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Post-operative Instructions |
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Hysterectomy 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.
- o 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.
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Hysteroscopy, D&C,
Endometrial Ablation
Procedures
- Hysteroscopy may be performed alone or in combination
with one or both of the other two. They are out-patient, same-day-surgery
procedures.
Anesthesia
- You will receive I.V. sedation (MAC, Monitored Anesthesia
Care), and local anesthesia injected into the cervix.
Activity
- You should "take it easy" the day of surgery. In most
cases you will feel pretty normal the day after surgery. If you have had an
ablation, you may have cramping lasting for a few days post-operative. You may
shower the day after surgery. Refrain from intercourse for a week after
surgery.
Pain relief
- Generally over-the-counter medicines such as ibuprofen,
3-4 tablets 3-4 times a day, and acetaminophen (Tylenol®) can help. If you
have had an ablation, you may 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). If you have pain unrelieved by these measures, call the office.
Bleeding
- You will probably have some vaginal bleeding but it
should be less than a period. Following ablation you can expect some discharge
of varying consistency lasting until your post-op exam, and often up to 2-4
weeks.
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 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.
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Laparoscopy
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.
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Tension Free Vaginal Tape Obturator
(TVT-O) Suburethral Sling
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.
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