(excerpted from The Essential Guide to Hysterectomy, by Lauren Streicher, MD)
How long you stay in the hospital is dependent on a number of factors, including what procedure was done, how difficult it was, and, yes, what your insurance company allows. In general, a laparoscopic procedure usually requires only an overnight stay. Many laparoscopic hysterectomies are also performed as an outpatient procedure. An abdominal procedure usually requires a three to four day stay.
We will let you know when it is safe to get in the shower. Usually, that will be one or two days after surgery. The real danger in showering is not that the incision might get wet; it is that you might pass out. Most people prefer warm showers to cold showers. Heat makes blood vessels dilate. Dilated blood vessels can make your blood pressure drop, particularly if your blood volume is low. Most women are at least a little anemic after surgery. A hot shower could easily cause someone to faint, particularly if she is somewhat light-headed from a narcotic painkiller. Once you get permission to shower, don't make the water too hot, and don't stay in too long. This is not the time to bask in the warm water and sing the entire score of Oklahoma. Get in, wash, and get out. Make sure someone else is around in case you do feel faint.
If you have an abdominal incision, you will be given something to cover it so it doesn’t get wet. If it does get wet, it is certainly not catastrophic. The skin is sealed closed within 24 hours. A wet incision will cause the strips of tape to come off, but you won't fall apart. If you have staples, they are stainless steel. You won’t rust.
Tub baths are another story. Getting in and out of the tub is a little tricky. Hot tubs have the same issues as hot showers. Most surgeons recommend waiting two weeks before you attempt a tub bath. If you want to take a bath earlier, it may be fine depending on your circumstances, but definitely ask.
Going home is exhausting. Hopefully, no one has sent you flowers. If they have, leave them there, or have someone take them home the night before. Next time a friend or relative is in the hospital for a short stay, send flowers to their home. Baggy pants with an elastic waistband or a loose dress are essential since your belly will still be too swollen and uncomfortable to get into normal clothes.
Make sure you have any prescriptions you need. We will give you prescriptions at your pre-op visit or when you leave the hospital. If the hospital pharmacy has not filled them, swing by your local pharmacy on the way home.
Speaking of stairs, you can climb a flight of stairs. If you have stairs that lead into your home, you must climb stairs. Just do them slowly, and rest when you need to.
Once you get inside, you most likely be ready for a nap. This is normal. In fact, you will find that fatigue will be your limiting factor for about two weeks, sometimes longer. Even if all went well, even if you are not anemic, even if surgery was laparoscopic, the most common complaint is fatigue. You may get up in the morning feeling like you have enough energy to paint the garage, by afternoon, you absolutely must take a nap. It’s a combination of your body healing, and the effects of the anesthesia. Postoperative anemia is another reason for an overwhelming fatigue even if you otherwise feel fine. Don’t fight it. Take a nap and know that you will back to your usual energy level in a few weeks.
It’s normal to feel a little lower abdominal heaviness or pressure. If pressure is building throughout the day, it means you’ve been on your feet too long. Get off your feet. Listen to what your body is telling you.
People are well meaning, but unless they have had major surgery themselves, they have no clue. The last things in the world you want when you get home from the hospital are visitors and phone calls on a constant basis. But that’s exactly what always seems to happen. What should happen is that people should drop food off at the door and leave, perhaps taking your children with them.
Feel free to lie. Use your doctor as an excuse.” My doc says no visitors for…” fill in the blank. Have someone at home answer the phone to let people know that you are fine, but can’t come to the phone. Don’t promise that you’ll call them back otherwise you’ll have to. That way you can return calls to people that you actually want to talk to, which is usually nobody. Answering machines are fine, but then you feel obligated to return the call. You can always unplug the phone for a few hours rest, but you are just postponing the inevitable, since they will try again later.
If you think you have a fever, don’t rely on how you feel. Take your temperature. This may seem obvious, but it is astonishing the number of times a patient calls to report a fever when they have not even taken their temperature. It’s easy to get fooled since you may be warm from a hot flash (if your ovaries were removed), or you may wake up in a pool of perspiration from sweating off the extra fluid you accumulated in the hospital. Buy a thermometer before surgery so that no one has to do the 2:00 A.M. run to the drugstore. Call us if your temperature is over 100 degrees unless you have been told otherwise.
In addition to fever, it is important to watch for other indications of infection. The most common infections after gynecological surgery are urinary tract infections and wound (incision) infections.
It’s normal to urinate a lot. It is also normal to have a slight pilling or drawing sensation in the lower abdomen when you urinate. If you have pain with urination, the urge to urinate without the ability to do so, or frequently urinate tiny amounts, you may have an infection. Blood in the urine is also a sign of infection, but that gets a little tricky since a little vaginal bleeding is normal and it’s often hard to tell if the blood is in the urine, or coming from the vagina. If your urine comes out red, it’s in the urine. If it comes out yellow but seems to be mixed with red, it’s almost always vaginal blood.
Vaginal bleeding should be minimal. If it’s getting heavier or is persistent for more than a few days, call us. Light spotting for a week or two is not unusual.
What should your belly look like?
Slight abdominal swelling is normal and may last as long as 6-8 weeks. If your belly is getting distended, hard and tender, there may be a problem. Nausea and vomiting are also indications that something is amiss and your doctor should be notified.
Some degree of skin bruising is normal, especially after a laparoscopic procedure. The green/blue bruises will turn lovely shades of orange and yellow before they fade away, and the whole process might take weeks. If the bruises are expanding after you get home, call.
A little odor is normal. If your discharge is really smelly, green, or pus-like, it may indicate an infection in the back of the vagina (see Ch. 22 Complications), so call your doc. If you had your cervix removed, or other vaginal procedures were done with your hysterectomy, you probably have stitches inside your vagina. No, they don’t have to be removed. They will simply dissolve away. It’s not unusual though to see the tan or blue thread- like remnants of these stitches on your underwear, or when you wipe, weeks after your surgery.
If you had a laparoscopic procedure, you will have four tiny incisions on your belly with a bandage on each one. Sometimes the bandages are removed in the hospital; sometimes they are left on. It is fine to take the bandage off the day after surgery unless you have been told otherwise. You may see a stitch or two, or they may be invisible, depending on how they were placed. Most surgeons use dissolvable stitches, but occasionally the kind that have to be taken out are used, in which case your doctor will arrange for you to come to the office for removal. A little dried blood is not unusual. There should be no bright red active bleeding from any incision.
If you had an abdominal incision, you will most likely have been sent home with your staples removed and a row of tape (steri-strips) across the incision line. (See Ch. 10 Abdominal hysterectomy). Steri-strips can be removed four or five days after surgery. Sometimes steri-strips are intended to remain in place for two weeks depending how the closure was done. It’s best to ask your surgeon what he or she recommends before you go home from the hospital.
It is normal for any incision to be a little tender, a little puffy, or numb. Everyday your incision should feel a little better. If the incision is getting more painful, that may be a sign of a problem. If the skin surrounding the incision is bright red, hard, and tender, you may have an infection. Call your surgeon sooner rather than later since the earlier an infection has been detected, the easier it is to treat. Drainage from the incision should also be reported.
Normally, the puffiness and tenderness are gone by two to three weeks. Numbness can last for months. Many women find that there is a numb patch near an incision .In some cases it takes years until completely normal sensation returns.
The final appearance of an incision has less to do with how the surgeon closed it, and more to do with genetics and luck. There are things that can be done to influence the long-term appearance of an incision. Dr. Thomas Mustoe, Chairman of the Division of Plastic and Reconstructive Surgery at Northwestern Hospital recommends the following steps to optimize healing of an abdominal incision;
Once you leave the hospital, if all is well, we usually see you a week or two weeks after surgery. This visit is usually an incision check to make sure your incision is properly healing. Sometimes steri-strips are removed. A blood count may be done, especially if you were anemic when you left the hospital. Sometimes a speculum exam is necessary to check internal vaginal healing.
The main purpose of this check up is to see how you’re doing in general, and make sure that you are where you should be in the healing process. If all is well, a lot of physical restrictions will be lifted. Usually driving is fine after two weeks. If you want to start exercising, be specific about what you want to do. When one person asks her physician at two weeks if she can exercise, she may be thinking about riding her exercise bike for ten minutes. Someone else may be planning a seven-mile run.
The first visit is also the time to see how things are going hormonally (if ovaries were removed), and make adjustments. This is an appropriate time to change your estrogen dose if you’re having symptoms that may indicate that you need a little more estrogen.
This appointment is also your first opportunity since your hospitalization to ask questions about what happened during surgery. Certainly you us and talked to us in the hospital, but a lot of people don’t remember the details of that discussion. This is the time to ask any questions that you are unclear about as far as what was found, what was done, and what you should expect. This is particularly relevant if the procedure you actually had was not the procedure you planned to have.
We will also discuss the final pathology report. It’s not unusual for the biopsy results from your uterus and /or ovaries to get to your doctor days after you have left the hospital. Certainly, if anything serious such as an unsuspected malignancy was detected, you would already have been notified, so you shouldn’t be nervous about this report. Frequently though, benign findings that were unanticipated may have been found, such as endometriosis, or an ovarian cyst. If you are curious what your uterus weighed, that is usually included on the report. Inevitably, you will be disappointed.
The six-week visit is generally the final visit. Expect a pelvic exam, which will be no more uncomfortable than the usual pelvic exam. If all is well, you will be told to resume all normal activities, including sex, exercise and pretty much anything else you can think of. In general, you won’t need a return visit until it is time for your annual gynecologic exam
Speaking of annual gynecologic exam, do you still need to see your gynecologist after a hysterectomy? What is there to check for anyway? The answer is yes, absolutely, you do. If you still have a cervix, you need an annual PAP smear. If you still have ovaries, those need to be checked. If you have no uterus, cervix, or ovaries, you’re still not off the hook.
Your gynecologist is the expert who will deal with hormone replacement, or alternatives, if you choose not to take hormones. Your gynecologist will be the only one of your physicians who puts a speculum in your vagina to screen for vaginal cancer and look at your vulva to check for vulvar cancer. The bimanual exam (one hand on your belly and two fingers in your vagina) will detect masses in your pelvis from colon or other cancers. Dropped bladders, rectums, sexual dysfunction, sexually transmitted diseases, osteoporosis screening, breast examinations, are typical of the things a gynecologist deals with in the woman who has had a hysterectomy.
Physical recovery from the surgery is one thing. Resuming “normal” activities like exercise, work and sex are addressed in Chapter 21, The Essential Guide to Hysterectomy.
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