Recovering from Gynaecological Surgery
Recovering from Gynaecological Surgery

Recovering from any surgical procedure will take a variable amount of time, depending on the type of procedure that you have had and individual health factors (such as age, medical problems and smoking status).  Even simple procedures may require time to recover as your body attempts to heal the damage that surgery naturally causes.  For gynaecological surgery, the approach to surgery will often drive recovery times. There are general and specific issues that may make your recovery more smooth.

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What to expect after your surgery

Following your surgery, there will be a variable length of time for you to recover based upon a number of factors:

  1. The type of surgery performed;
  2. Your age and previous medical problems;
  3. The occurrence of any post-operative complications;
  4. Individual factors unique to you (e.g. pain threshold, tolerance of nausea, ability to move freely).

The recovery time may be anywhere from a few days to a few months depending on these factors. The following information will be broken down into 4 groups, from the quickest recovery to the slowest recovery:

  1. Hysteroscopic surgery
  2. Laparoscopic surgery
  3. Vaginal surgery
  4. Laparotomy (open surgery)

You should discuss with your Alana doctor which group applies to you and ask about any specific issues that may be encountered based on your problem and any additional medical factors that may change your recovery. If you are having a number of different types of surgery at the same time, then the one with the longest recovery will usually be the one that applies to you.  At discharge from hospital, you will be given a discharge summary. All patients receive this and you should ask the nursing staff if it is not given to you. It contains important information regarding your procedure and discharge instructions as well as contact phone numbers.

The Recovery Room

Following your surgery, you will be taken to the recovery room where you will be monitored by the recovery staff until you are ready to be transferred back to the ward.  You may be initially disoriented and confused, and this may be worse if you have had prolonged surgery.  Your doctor may see you during this time and advise you of how your surgery went.  Do not be concerned if you do not remember all the details, as the findings will be explained to you again until you are happy that you have all of the details correctly and understand fully the outcome of your surgery.

When the nursing staff are satisfied that you have recovered well enough you will be transferred to the post-operative ward for a further period of observation.  If you are a day surgery patient, then you will be discharged on the same day, after the nursing staff are happy with your recovery.  You will be given pain-relieving medications, fluids either through a vein or orally as directed.  You should not eat unless the nursing staff directs that this is acceptable.

The following points summarise the recovery phase for each of the different types of surgical approaches.

Hysteroscopy: If you are having hysteroscopic surgery, you will generally be discharged from hospital the same day. Pain relieving medications will be prescribed for you before you are discharged. Sometimes your Alana doctor may be delayed in the operating room at the time when you are ready to be discharged. If this is the case, then you should contact your Alana doctor on the next day through Alana Healthcare and they will explain the findings with you on the telephone. Alternatively, you may discuss all of the findings at your post-operative consultation.

You cannot drive yourself home from hospital after your surgery and you should not drive for 24 hours following hysteroscopic surgery. You should contact your car insurance company to see if there are any additional restrictions applied to driving after surgery. You should not operate heavy machinery or make important decisions during the same time period. Normal physical and sexual activity may be resumed when vaginal bleeding and discomfort have ceased. This may be from 2 days to 2 weeks. You should not use tampons for the first 2 weeks after hysteroscopic surgery and should use pads instead.

Laparoscopy: If you are having laparoscopic surgery, then you will usually be kept in hospital overnight. When you are back on the ward, your Alana doctor will see you and explain the results of the surgery to you. Don’t worry if you do not remember all of the details as these will be explained again at any and/or all of your subsequent visits. If you have specific questions regarding your surgery then you can contact Alana Healthcare and we will answer your questions when possible.

On the ward when you wake up you will find that there are dressings over the wounds from your surgery, there is a drip in your arm to give you fluid, a catheter in your bladder to drain urine out and a small drip under the skin to give you pain relieving medication. Very occasionally there may be a drain coming out of one of the wounds to remove any fluid from the pelvis. These tubes will be removed in the day or two following your surgery and your bladder will be scanned to make sure that it is emptying appropriately. The drain will be removed when there is minimal fluid coming out of it to indicate that there is no further fluid accumulating inside. You will initially walk with the nursing staff on the first post-operative day and you should be able to move yourself by the end of the day (in most cases) and shower and go to the toilet by yourself. You will often be passing wind but will not be opening your bowels because of the medications given during your procedure that slow the bowel down.

When you have fully recovered, your observations are stable, your bladder is working normally, your pain is under control with oral medications, and you can eat, drink and walk as normal, you will be discharged home. Generally, this will be the day after your surgery. You should contact Alana Healthcare on the next working day to arrange a follow-up visit. You will be given a prescription for pain medication and instructions on wound care by the medical or nursing staff. Generally, the dressings that are put on at the time of your surgery will stay on for 7 days. You can shower as normal with these dressings and pat dry with a towel. At the end of 7 days, if the dressings have not already come off, then you should remove them and any tape that may be present underneath them.

At discharge, you cannot drive yourself home and will need to be picked up from the hospital where your surgery was performed. You are likely to experience discomfort in the following areas in the days after your surgery:

  1. At the wound sites
  2. In your pelvic area
  3. Under your ribs
  4. In your shoulder tips

This discomfort is usually mild and should get better over time. If there is no improvement after a few days, you should contact your doctor at Alana Healthcare.  Simple painkillers such as paracetemol and anti inflammatory medications (e.g. Nurofen) should help with this type of pain.  Resting by lying down may help to relieve these symptoms.  You should contact your car insurance company to see if there are any additional restrictions applied to driving after surgery.  Generally you should not drive until you are feeling comfortable making an emergency stop.  This may be 1-2 weeks following your surgery.  You should not operate heavy machinery or make important decisions during the same time period.  You can resume normal physical and sexual activity when any vaginal bleeding that is present has stopped and you are feeling well.  This may take between 2 days and up to 8 weeks. Generally it should be around 2 weeks.  If you experience fever, chills or sweats, an increase in pain, vaginal discharge that is offensive or copious then you should contact your Alana doctor.

Vaginal surgery: After vaginal surgery there are usually no visible external wounds, with the procedure having been performed through the vagina and any stitches placed inside the vagina. If you are having prolapse or incontinence surgery, then there may be additional small wounds on the inner aspects of the thighs. You will usually be kept in hospital overnight. When you are back on the ward your Alana doctor will see you and explain the results of the surgery to you. Don’t worry if your do not remember all of the details as these will be explained again at any and/or all of your subsequent visits. If you have specific questions regarding your surgery then you can contact Alana Healthcare and we will answer your questions when possible.

On the ward when you wake up you will find that there is a drip in your arm to give you fluid, a catheter in your bladder to drain urine out and a small drip under the skin to give you pain relieving medication. The catheter will usually be removed in the day or two following your surgery and your bladder will be scanned to make sure that it is emptying appropriately. If there has been a drainage tube placed, then this will be removed when there is minimal fluid draining from the surgical area. You will initially walk with the nursing staff on the first post-operative day and you should be able to move yourself by the end of the day (in most cases) and shower and go to the toilet by yourself. You will often be passing wind but will not be opening your bowels due to medications given during your surgical procedure.

When you have fully recovered, your observations are stable, your bladder is working normally, your pain is under control with oral medications, and you can eat, drink and walk as normal, you will be discharged home. You will be given a prescription for pain medication and instructions on wound care by the nursing staff. You should take a salt bath twice a day fro the first 5 days. For this, you place a tablespoon of table salt in the bottom of a warm bath and sit in this for 10 minutes both morning and night. This will help keep the surgical areas clean. If you do not have a bath, a teaspoon of salt in a container large enough for you to sit in will substitute. You can expect to have a small amount of bleeding, but should report any heavy bleeding or offensive vaginal discharge to your Alana doctor. You should use sanitary pads (not tampons) for any post-operative vaginal discharge or bleeding.

You can shower as normal. A follow up visit will have been arranged at the time of your booking visit.  If not, please contact Alana Healthcare to make an appointment.

At discharge, you cannot drive yourself home and will need to be picked up from the hospital where your surgery was performed. You are likely to experience discomfort in the following areas in the days after your surgery:

  1. At the top of the vagina
  2. In your pelvic area
  3. In the middle part of your abdomen

This discomfort is usually mild and should get better over time. If there is no improvement after a few days, you should contact your Alana doctor. Simple painkillers such as paracetemol and anti-inflammatory medications (e.g. Nurofen) should help with this type of pain. You should contact your car insurance company to see if there are any additional restrictions applied to driving after surgery. Generally you should not drive until you are feeling comfortable making an emergency stop. This may be 1-2 weeks following your surgery. You should not operate heavy machinery or make important decisions during the same time period. You can resume normal physical and sexual activity when any vaginal bleeding that is present has stopped and you are feeling well. This may take between 2 days and up to 8 weeks. Generally it should be around 4 weeks. If you experience fever, chills or sweats, an increase in pain, vaginal discharge that is offensive or copious then you should contact your Alana doctor. You should not lift anything heavier than 10 kg (two telephone books) during your recovery phase and if you have had prolapse or incontinence surgery it is important that you do not lift for the first 6 weeks as this may cause a failure of the surgical procedure. You should discuss any further lifting restrictions with your Alana doctor at your post-operative visit.

Laparotomy: After a laparotomy there is a wound on the abdomen that is covered with a sterile dressing. When you are back on the ward your Alana doctor will see you and explain the results of the surgery to you. Don’t worry if your do not remember all of the details as these will be explained again during the following days that you are in hospital and again at your subsequent visits.

On the ward when you wake up you will find that there is a drip in your arm to give you fluid, a catheter in your bladder to drain urine out and a small drip under the skin to give you pain relieving medication. The catheter may stay in for 2 or more days so that you do not have to empty your bladder. When it is appropriate, the catheter will be removed and your bladder will be scanned to make sure that it is emptying appropriately. If there has been a drainage tube placed, then this will be removed when there is minimal fluid draining from the surgical area. You will initially sit out of bed on the first post-operative day, gently walk on the second post-operative day and you should be able to move yourself by the end of the third day (in most cases) and shower and go to the toilet by yourself. There may be some variation on these numbers depending on surgical and individual factors. You will not be allowed to eat until you are passing wind.

When you have fully recovered, your observations are stable, your bladder is working normally, your pain is under control with oral medications and you can eat, drink and walk as normal you will be discharged home. This is usually at between 3-5 days. You will be given a prescription for pain medication and instructions on wound care by the nursing staff. The abdominal wound will be closed with either stitches or staples. These will need to be removed between 5-7 days. Your Alana doctor will make arrangements for this to occur. If you have a dissolving stitch then your doctor will tell you that it does not need to be removed. You should use sanitary pads (not tampons) for any post-operative vaginal discharge or bleeding.

You can shower as normal. The wound should be covered during the day to prevent your clothes rubbing or chafing. A follow up visit will have been arranged at the time of your booking visit.  If not, please phone Alana Healthcare to arrange an appointment.

At discharge, you cannot drive yourself home and will need to be picked up from the hospital where your surgery was performed. You are likely to experience discomfort in the following areas in the days after your surgery:

  1. Around your wound
  2. In your pelvic area
  3. In the middle part of your abdomen
  4. You may feel generally tired and weak

This discomfort should get better over time and you are advised to continue with simple painkillers such as paracetemol and anti-inflammatory medications (e.g. Nurofen). Stronger pain killers such as Tramadol or Panadeine Forte may be required intermittently but should not be used all of the time because of the side effects such as constipation. You should contact your car insurance company to see if there are any additional restrictions applied to driving after surgery. Generally you should not drive until you are feeling comfortable making an emergency stop. This may be 2-4 weeks following your surgery. You should not operate heavy machinery or make important decisions during the same time period. You can resume normal physical and sexual activity when any vaginal bleeding that is present has stopped and you are feeling well. This may take between 4-8 weeks. If you experience fever, chills or sweats, redness around the wound, nausea or vomiting, an increase in pain, abdominal swelling especially if you are not passing any wind, then you should contact Alana Healthcare. You should not lift anything heavier than 10 kg (two telephone books) during your recovery phase and for the first 6 weeks. You should discuss any further lifting restrictions with your doctor at your post-operative visit.

Complications of Surgery

Serious complications at the time of most surgeries are uncommon but no surgery is risk-free. Even the simplest procedure can result in a complication. The most serious complications following surgery are considered to be injuries to the bladder (the organ that holds urine), the ureter (the tube that leads from the kidney to the bladder), the bowel and the major blood vessels. In addition, medical complications such as clots that develop in the legs or lungs, or excessive stress that is placed on the heart and lungs from the surgery can occur resulting in heart attack or stroke. The likelihood of these complications occurring will depend on the reason for your surgery, your past surgical and medical history and your age. It is important factor to recognise that your long-term safety is the most important aspect of your treatment and the necessary steps to ensure your safety is the first priority.

Specific problems can include bladder injuries, which are usually recognised at the time of surgery. These injuries may be dealt with laparoscopically, without having to make a large incision in your abdomen. Occasionally a large incision in the abdomen would have to be made to repair the bladder. If you require a bladder repair following an injury, you would have a catheter in your bladder, which may stay in for up to one week. You may be able to go home with the catheter in after instruction on caring for it at home if this is your preference.

Injuries to the ureter (the tube that leads from your kidney to your bladder) may only require a stent – a small hollow tube placed through the ureter from the kidney to the bladder for about 6 weeks. These can be inserted through the bladder without an incision in the abdomen and can be removed through the bladder in a simple procedure, again without an incision in the abdomen. Sometimes the ureter must be ‘reimplanted’ in the bladder. This means that a large incision is made in the abdomen (vertical midline incision see picture over), the ureter is cut and placed into the top of the bladder to drain normally. A stent would be placed as above and would need removing, usually at about 6 weeks. This procedure would normally be performed as an outpatient. The bladder and the ureter will usually function normally after this procedure. You will require a special X-ray test at between 6 weeks and 3 months to make sure that the bladder and the ureter are working normally.

Injuries to the large blood vessels are the most urgent complication and require immediate attention. It is likely that a very large incision (vertical midline incision) would be made in the abdomen for immediate repair. Almost certainly there would be a blood transfusion. Your stay in hospital is likely to be longer than anticipated. Injury to a blood vessel is a very serious and life-threatening complication.

Injuries to the bowel may occur and can be very serious. The injury to the bowel may be very small and may not be detected at the time of the initial surgery. If the injury is detected, it can often be repaired simply by laparoscopy and your post-operative treatment may not be significantly altered. It may not be possible to repair the injury by laparoscopy and you may require a laparotomy to repair the injury. You will be given antibiotics and you may require a colostomy. A colostomy is where a loop of bowel is brought to the skin and stitched in place with a bag is placed over this. The bowel contents will empty into the bag. This will usually be in place for three months after the surgery to allow the bowel time to heal. When the bowel is healed, the loop of bowel is closed and placed back in the abdomen. Very occasionally the colostomy may be permanent. If a bowel injury occurs during surgery and is missed, then there may be development of a serious infection in the abdomen. This will require surgery with a large incision in the abdomen and a colostomy (see above). You are likely to have a prolonged hospital stay whilst the infection is treated and may require admission to an intensive care ward. This is a very serious and life-threatening complication.

Other Post-operative Complications

In the post-operative phase common complications may include infection in the bladder, the surgical wounds or sites, or medical complications such as clots developing in the legs or lungs or chest infection. Whilst in hospital your observations will be taken and signs of temperature, increasing pain or problems with your urine will be monitored. You may require more tests and treatments if one of these complications occurs.

After you have gone home, if you have an increasing amount of pain, abdominal distension or cramping, vomiting, high fever or sweats, vaginal discharge that is offensive or shortness of breath then you should contact Alana Healthcare or attend the emergency department of your nearest hospital and ask for further advice.

Specific problems that should be reported to your doctor at Alana Healthcare include:

  • Bright or heavy bleeding from the vagina that is persistent and is more than a usual period.
  • Persistent redness, pain, pus or swelling around the surgical wounds, a fever of more than 38ºC, or chills/shakes that may indicate infection
  • Pain or burning on passing urine or the need to pass urine frequently, as this may indicate a urinary tract infection
  • Increasing nausea
  • Increasing abdominal pain with vomiting
  • Pain in one or both calf muscles
  • Sudden onset of chest pain or difficulty with breathing

Post-Operative Visit

At your post-operative visit your Alana doctor will discuss the operative findings with you and the implication of your surgery. This is also the opportunity to ask any questions that you may have arising from your surgery. You may need to have one or more further follow-up visits after this and your Alana doctor will make you aware of these.

You should receive a time for your post-operative visit at the time of making your surgery booking.  If you do not, please telephone us on 02 9009 5255 to book your post-operative appointment.