the top of the vagina where the incision was made to detach the uterus, creating a closure known as the vaginal cuff. The tissues in this area can become inflamed and infected, often presenting a few days to a week after the operation. If this infection is not addressed, it can potentially deepen into a pelvic abscess, a localized collection of infected fluid in the deeper pelvic spaces.
Another frequent post-operative infection is a Urinary Tract Infection (UTI), related to the manipulation of the bladder or the use of a urinary catheter during surgery. UTIs are common because bacteria can travel up the catheter into the bladder. While a UTI is not an SSI, it is a significant source of fever and discomfort in the early post-operative period.
Identifying Symptoms That Require Medical Attention
The ability to distinguish normal post-operative recovery from a developing infection is important for patient safety. One of the most common signs of a systemic infection is a fever, specifically a temperature of 100.4°F (38.0°C) or higher. While a low-grade fever is often expected in the first 24 to 48 hours after major surgery, a persistent or rising fever should prompt a call to the medical provider.
Patients should watch for changes in vaginal discharge, especially if it becomes foul-smelling, yellow, or purulent, as this suggests a vaginal cuff infection. Severe or worsening abdominal or pelvic pain that is not relieved by prescribed pain medication also signals a potential deep infection or abscess formation. Increasing pain, particularly when combined with fever, requires immediate medical evaluation.
Signs that an external Surgical Site Infection is developing include increased redness, warmth, swelling, or tenderness around the incision. Any drainage from the site that is cloudy, thick, or green, or if the incision begins to separate, indicates a localized infection that needs prompt attention. For potential UTIs, symptoms like a burning sensation during urination, an urgent or frequent need to urinate, or pain above the pubic bone should not be ignored.
Managing and Treating Infections
Once a post-hysterectomy infection is suspected, the medical team begins confirmation and targeted treatment. Diagnosis typically involves a physical examination, which may include a pelvic exam to check for tenderness or swelling at the vaginal cuff. Blood tests are ordered to look for an elevated white blood cell count, suggesting the body is fighting an infection, and cultures of urine or blood may be taken to identify the specific bacteria.
The core treatment for most post-hysterectomy infections is antibiotics, often started empirically with a broad spectrum to cover the most common pathogens. For severe or deeper infections, such as a pelvic abscess or significant cellulitis, antibiotics are initially administered intravenously in a hospital setting. Less severe infections, like a superficial wound infection or a mild urinary tract infection, may be managed at home with oral antibiotics.
In cases where an abscess or a collection of pus has formed, treatment involves a drainage procedure in addition to antibiotics. Draining the infected fluid collection, which can be done surgically or with a needle under imaging guidance, helps to shorten the duration of the infection. Patients are monitored closely until their fever resolves and clinical symptoms significantly improve, often requiring a switch from intravenous to oral antibiotics before discharge.
Reducing the Likelihood of Infection
Preventing infection begins even before the patient enters the operating room with the administration of prophylactic antibiotics. A single dose of an antibiotic, often a cephalosporin like cefazolin, is given intravenously within one hour before the first incision is made to ensure adequate drug concentration in the tissue during the procedure. For long surgeries or those involving significant blood loss, a second dose may be given to maintain protection.
The medical team also focuses on meticulous skin preparation before surgery, often using an antiseptic solution that contains alcohol and chlorhexidine gluconate on the abdominal skin. For procedures involving the vagina, a separate antiseptic preparation is used to reduce the bacterial load from the vaginal flora, which is a major source of post-operative infection. Treating any pre-existing conditions, such as bacterial vaginosis, is also an important preventative step.
After the surgery, the patient’s role becomes the focus of prevention, centering on proper care of the surgical site. The patient should follow instructions to keep the external incision clean and dry, which involves avoiding soaking the wound in baths or pools. Activity restrictions are also put in place, as avoiding heavy lifting and strenuous activity prevents tension on the healing tissues, minimizing the chance of wound separation or internal trauma that could create a space for infection to grow.