Postoperative FAQ

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This is a very common scenario. After any vaginal hysterectomy, or laparoscopically-assisted vaginal hysterectomy substantial vaginal discharge will be noticed postoperatively because the suture closing the vagina is exposed to the vaginal environment. As that suture dissolves, bleeding may be noted from a skin edge. This is usually not an emergency. Either wait until a follow-up appointment or call for a sooner follow-up. The surgeon can treat the skin edges with a chemical which will resolve the problem. Total laparoscopic hysterectomy and abdominal hysterectomy patients typically experience less discharge but, can experience the same bleeding postoperatively and will typically be treated in the clinic. If the bleeding is brisk, we recommend going to the emergency room.

The fluid can appear yellow, or red like blood. It can even be quite dark like oil. Typically, this is due to a seroma or pocket of fluid in the skin layer or even a stable clot of blood which has formed in the skin layer. Rarely does it mean the fascial or muscular wall closure has been compromised. The volume of fluid can be profound. Rarely does it need immediate attention. Cover the area with several sterile guaze pads and call for an asap appointment.

The fluid can appear yellow, or red like blood. It can even be quite dark like oil. Typically, this is due to a seroma or pocket of fluid in the skin layer or even a stable clot of blood which has formed in the skin layer. Rarely does it mean the fascial or muscular wall closure has been compromised. The volume of fluid can be profound. Rarely does it need immediate attention. Cover the area with several sterile guaze pads and call for an asap appointment.

Call the office or if after hours go to the emergency room. The inability to urinate soon after bladder surgery is not something to worry about though if not dealt with quickly can be become quite uncomfortable. Usually it occurs due to some peri-urethral inflammation. Another cause is pain. Being able to urinate is dependent on being able to relax the pelvic muscles. If an increase in pain is noted secondary to over-exertion or a variety other potential causes, urinary retention may result.

  • Drive: For most surgery, you will be advised to abstain from driving for at least a week. Certainly the patient needs to be able to move her feet from pedal to pedal without hesitancy or pain and she should never drive while under the influence of a narcotic. So, for most surgeries involving a larger abdominal incision we recommend at least two weeks.
  • Shower: For most surgery, you need to wait only 24 hours before being able to shower. You can do this without having to cover the incision.
  • Take a bath: greater than 24 hours after surgery. Do not bother covering the incision.
  • Walk up stairs: When tolerated by the patient. Any activity that involves increasing abdominal pressure such as rising from a seated to a standing position, having a BM or walking up stairs, has the potential to cause some discomfort due to the increased pressure stressing the incision. We are not concerned about damaging the incision in these cases though we recommend caution.

Become sexually active:

Any vaginal surgery at least 6 weeks
Hysterectomy at least 6 weeks
Cesarean section 6 weeks
Episiotomy or laceration 6 weeks
LEEP 2 weeks
Operative laparoscopy 2 weeks
Minor Laparoscopy ie BTL 1 week
Hysteroscopy, endometrial ablation 1 week
Colposcopy 3 days
  • Lift: This depends on the surgery and what is being lifted as well as where. Lifting a 25 lb bag off of the floor is not the same as moving it from one counter to the other. Holding a baby away from the body in a car seat is not the same as holding that same baby next to your chest. What you want to avoid postoperatively is an all-out valsalva(bearing down), or using poor lifting mechanics because you know the abdomen is compromised. There are some no brainers, don’t move furniture, carry full laundry baskets, or large bags of groceries. Avoid cartwheels and construction projects…

Some general recommendations are:

Abdominal surgery ie cesarean section  6 weeks
Prolapse surgery  6 to 12 weeks
Cesarean section  6 weeks
Episiotomy or laceration  No precaution
LEEP  No precaution
Operative laparoscopy ie laparoscopic hysterectomy  3 weeks
Minor Laparoscopy ie BTL  1 week
Hysteroscopy, endometrial ablation, or D&C  No precaution
Colposcopy  No precaution
  • Exercise: In general, we would follow the same guidelines as above for sexual activity. We would add the caveat. Anyone undergoing reconstructive surgery for prolapse should abstain from heavy lifting for 100 days after the surgery. “Heavy” lifting is vague. For most that means that weight at which the patient must substantially strain as in to lift a 25+ pound of dog food.
  • Smoke: Never!!!!!!
  • Fever: an ongoing or sporadic fever greater than 100.5 may be a concern.
  • Pain: We expect patients to have discomfort after surgery. We also expect patients to have times when they feel even sharp discomfort where they didn’t feel it before, we call them “ouchies” this is normal while healing and they should resolve. What is not normal is to have a progressive pain that does not respond to pain medicine. There is no clear guideline, but patients generally can tell when something isn’t right.
  • Bleeding: We expect patients who have any type of vaginal surgery to have some vaginal bleeding. This will typically evolve into a discharge and may evolve back into more a bright red scenario as the sutures dissolve. Even laparoscopy patients should expect some bleeding due to the clamp that was placed on the cervix. We do not expect patients to have active copious bright red bleeding. These patients should go to the emergency room.
  • Nausea and vomiting: Nausea and vomiting around the time of surgery is not uncommon. If you had surgery within the last 24 hours, this is likely a residual effect of the anesthetic. We recommend liquid diet as tolerated. Advance as you improve. If the nausea and vomiting does not improve or advances, go to the ER. Nausea and vomiting that occurs more than 24 hours after surgery should never be considered normal and if the problem is ongoing or worsening, we recommend you call or go to the emergency room.
  • Constipation: Postoperative constipation is one of the most difficult issues. The combination of narcotics, immobility, and dietary changes following surgery can lead to significant morbidity. We become more concerned when there is significant pain, nausea or vomiting, fever, or cessation of gas passage. These would all be indications to seek immediate medical help. In the absence of more concerning signs, I recommend Colace (docusates sodium). Milk of Magnesia usually works overnight. For a more immediate response, you can try magnesium citrate laxative.