Questions After Surgery:
About 2-3% of women who have had hysterectomy develop a new pain problem after surgery. Because we specialize in the evaluation and treatment of pain, we often see women with this problem.In some instances, the pain comes from scar tissue that has formed during the healing process of the original hysterectomy surgery. When this scar involves one or both ovaries, the pain may occur in monthly cycles, in a pattern similar to menstrual discomforts a person may have had before hysterectomy. Pain during sexual intercourse is common in this situation as well.
In other instances, the ovaries may be innocent, but the pain can come from the healed tissue at the very top end of the vagina, where sutures were placed. In this problem, when the doctor puts a speculum in the vagina to see the upper end, it may look perfectly normal. If he/she then touches the tissue at the upper end with a cotton-tipped applicator, even gentle touch may be felt as pain. This means that there is neuropathic pain, or pain that comes from nerve endings that are sending out pain signals when they shouldn't be. There often is no evidence of a lump or tissue damage or anything else that is different from the expected.
It is important to recognize this, because if this problem isn't detected, then the ovaries may be suspected as the cause of the pain, and may be removed for no good reason! Pain of this type can be treated by a variety of techniques aimed at quieting the abnormal nerve signals. These include putting local anesthetics high in the vagina, injections, medications aimed at decreasing abnormal pain signals, and sometimes, surgical revision of the top end of the vagina. We have had good success performing this surgery laparoscopically when it is needed.
Q: What if I can’t move my bowels after surgery?
A: Begin stool softener (Colace or generic docusate sodium) as soon as you come home. Take a 100mg capsule three times daily. Chew Gum. Recent research has demonstrated that gum chewing makes bowel contents travel through faster. A high fiber diet will also help speed the return of normal bowel function. Adding an over the counter fiber laxative (Benefiber, Metamucil, Citrucel, etc.) twice daily should be sufficient. If you go 3-4 days and still haven’t moved your bowels, take a mild laxative like Milk of Magnesia or Senokot. Repeat every 12 hours till you get results
Q: How should I care for my incisions?
A: Incisions are closed with a suture material that dissolved in approximately two weeks so you may see some threads there. They do not need to be removed; they will dissolve and fall out on their own. The paper “Steri-strips” should be removed 10 days after surgery.
Incisions that do have sutures and/or steri-strips can be cleaned with soap and water in a shower immediately. If an incision looks at all open or is oozing it is a good idea to apply ½ strength hydrogen peroxide (mixed half and half with tap water). After the peroxide stops bubbling, blow the skin dry with a hair dryer on the warm setting. Then apply Neosporin or triple antibiotic ointment. This regimen should be repeated twice daily until incisions appear closed and dry.
Q: “I have a heavy pressure sensation in my lower pelvis. It hurts to sit a long time and I feel as though all my pelvic organs are trying to fall out.”
A: Many women experience a reactive muscle spasm in the muscles of the pelvic floor. These muscles attach at the pubic bone in the front and the tail bone in the back. The vagina and rectum are between them. When they go into spasm, women experience a downward pressure feeling that may increase when standing for prolonged periods, sitting on those muscles, or passing a bowel movement. The best recommendations are to consciously relax those muscles, ie “Let it fall!” Apply a heating pad to the front and/or back, and take ibuprofen. This should improve after a few days of employing these measures.
Q: I feel like I need to urinate all the time and when I do go, it burns and not very much comes out. What’s wrong?
A: You probably have a bladder infection. Drink a lot of water, avoid caffeine, and please call the office (919-966-7764).
Q: I don’t have pain at the beginning of urination, but do have intense pain as I finish emptying my bladder. What’s wrong?
A: You are probably experiencing bladder spasms which are most common after a hysterectomy. This usually shows a gradual improvement over the first several weeks after surgery. As long as you don’t have frequency, urgency or burning, this is not a problem. However, if the discomfort is bothersome to you, you may try AZO-standard over the counter. If this does not offer enough relief, medications may be prescribed temporarily.
Q: I’m exhausted and just don’t feel well after my surgery. Is this normal?
A: To some extent, your fatigue is related to your general condition before your surgery and the length of time you were under anesthesia. After resting for a couple of days post-op, some muscle wasting is to be expected and you will need to rebuild your activity gradually. However, if you are short of breath going up stairs, feel generally ill (rather than just sore), or are running a fever over 100.5 degrees for more than 24 hours, please call the office. Each day, you should feel a little better. If this is not the case, please let us know.
Q: I’m having my first period after my laparoscopy and my flow is unusually heavy and my cramping is worse than usual. Is this normal?
A: During a laparoscopy, an instrument is placed inside the uterus which allows your surgeon to manipulate the uterus so he or she can see behind it. This instrumentation and manipulation often increases the flow of the first menstrual period after surgery and may also make the cramping more severe. This does not predict how you will do in the future.
Q: I had a hysterectomy within the last month and am now experiencing vaginal bleeding. Is this normal?
A: Light spotting is normal for up to six weeks while the suture line heals. Some women experience a gush of blood followed by spotting for several hours. This is usually due to a clot or hematoma forcing its’ way through the suture line at the top of the vagina. If you experience this gush, sit down, put your feet up and see if the bleeding lessens and stops. If it does, do not worry about this. If you have bleeding that requires pad changes every 2 hours or less that persists, please come in to the emergency room.
Q: How can I make my incisions scarless?
A: As a scar “matures” over the months after surgery, it shortens and tends to become attached to the layers of tissue underneath. One of the best things we’ve found for incisions, both small incisions from laparoscopic surgery and larger incisions from open laparotomy surgery, is to have a person massage the scar once it has healed for about three weeks. Place your 2nd and 3rd fingers over the scar and apply gentle pressure while moving your hand in a circular motion. Do this for a few minutes each day, and keep it up for the first few months after surgery. This may both make the scar feel more comfortable and keep it from developing an indentation or “puckered” look.
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