Post-Operative Instructions

General

• If you are having a Laparoscopic Hysterectomy or Vaginal Hysterectomy you can expect to spend one night in the hospital. Your doctor will routinely see you the morning after surgery within 24 hours of your procedure and you will be “discharged” to leave sometime that day.
• If you are having an Abdominal Hysterectomy you can expect to spend 2 nights in the hospital.
• Both of these projected hospital stays are dependent on your ability to urinate, have some bowel function (pass gas), and obtain relief with oral pain medicine.
• The night of surgery you will be gotten out of bed, but will have an I.V. line for fluid replacement and pain medicine, and a catheter in your bladder. The next day the I.V and catheter will be removed, and you will be ambulating, getting out of bed to the bathroom, and probably showering.
• If you have your ovaries removed you will usually have an estrogen patch applied when you get to your room. When being discharged your doctor will discuss what method of estrogen replacement you will use (oral, skin patch, gel, or spray). There is much public discussion about “Bioidentical Hormones”. There is, however, no evidence that these compounded products are safer or more effective than natural hormone replacement products currently available by prescription which have undergone scrutiny and testing by the FDA for both effectiveness and safety.

Driving

• We suggest that you do not plan on driving for 2 weeks following surgery and especially while taking narcotic pain relievers.

Activity

• At home we encourage you to “take what your body will give you”. You may go up and down stairs (a rough guideline is to limit your “round-trips” to 2 a day for the first week), take a tub bath or shower, and do what’s necessary to take care of yourself (though nobody else) for the first week or so. Gradually increase your activity daily, especially walking. Our guideline is to wait 3 weeks following surgery before “strenuous” activity, meaning straining that will cause your face to flush for an extended time.

Pain

• You will be prescribed oral pain medicine, usually a narcotic/acetaminophen (Tylenol^®) combination. Additionally you may take Ibuprofen over-the-counter 3-4 tablets 3-4 times daily. This can reduce the amount of narcotic pain medicine you need to take. Each prescription tablet will contain 325 or 500 mg of acetaminophen, and that number will be on the prescription label. You can also take acetaminophen alone. If you have pain unrelieved by these measures call the office.

Nausea

• Occasionally people require medicine for nausea relief when they go home. If so, we will prescribe something.

Incisions

• Most of the time your will have absorbable sutures under the skin which do not need to be removed. You may also have Dermabond, similar to “super glue” applied, which will gradually come off. Occasionally we use skin staples for wound closure, and these will need removal in approximately one week.

Bowels

• Usually passing gas from below is a condition for discharge. After surgery it is extremely important that you do not get constipated. The single major thing that makes people feel well after surgery is resumption of bowel function. We encourage you to have adequate to extra fluid and fiber intake. Products such as Metamucil, Citrucel, Benefiber, etc. taken on a routine basis, 2-3 times a day until bowel movements become regular and normal, can help you recover more quickly. Surgery and narcotics both contribute to constipation. It is important, however, to take adequate pain relief since pain can also inhibit your ability to relax and have bowel movements more easily. Early discharge from the hospital also facilitates return to normal bowel function since most people more easily relax in the familiarity of their own home.

Bladder

• You should be emptying your bladder normally when discharged. In the rare instances when you are discharged with a catheter we will instruct you on how and when to remove it. If unable to void, call the office.

Bleeding

• You will probably have some slight bloody discharge that will gradually become white/yellow vaginal discharge, usually still be present at your Post-Op visit . Any bleeding should always be less than a “normal” menstrual period. You may have a “gush” of bloody discharge 2-3 weeks after surgery. If persistent or if you have questions please call the office. Many times at the post-op visit a small amount of raw slowly healing tissue at the top of the vagina called “granulation tissue” is seen and is usually dispensed with by an application of silver nitrate. This is quite common, can be a source of discharge, but can always be eliminated.

Questions

• Please call the advice nurse at 919-781-9555 for any questions or concerns. That is also the number to call to reach the doctor on-call for after hours emergencies.

Post-op appointment

• You will always be seen in 5-6 weeks. You will often be made aware of this appointment date and time prior to your surgery, but we will also mail it to you. If for some reason you have not received this by one week following surgery, call the office 919-781-9555 to clarify. We may also ask to see you sooner than that, and you will be told if we feel that is necessary.

Discharge from hospital

• Normally you will go home the same day of surgery.

Incisions

• The number and size of incisions depend on the procedure, and may range from one to four. They will all be small and closed either with absorbable sutures (do not need removal), Dermabond (an adhesive like “super glue”), or both. If your incision has a bandage on it you may remove it the day following surgery unless specifically instructed otherwise.

Shower and bath

• Ordinarily you may do either, though “soaking” incisions is less advisable for the first few days after surgery. It’s important to gently clean the umbilicus and make sure it is gently and completely dried.

Pain

• You can expect to have varying degrees of discomfort (Don’t you like that word?) from your incisions, your pelvis, and from your shoulder(s). The incision and pelvis because these are the sites where incisions and tissue manipulation actually took place. The shoulder pain is due to the small amount of gas (CO2) used to create space during the operation left in the abdomen. This will usually disappear the first or second day. It is felt in the shoulder area because the gas “floats” up irritating the diaphragm which gets it’s nerve supply from the same area of the spine as the shoulder.

Pain relief

• You may use ice on the incisions. If you experience shoulder pain, when upright, lying down will usually relieve it. Over-the-counter medicines such as ibuprofen, 3-4 tablets 3-4 times a day, and acetaminophen (Tylenol^®) can help. You will also be given a narcotic/acetaminophen combination prescription for pain relief. Your prescription will be labeled with the mg of acetaminophen contained in each tablet (either 325 or 500).

Bleeding

• Depending on your procedure you may have a small amount of vaginal bleeding. If it is greater than a period call the office.

Post-op appointment

• You will normally be seen in 2 weeks. You will often be made aware of this appointment date and time prior to your surgery, but we will also mail it to you. If for some reason you have not received this by one week following surgery, call the office 919-781-9555 to clarify.

Questions

• Please call the advice nurse at 919-781-9555 for any questions or concerns. That is also the number to call to reach the doctor on-call for after hours emergencies.

Procedure

• You will have a 5 mm (about ¼ inch) mesh sling placed in the vagina to support your urethra to prevent urine loss with straining. This mesh will be placed through a small incision inside your vagina and brought out through two small incisions in the very upper inner thighs. This will be done as an outpatient through Same day Surgery at Rex Hospital. You will go home that day and almost always able to empty your bladder without leaking.

Anesthesia

• You will have a “light” general anesthesia from which you will wake-up very quickly.

Pain

• The most common pain is in the upper thighs where the sling is pulled through the skin (the sling is cut-off below the skin, so doesn’t protrude). This usually lasts 2-3 days. You may use cold packs to this area as needed to reduce pain, and bruising. Generally over-the-counter medicines such as ibuprofen, 3-4 tablets 3-4 times a day, and acetaminophen (Tylenol^®) can help. You will be given a narcotic/acetaminophen combination prescription for pain relief. Your prescription will be labeled with the mg of acetaminophen contained in each tablet (either 325 or 500). If you have pain unrelieved by these measures, call the office.

Activity

• This procedure works by creating a “floor” or “hammock” which keeps your urethra (the tube from your bladder to the outside of your body) from moving too much when you strain, such as coughing. Consequently it is important that it have a chance to get fixed or incorporated into the tissue under your urethra. So you must limit strenuous activity including intercourse for 4 weeks minimum, and 6 weeks is better. Gradually increase your activity as tolerated. Plan on not driving for one week, though you may feel like doing so sooner, but you should wait a minimum of 4 days.

Incisions

• The incisions in your upper thighs will be covered with Dermabond which will wear-off. The small incision in your vagina will be closed with sutures which will dissolve automatically.