Tubal Ligation

Tubal ligation, which is sometimes known as having your tubes tied, is a surgical procedure that closes your fallopian tubes so that your eggs cannot be fertilized. Tubal ligation is considered a permanent method of birth control.

Understanding Tubal Ligation: Risks and Benefits

Since this is a permanent procedure and difficult to reverse, you should have a tubal ligation only if you never want to become pregnant in the future.

Even though considered permanent, a tubal ligation, through major surgery, can sometimes be reversed. The reversal attempt carries risks, is expensive and not always successful. Women under the age of thirty must be particularly cautious when considering tubal ligation, as regret is common later on. Tubal ligation does not protect against sexually transmitted diseases. You must use other methods to guard against these infections. A tubal ligation does not affect your menstrual cycle.

Treatment Options

If, after careful consideration, you have decided to get a tubal ligation, the procedure may be performed by laparoscopy or mini-laparotomy. Depending on which method is used, the surgery can be done under general anesthesia, spinal anesthesia, or, rarely, local anesthesia with sedation. The procedures are performed in the hospital right after childbirth or as an outpatient.

In laparoscopic tubal ligation, your surgeon will typically make two small surgical cuts in your stomach. Gas may be pumped into your stomach to create a space for the surgeon to work in. This helps protect the other organs during the surgery. The laparoscope, a small tube with a camera attached to the end, is inserted into one of the openings , allowing your surgeon to see inside your stomach during the surgery. Surgical tools are inserted through the other small cut to block off your tubes.

Mini-laparotomy, which is an open surgical procedure, may be preferred if you are having a tubal ligation immediately after giving birth, or if you are severely obese. In this procedure, a small incision is made just above the pubic bone. The fallopian tubes are closed under direct vision through the mini-laparotomy incision.

Regardless of the type of surgery, the tubes will be closed by one of two ways. The surgeon will use a heated needle to cauterize or burn the tubes shut. Or, the tubes will be clamped with a small clip or band that loops around and closes the fallopian tube. The small surgical cuts are then closed with stitches or staples.

Risks of Tubal Ligation

Tubal ligation is a very common procedure and relatively safe. Complications rarely occur. There are risks, however, as with any surgical procedure. The risks related to tubal ligation include:

  • Bleeding in the surgical wound or the abdomen
  • Infection in the surgical wound or the abdomen
  • Blood clots, and
  • Damage to blood vessels, nerves, muscles, or organs such as the bladder, ureter, or bowel, which may require surgical repair

There are also risks associated with general anesthesia, such as allergic reaction to the anesthetic, difficulty breathing, nausea or vomiting, and death.

The last type of complication that can occur is failure of the procedure, which may lead to pregnancy, even several years after surgery. A missed period should always be investigated. Pregnancy can happen if the tubes create a new opening for the egg to pass through or a clip or band comes off. If this happens, an egg may become fertilized and implant within the fallopian tube, an ectopic pregnancy. This is a medical emergency and may require surgery to remove the implanted embryo or fallopian tube.

What to Expect after Tubal Ligation

After your surgery, you may be given medications to help control pain. Take these medications as directed. Following surgery, you may experience:

  • Minor pain at the incision sites
  • Shoulder pain
  • Vaginal spotting

These are all common symptoms and should get better in a few days. Heavier menstrual flows may occur for a few months.

Be sure to get plenty of rest. Avoid strenuous activity, heavy lifting, driving and resumption of normal activities until directed by your surgeon.

When to Call Your Surgeon

Call your surgeon if you notice any unusual symptoms, such as:

  • Swelling, oozing, worsening of pain, or unusual redness around the incision
  • Fever over one hundred degrees Fahrenheit
  • Worsening abdominal pain
  • Diarrhea, bloating, or constipation
  • Nausea or vomiting; or
  • Calf pain, leg swelling, or shortness of breath.

What to Do

Before your surgery, discuss any questions or concerns you may have about the operation with your surgeon.

Alternative Therapy

Several other methods of permanent birth control are available and do not require a major surgical procedure. These include fallopian tube springs or plugs, which work by permanently blocking the fallopian tubes. There are other effective forms of birth control that are not permanent, including hormone injections, contraceptive implants, and the intrauterine device, or IUD. The birth control pill is almost as effective and very easy to discontinue. Birth control pills and IUDs have the added benefit of helping to regulate your menstrual cycle. If you are taking birth control for the purpose of regulating or lessening your menstrual flow or cramping, tubal ligation may not be a good choice for you. Talk with your health care provider if you are interested in one of these methods.

What We Have Learned

Tubal ligation is a method of birth control that is considered permanent.
True or false.
The answer is True.

A tubal ligation may be performed by laparoscopy or mini-laparotomy.
True or false.
The answer is True.

Hormone injections and contraceptive implants are effective and reversible forms of contraception.
True or false.
The answer is True.