MY SURGICAL PROCEDURE

PELVIC FLOOR SURGERY-ADVICE FOR PATIENTS

WHAT SHOULD I EXPECT?

The following is intended as guidance. Circumstances may vary depending on the extent of surgery you have undergone and any medical conditions you may have.

Dr. Agnew will explain the procedure to you during your consultations and again before going into the operating theatre. You will also find a detailed information leaflet explaining your condition and specific procedures in the clinical information section of this website.

Generally, patients are booked for either a Day Case procedure or an Inpatient stay.

Bring a list of all medications you are on with you to the hospital in case these need to be checked. Once in the hospital however, all medications will be provided and you should not take any medications you have brought with you unless specifically advised to do so.

If booked for an overnight procedure bring your nightdress, dressing gown, slippers and toiletries.

Day Case Procedures

If you have been booked for a Day Case procedure it may be carried out under local or general anaesthetic. Most Day Case procedures last only a few minutes. However, they usually involve the placement of a camera into your bladder (cystoscopy). Following the procedure, it is important to ensure that you are able to pass urine comfortably before you are allowed to leave the hospital. So, following your procedure, you may have to stay in hospital for a few hours.

If under local anaesthetic, it is not necessary to fast from midnight the night before surgery. Dr. Agnew will advise you about taking pain medication approximately one hour before your procedure. If your procedure is under local anaesthetic you may drive yourself home once you have been discharged. Dr. Agnew may give you a prescription for an antibiotic to take following the procedure to reduce your risk of getting a urinary tract infection (cystitis).

If under general anaesthetic, you must fast from midnight the night before surgery. An antibiotic is usually given by the anaesthetist while you are asleep to prevent urinary tract infections (cystitis). Once you are discharged you will not be permitted to drive yourself home. Please make arrangements for someone to collect you after your procedure.

It is advisable that Day Case procedures take the day off work for their procedure, however, most patients should be fit to resume work the following day.

In-Patient Procedures

These procedures require you to fast from midnight the night before surgery. The majority of these procedures are performed through the vagina and do not involve any cuts to the tummy. Most in-patient stays are for three nights. The procedure is performed on the day you arrive.

Immediately after surgery

Patients will be allowed a light diet a few hours after they have returned from the operating theatre. Nausea is a frequent occurrence after you wake from surgery but passes reasonably quickly. Medicine to treat your nausea will be available should you require it.

Following the procedure, you will have a large length of dressing in your vagina. This is called a vaginal pack. It feels like a large tampon. While it may feel strange and uncomfortable it provides very useful compression to reduce the amount of bleeding after surgery.

Patients will also have a catheter in their bladder following surgery. This is to allow the bladder to rest and also means that patients don’t have to try to get themselves to the toilet following surgery.

The first day after surgery is for rest and recovery.

Second day after surgery

On the second morning after surgery, the vaginal pack and the catheter will both be removed. This is not painful and usually makes you feel much more comfortable.

Passing Urine

Passing urine after the catheter has been removed is usually slow. Often patients will pass only small amounts on their first few trips to the loo. Give yourself plenty of time to pass urine. When you think you are finished, lean forward for a minute on the toilet, to see if you can get any more urine out. Then, stand up, wash your hands at the sink and sit back on the toilet for a further minute to see if more will come out. The nursing staff will then measure the amount of urine you have passed and as soon as you have returned to your bed they will place an ultrasound scanner on your tummy to check how much urine is still left inside your bladder. The procedure is not at all uncomfortable and once the staff are satisfied that you are emptying your bladder well they will stop checking.

If the bladder is slow to return to normal emptying, a specialist nurse may visit you on the ward to give you extra assistance. The bladder will return to normal emptying but often just requires some patience and time. Please don’t let this cause you any worry or distress as it is very common and will settle.

Passing Bowel Motions

The bowels may take a few days to open after the surgery. Do not be afraid to strain as normal. YOU WILL NOT DAMAGE THE SURGERY. The bowels often take a few weeks to settle back to a regular pattern. You will be given laxatives in the days following surgery. This is not so much to make you pass a motion. It is more to make your stools soft so that when you do open your bowels it is hopefully less uncomfortable. If you have opened your bowels and if your stools are loose, let your nurse know and we can stop the laxatives.

Pain Relief

Following surgery, many patients have described their pain as similar to how they felt after they had a baby. Plenty of pain medication will be available and will be given to you regularly as required.

Blood Clots

After any surgical procedure, patients are at risk of developing a blood clot, particularly in the blood vessels of their legs or chest. To prevent this, you will be fitted with a pair of compression stockings. You will also receive a daily injection while you are in the hospital to prevent the formation of blood clots. It is important that if you are having a shower, that you replace your stockings once you have dried off.

Many patients will be surprised at how well they feel in the days following the surgery. Ask your nurse if you can spend some time sitting out on a chair or having a walk on the corridor. It is better for your chest and your legs to get up and begin moving again soon after a surgical procedure.

Returning Home

The First week at home

Most patients spend three nights in total in the hospital. When you have been discharged home you should spend the first seven days resting. However, it is better for your chest and your legs to be up and about rather than staying in bed. You should not be doing any housework for the first week. You should not be lifting anything heavier than a full kettle for the first six weeks.

For most patients, regular paracetamol, three times a day, for the first three days at home, whether you feel you need it or not is usually sufficient. After this time, just take it if you need it.

Many patients ask about returning to work on their computers in the first few days after surgery. This will not do any harm, but do be mindful that even if everything goes very well, patients may feel fatigued and physically drained for several weeks following surgery.

Do not be frightened if days or weeks after your surgery you experience a gush of blood or fluid from the vagina. This is very common, particularly as you start becoming more active, and will usually settle down after about 2 weeks. However, if bleeding is continuous or you feel that pain is increasing, or you develop a fever, it is best to consult your G.P. If it is out of hours and you are unwell then it would be best to attend your local Emergency Department. Urine infections (cystitis) are particularly common following vaginal surgery. If you feel any stinging or burning on passing urine it is best to attend your G.P to have your urine checked as you may need an antibiotic.

In terms of foreign holidays, most people would be fit to travel overseas two weeks following surgery, provided they are mindful not to be carrying heavy suitcases and follow the advice already given about activity during the first six weeks.

One week after returning home

After one week at home, you can start walking outside as much as you like. Build it up slowly and listen to your body.

You may begin driving short distances after one week at home. Check that you can sit in the car comfortably, adjusting the controls and looking over both shoulders without undue discomfort before starting the engine.

You may resume normal household activities such as preparing meals for yourself after one week at home. Gradually build up these activities according to how well you feel.

We recommend no other physical exercise except walking for the first six weeks. So, no gyms or exercise classes. However, if you feel well enough, you can walk as much as you like. Stairs and even hillwalking are not a problem

Nothing should go into the vagina for six weeks following surgery, this includes tampons and sexual intercourse. This is because there are many delicate stitches in the vagina and time is required to allow healing. Showers are preferable to baths. After showering gently pat dry with a towel and leave the area of surgery undisturbed. Many people ask about returning to swimming. Physically, swimming should be fine about three weeks after surgery. However, remember there is a wound in the vagina that is trying to heal. Avoiding bacteria in dirty water for six weeks seems sensible advice.

Most patients take 6 weeks off work, particularly those patients whose work requires long periods of standing or who are doing any form of physical work. For those in office environments or in sedentary occupations three to four weeks will often suffice. The house doctor on the ward will provide you with a letter recommending six weeks off work on your discharge.

Six weeks after surgery

You will be booked for a follow-up consultation with Dr. Agnew six weeks after your surgery. This will allow Dr. Agnew to explain your procedure again, to check how your symptoms are progressing and to carry out a gentle examination.

At this time, you will be advised about making an appointment with a Women’s Health Physiotherapist. This is a highly recommended part of your programme. The physiotherapist will also assess your symptoms, examine you and provide specific advice tailored to your lifestyle. This is so important. Dr. Agnew can restore your pelvic floor structures to their normal position but the physiotherapist is the best person to advise you on how to get your bladder, bowel and pelvic floor muscles working effectively again. They will also give you detailed advice on what you should or shouldn’t be lifting and what exercise programmes are suitable for you.

OUR AIM IS TO PROTECT THE IMPROVEMENTS WE MAKE IN YOUR QUALITY OF LIFE FOR MANY YEARS TO COME