You have been scheduled to undergo pelvic reconstructive and/or urinary incontinence surgery. Below are some general guidelines to assist you in your surgery and recovery.
The goals of pelvic reconstructive surgery are to restore normal anatomy, to maintain of restore normal bowel and bladder function and to maintain vaginal capacity for sexual intercourse. If your own tissues appear too weak or insufficient, other materials may be used to aid in the repair. These materials include biologic and synthetic products, some of which are permanent.
Please make sure that you get copies of all preoperative tests done by your family physician and bring it with you for your preoperative appointment at the hospital. The hospital will call your home the night before surgery regarding what time you are to arrive on the day of surgery. Our office does not determine this time and cannot provide this information.
This includes medications such as Motrin, Advil, Ibuprofen, and Aleve. If necessary, you can take Tylenol for headaches or pain. In addition, stop all herbal medications or supplements, such as vitamins E and C, as they sometimes may cause problems with bleeding during and after surgery. Any other medication such as antibiotics, high blood pressure medications, and heart medications should be continued unless otherwise specified.
However, each case is different; So you must check with the Doctor who is prescribing you this medication to see what he/she prefers and confirm this with Dr. Stubbs.
Cigarette smoking is one of the greatest causes of preventable mortality in the United States, and patients who currently smoke or have smoked in the past are at higher risk for complications both during and after surgery.
Tobacco smoke has a damaging effect on the heart, lungs and immune system which means that smokers and previous smokers are more likely to suffer from problems with the heart or lungs, and/or with wounds not healing properly after surgery. If you need assistance with quitting, please ask us so that we can help.
You are scheduled to undergo an operation that includes the risk of possible bowel injury. To keep the bowel clean at the time of surgery and reduces the risks of contamination you will need to complete a “bowel prep” the day before surgery using the “Fleet Prep Kit #1.” This prep kit may be picked at the local pharmacy without a prescription.
Instructions for Fleet Prep Kit #1
- Noon - Drink Fleet phospho-soda solution and follow immediately with 8 oz of clear liquids.
- 2 pm - Take 4 Fleet bisacodyl tablets by mouth.
- 4 pm - Insert Fleet bisacodyl suppository per rectum.
This encompasses anything you can see through such as fruit juices that don’t have any pulp (apple, grape, cranberry, etc.), broth soups (nothing with pieces of vegetables, meat, potatoes, pasta, etc.), Jell-O, and sherbets. Make sure that your drink plenty of fluids in order to flush out your bowels.
Any medication that must be taken the morning of surgery should be taken with a very small sip of water.
Surgeries are usually performed on a “23-hour” basis in which you will stay overnight and go home the following morning after breakfast. The majority of surgeries are done almost entirely through the vaginal. Small puncture incisions along the pubic hair line or buttocks are sometimes necessary. You will have absorbable suture in the vagina that will dissolve in several weeks and some deeper permanent sutures what maintain your repair. In select cases, small bone anchors (titanium screws) are inserted into the pubic bone.
Although complications are infrequent, they do occur. They may include bleeding and infection (of the suprapubic area, vaginal area, or pubic bone), erosion or infection of the graft material (possibly requiring further surgery), accidental injury to the bladder, pain, inability to urinate (retention of urine), recurrent or worsening incontinence, new or worse vaginal prolapse, urgency or urge-type incontinence, injury to the ureter (tube that carries urine from the kidney to the bladder) or bowel (which may require an abdominal procedure to correct), narrowing of the vagina or pain with sexual relations and other medical problems. We do not require routine blood donation before surgery.
It is possible that a graft or mesh may be used to help in the long-term success of the repair. With any type of graft or mesh there is the possibility of rejection or exposure of the graft/mesh, such that the vaginal incisions partially separate. The more common exposures may be able to be treated with observation, vaginal estrogen cream, or a minor procedure in the office. Occasionally, patients may have another surgery to remove the graft/mesh partially or in it entirety. In rarer instances, the graft/mesh may invade into the surrounding organs such as the bladder, bowel, or rectum, which would require more extensive surgery.
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When you wake up from your surgery, you may have a large tampon-like pack in your vagina. This is typically removed the day or so after surgery. You will also have a Foley catheter exiting from the urethral (the tube that empties your bladder) to allow urine to drain from the bladder into a bag. The catheter has a balloon on it to prevent if from falling out. This catheter may be removed the day or so after surgery to see how effectively you can empty your bladder. As there is often swelling after surgery, some patients are unable to effectively empty their bladder immediately after surgery, and either they go home for with a Foley catheter or are taught intermittent self-catheterization. The ability to empty your bladder effectively is not a reason to remain in the hospital.
You may cleanse the catheter area daily with mild soap just where the catheter enters the urethral meatus (where the catheter enters your body). In most cases, the catheter will be connected to a drainage bag that allows urine to empty from your bladder continuously. The drainage bag should be emptied every few hours as it fills up. Always keep the bag lower than the bladder area, so that it drains properly with gravity. In other cases, the catheter is not connected to a drainage bag, but instead has a plug in it. By removing the plug, urine will be allowed to empty from the bladder. How often the bladder needs to be emptied will depend on your fluid intake, but in general, it will be around every 4-6 hours.
In rare cases, this plugged catheter may be small enough to allow you to urinate around it and the plug is removed only after urination to empty the urine remaining in the bladder. The amount of urine remaining in the bladder after normal urination is called the postvoid residual (PVR). Once your postvoid residuals are consistently less than 100 ml, the catheter may be removed. The catheter may be tape loosely to your leg to prevent tugging on it as you move or walk.
How often you will need to catheterize yourself will depend on your fluid intake, but in general, it will be around every 4-6 hours. You always want to try to urinate normally before each catheterization, and it is very important that you do not strain to try to urinate, but instead relax. Once your postvoid residual (PVR) is consistently less than 100 ml you may stop catheterizing. For detailed instructions on intermittent self-catheterization, please refer to the pamphlet provided in your pre-op packet.
When you go home you will be walking around, probably without assistance. For the first week or so after surgery, it is usually a good idea to stay around the house, but you are NOT on strict bed rest. It is important that you be fairly active in order to avoid infections, blood clots, and slow intestinal recovery. After the first week, depending how you feel, you may walk outside, go to Services, go shopping, etc.
It is possible that a graft or mesh may be used to help in the long-term success of the repair. With any type of graft or mesh there is the possibility of rejection or exposure of the graft/mesh, such that the vaginal incisions partially separate. The more common exposures may be able to be treated with observation, vaginal estrogen cream, or a minor procedure in the office. Occasionally, patients may have another surgery to remove the graft/mesh partially or in it entirety. In rarer instances, the graft/mesh may invade into the surrounding organs such as the bladder, bowel, or rectum, which would require more extensive surgery.
Bathing
You may begin showering two days after your surgery, but make sure someone is there to assist you getting in and out of the shower. Some patients find that placing a chair in the shower is helpful. You may resume tub baths 10-14 days after your surgery, if you desire.
Diet
Please eat and drink what you like. It is not uncommon to have a poor appetite after surgery. It is not a cause for alarm as long as you keep up some food intake. It is important to have a healthy fluid intake, 6-8 glasses per day. Although all liquids are OK, water is the best as some patients find juices and caffeinated fluids irritating to the bladder. There is no advantage in drinking excessive amounts of fluid as it will cause urinary frequency.
Pain
Post-operative pain varies widely from person to person. In any case, we expect you to have good pain control. At discharge you will be given a prescription for a mild narcotic. It is also OK to use anti-inflammatory medications like Motrin, Naprosyn, Ibuprofen, Aleve, etc. along with your mild narcotic.
Bowel Function
We typically begin using stool softeners in the immediate post-operative period. The change in activity and diet following surgery can lead to constipation. Pain medication can be another problem in this area. If you do not have a normal bowel movement within the first few days of surgery, please take a gentle laxative such as Milk of Magnesia or Senekot. Anything that you have used in the past with success is OK. It is extremely important to avoid straining with bowel movements.
Vaginal Bleeding
It is common to have some vaginal bleeding for 10-14 days after surgery. Over time this bleeding should decrease overall and usually after the first week or so, it is only spotting on a pad. You may notice some increased bleeding or spotting as your activity increases, but usually this subsides with rest. If the bleeding persists despite decreasing your activity, call our office.
Vaginal Discharge
There are stitches inside the vagina from the surgery. Some of these will dissolve, but it may take a full 6 weeks. In the meantime, your usual vaginal secretions can collect on the stitches. This can cause bacteria to grow leading to discharge, odor, and itching. The best prevention is to soak in a tub a few times per week starting about 10-14 days after your surgery to help keep this area clean. Avoid using strong soaps or perfumes which may contain chemicals that will irritate the tissues. You may notice some small sutures passing vaginally. These are absorbable and passage of them is normal.
Normal Activity
It is important to be active, walk, and breathe deeply to prevent blood clots and pneumonia. It is OK to go up and down stairs carefully. Remember that your body is using much of its energy in the healing process, so is normal to feel tired. Plan to take naps and get extra sleep. You will not be able to do all of your usual tasks, so it is wise to plan for assistance from friends and family, particularly in the first week.
Prohibited Activity
Heavy lifting (no lifting more than five pounds, and in general, anything which requires two hands to lift is too heavy), exercising (no treadmill, golf, aerobics, etc.), and vaginal intercourse. There is no exact time frame for resuming full activity. For simple incontinence surgery, it is probably OK to resume activities after about 3-4 weeks. For more complex reconstructive surgery, it is best to wait for at least 6 weeks. Complete wound healing does not occur for up to 12 months after surgery, so make sure you are careful about lifting and doing strenuous activities the first several months after your surgery.
Driving
It is fine to ride in a car, but you should not drive until you have adequately recovered. Your reflexes may be slowed by post-operative pain or pain medication. Therefore you must abstain from driving or operating machinery while you are on pain medications and for at least the first 2 weeks after surgery. A good rule of thumb is that if you have not needed any pain medication for 3-5 days then you are probably safe to drive.
Returning to Work
In general pelvic organ prolapse surgery and incontinence surgery are major surgeries, and as such, they require adequate time for proper healing and long-term success. Returning to work will depend on what type of surgery you have and how quickly you recover. Most patients may return to work 4-6 weeks from the date of surgery. Some patients, however, feel that they do not need this 4-6 weeks convalescence.
Sexual Activity
Refrain from sexual activity for 6 weeks after surgery. In addition you should not put anything in the vagina including tampons and douches for 6 weeks after surgery. When resuming intercourse, most patients experience some soreness and discomfort initially, but, in the majority of cases, this will improve with time. To help alleviate some of this discomfort, it is a good idea to use water-soluble lubricants such as Astroglide or KY, both of which are available over the counter without a prescription.
For the great majority of postmenopausal patients, we recommend resuming vaginal estrogen therapy (usually in the form of Premarin cream, Estrace cream, or Vagifem tablets) 2-3 weeks following surgery. This will promote healing and help maintain the suppleness and health of the vagina long after healing has occurred. In fact, we recommend continuing this treatment two to three times per week indefinitely (forever).
- Bright red vaginal bleeding larger in quantity than a period.
- Temperature greater than or equal to 101.
- Persistent nausea/vomiting.
- Worsening pain not relieved by prescription pain medication.
- Redness in incision areas or severe tenderness or drainage from incisions.
- Constipation that does not respond to the above described over-the-counter remedies.
- Urinary retention (unable to urinate).
Any questions or concerns that you may have regarding your surgery or recovery:
912-303-0891
Prior to your surgery please make sure that all your questions and concerns have been addressed to your satisfaction. It is our privilege to have you as a patient, and we hope that your surgical experience will be as pleasant as possible.
