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Women's health-prolapse and urinary incontinence surgery

Prolapse and urinary incontinence surgery

Mater Mothers' Hospital is one of Brisbane's leading public health facilities. It is built on a foundation of clinical excellence and a commitment to safe, compassionate care that is customised to women's needs and lifestyles. Situated within Mater Mothers' Hospital, the Women's Health Unit features single or two bed rooms with ensuites, disabled access, external views, natural light and proximity to the Mater Adult Hospital Critical Care Unit.

For more information about Mater Mothers' Hospital please contact reception on 07 3163 8664.

Inpatient visiting hours

11 am to 1 pm and 3 pm to 8 pm (patient rest period 1 pm to 3 pm).

Our Mission

In the spirit of the Sisters of Mercy, Mater Health Services offers compassionate service to the sick and needy, promotes a holistic approach to health care in response to changing community needs and fosters high standards in healthrelated education and research. Following the example of Christ the Healer, we commit ourselves to offering these services to all without discrimination.

Our Values

Mercy: the spirit of responding to one another

Dignity: the spirit of humanity, respecting the worth of each person

Care: the spirit of compassion

Commitment: the spirit of integrity

Quality: the spirit of professionalism

Welcome

At Mater Health Services we understand that having an operation can be a very stressful experience. This booklet aims to alleviate some of your concerns in keeping with our Mission to offer compassionate, quality care that promotes dignity whilst responding to patients' needs. It explains briefly what to expect before you come to hospital, the events that may occur during your visit and the things to expect when you are discharged from the hospital.

It is, however, only a guideline as each person may require differing treatments. If you have any questions about your treatment please ask your doctor or nurse.

Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have.

Prolapse

What is a prolapse?

Genital prolapse is the protrusion of the pelvic organs into the vagina or even outside the vagina. There are a number of different types of prolapse:

  • uterine prolapse involves the descent of the uterus and cervix down the vaginal canal. In the most severe situation, the entire uterus and cervix protrude through the vaginal entrance
  • cystocele is where the tissues supporting the wall between the bladder and vagina weaken, allowing a portion of the bladder to descend and protrude into the vagina
  • rectocele is where the tissues supporting the wall between the vagina and rectum weaken allowing the rectum to descend and protrude into the vagina
  • vaginal vault prolapse occurs when the top of the vagina descends, usually following a hysterectomy.

What causes a prolapse?

Prolapse occurs due to a weakness or damage that has occurred to structures which hold the pelvic organs in place. There are a number of contributing factors listed below:

  • pregnancy and childbirth, which can cause prolapse through hormonal changes, damage to tissues or nerves. Damage to the pelvic floor may occur in long labours, assisted births (the use of forceps or vacuum extractions) and in the birth of large babies
  • menopause and ageing increase the risk of prolapse. The female hormone oestrogen plays an important role in maintaining the strength of the pelvic floor. At menopause, a woman's oestrogen levels decrease and, as a result, the pelvic floor becomes weaker. The lack of oestrogen at this time often exacerbates existing damage that may have occurred as a result of childbirth and other factors. The pelvic support structures also relax due to the natural ageing process
  • increased pressure in the abdomen, as a result of chronic coughing, lifting heavy objects or obesity, place pressure on the pelvic floor. If these pressures continue over a long period of time they can weaken the pelvic floor.
  • genetic and hereditary factors also play a role.

What are the symptoms?

The symptoms of prolapse vary according to the organs involved and the severity of the prolapse. A woman with minor prolapse may not have any significant symptoms at all. Common symptoms include:

  • a dragging sensation or feeling that something is falling down. These feelings are especially noticeable when sneezing, coughing, with physicalexertion, after long period of standing or at the end of the day
  • presence of something in the vagina or vaginal entrance. If the cervix and/or uterus protrudes through the vaginal entrance they may become ulcerated and infected or cause difficulty walking
  • aching discomfort in the pelvic region or lower back
  • urinary problems. The change in position of the bladder that can occur with prolapse may lead to stress incontinence (leaking of urine when coughing, sneezing, laughing), frequent urination, incomplete emptying of the bladder and urinary infections
  • bowel problems. A rectocele, for example, can result in constipation or difficulty in emptying the bowel
  • sexual problems. Prolapse pelvic organs can make penetration difficult and the loss of pelvic tone can result in decreased sensation.

How is a prolapse diagnosed?

A prolapse is usually diagnosed by a physical examination, including the front and back walls of the vagina. A rectal examination may also be performed. The woman may be asked to cough or push down during the examination to help look for prolapse and potentially identify incontinence.

What are the treatment options?

There are a range of treatment options available for prolapse. The most appropriate treatment will depend upon the type of prolapse present, severity of the symptoms, the age of the woman, her state of health and whether she wishes to have further children.

If a woman is not experiencing any symptoms then treatment is not necessary. For women who are bothered by symptoms, treatment can generally be divided into two types—non-surgical and surgical.

1. Non-surgical treatment

  • Reducing pressure placed on the pelvic floor. For a mild prolapse, simple measures such as losing weight (if overweight) may alleviate some symptoms and help prevent the prolapse from worsening
  • Pelvic floor exercises. These exercises are designed to strengthen the pelvic floor muscles. They may improve symptoms in women with mild prolapse but are of limited benefit for women with significant prolapse. Pelvic floor exercises are most useful in the prevention of prolapse.
  • Pessaries. This is a silicone device which is inserted into the upper part of the vagina to provide support to the pelvic structures. Pessaries come in a number of shapes and sizes. The pessary stays in for three to nine months, after which it will require changing. When inserted properly, a woman should not be able to feel a pessary. Pessaries provide a temporary solution to prolapse symptoms for pregnant women, women who have recently given birth or for women who are awaiting surgery. Pessaries can also be used permanently by women who do not wish to have surgery or for whom surgery may be particularly risky. If a pessary is too small it may fall out and if too tight-fitting it can cause irritation, ulceration, bleeding and pain. If a woman experiences any of these problems she should return to the doctor who fitted the pessary. Pessaries may be used in conjunction with a topical, low-dose oestrogen cream to improve skin tone and elasticity and, therefore, to reduce skin erosion.
  • Hormone replacement therapy has not been shown to help significantly with symptoms of prolapse. Topical low-dose oestrogen cream may be of some benefit when the tissues are very thin and dry.

2. Surgical treatment

If non-surgical treatment options do not provide sufficient relief from symptoms, an operation may be required. The aim of surgery is to repair and reconstruct the supporting structures so that the pelvic organs return to their normal positions. Restoring and maintaining bladder, bowel and sexual function are also key factors. There are various surgical procedures and approaches to treat prolapse. The most appropriate procedure will depend on which organ or organs have prolapsed, the woman's age and whether she wishes to retain her uterus.

  • Vaginal repair involves a repair to the tissues supporting the vaginal wall. There are different types of vaginal repair depending on where the weakness is located. Commonly, the existing supporting tissues around the vagina are reinforced with stitches. Alternatively, a synthetic sheet of permanent mesh can be used to further support the natural tissues in areas that are weak. Vaginal repairs are generally performed through the vagina but some surgeons repair prolapse via keyhole surgery.
  • Hysterectomy and vaginal repair. This procedure involves the repair of the vaginal wall supports, as discussed above, and the removal of the uterus (hysterectomy). The procedure may be performed through the vagina or abdominally. Removing the uterus does not fix a prolapse. The structures supporting the vagina need to be reinforced. A hysterectomy is an appropriate option in the setting of other menstrual problems.
  • Vaginal vault repair. There are several procedures performed to treat vaginal vault prolapse. A sacrospinous ligament fixation involves securing this ligament to the top of the vagina to provide it with additional support. It is performed through the vagina. Another procedure, sacrocolpopexy, involves attaching a piece of synthetic mesh to the top of the vagina and anchoring it to the sacrum, pulling the vagina upwards into its normal position. This procedure is performed through the abdomen.

Urinary incontinence

What is urinary incontinence?

Many women involuntarily leak small amounts of urine at times. When leaks become frequent or severe enough to be a problem, this is called urinary incontinence, or loss of bladder control. This condition often can be treated successfully.

How common is urinary incontinence?

It is estimated that urinary incontinence affects between 10 and 25 per cent of Australian adult women. It may affect women of all ages. Despite being so common, approximately 60 per cent of people suffering from incontinence do not seek professional help for their condition. It appears that a combination of embarrassment and the belief that urinary incontinence is a natural consequence of ageing and childbirth deters people from seeking the appropriate treatment.

What causes urinary incontinence?

There are a number of factors that contribute to incontinence:

  • Pregnancy and childbirth can cause prolapse through hormonal changes, damage to tissues or nerves. Damage to the pelvic floor may occur in long labours, assisted births (the use of forceps or vacuum extractions) and in the birth of large babies.
  • Menopause and ageing increase the risk of prolapse. The female hormone oestrogen plays an important role in maintaining the strength of the pelvic floor. At menopause, a woman's oestrogen levels decrease and, as a result, the pelvic floor becomes weaker. The lack of oestrogen at this time often exacerbates existing damage that may have occurred as a result of childbirth and other factors. The pelvic support structures also relax due to the natural ageing process
  • Increased pressure in the abdomen, as a result of chronic coughing, lifting heavy objects or obesity, place pressure on the pelvic floor. If these pressures continue over a long period of time they can weaken the pelvic floor.
  • Poor bladder habits—such as going to the toilet when it is not really required– —has the effect of irritating the bladder muscle, causing it to spasm before the bladder is full. This results in the bladder becoming less able to hold a normal quantity of urine.
  • Urinary tract infections and the associated inflammation of the bladder and urethra, may lead to urinary incontinence.
  • Urinary incontinence may be a side effect of medications such as blood pressure medications, cold remedies, sedatives, pain killers, diuretics, antihistamines and antidepressants.
  • Other medical problems such as a stroke, bladder tumours, diabetes, Parkinson's disease, Alzheimer's disease, multiple sclerosis and spinal injury may all cause urinary incontinence.
  • Constipation can contribute to incontinence. A full bowel can press on the bladder obstructing the flow of urine or affecting the bladder capacity making a person feel they need to go to the toilet more frequently. The straining often associated with constipation can also damage the nerves which feed messages to the pelvic floor muscles, causing the muscles to weaken.
  • Being overweight results in the pelvic floor muscles having to carry a heavier load.
  • Food and beverages such as caffeine, alcohol, artificial sweeteners, carbonated beverages, citrus juices and citrus fruit, greasy or highly spiced foods and tomatoes and tomato based products can all irritate the bladder.
  • Mobility and accessibility are factors in the development of incontinence. If a woman has restricted mobility due to arthritis or other disabilities she may findit difficult to reach the toilet in time. The inconvenient positioning of the toilet in the household can also be a contributing factor e.g. toilet located downstairs.
  • Genetic and hereditary factors may also contribute to urinary incontinence.

Different types of urinary incontinence

There are several different types of urinary incontinence, each with different causes and treatment options.

  • Stress incontinence is the involuntary loss of urine with activities such as coughing, sneezing, laughing, lifting heavy objects or during physical activity. Stress incontinence often results from weakened pelvic floor muscles which support the bladder.
  • Urge incontinence describes a sudden and urgent desire to urinate and an inability to hold the urine until a toilet is reached. Urge incontinence is caused by the involuntary contractions of an overactive bladder muscle.
  • Quite often, women will suffer a combination of urge and stress incontinence.
  • Overflow is characterised by an over distended bladder due to the bladder not emptying properly. Overflow incontinence occurs when the bladder is unable to sense that it is full, caused by damage to the nerve supply to the bladder, due to diabetes, drugs, multiple sclerosis, or because of an obstruction to the bladder opening. Women with overflow incontinence may only have a weak dribbling stream of urine or feel that they need to empty their bladder but cannot.
  • Functional incontinence results from the inability to reach a toilet on time due to poor mobility, poor dexterity, memory loss and/or the unsuitable positioning of the toilet in the building. This is more common in the elderly or disabled.

How is urinary incontinence diagnosed?

The diagnosis of the type of incontinence commences with a careful history and physical examination, including the front and back walls of the vagina. A rectal examination may also be performed. The woman may be asked to cough or push down during the examination to help look for prolapse and potentially identify stress incontinence.

Special tests call urodynamics may be performed to determine how the bladder works during the filling and emptying of the bladder. This will allow for an accurate diagnosis and appropriate discussion of treatment options.

What are the treatment options?

There are a range of treatment options available for urinary incontinence. The most appropriate treatment will depend upon the type of incontinence, the severity, the age of the woman, her state of health and whether she wishes to have a child or further children. Treatment can generally be divided into two types, non-surgical and surgical. Doing nothing is also an option. The problem of incontinence is it is hard to predict—it may remain the same, get worse, or improve over time.

1. Non-surgical treatment

  • Reducing pressure placed on the pelvic floor can help. For mild incontinence, simple measures such as losing weight (if overweight), avoiding lifting heavy objects and treating conditions like chronic coughing and constipation may alleviate some symptoms.
  • There are physiotherapy exercises designed to strengthen the pelvic floor muscles. They improve symptoms in women with urinary incontinence.
  • Hormone replacement therapy has not been shown to help significantly with symptoms of urinary incontinence. Topical low-dose oestrogen cream may be of some benefit when the tissues around the urethra are very thin and dry.
  • A variety of drugs are used in the treatment of incontinence. Drugs such as Ditropan, Oxytrol, Tolterodine relax the bladder muscle and therefore increasethe capacity of the bladder to hold urine. They can cause side effects such as dry mouth, constipation and confusion but these are less common with the newer drugs.

2. Surgical treatment

If non-surgical treatment options do not provide sufficient relief from symptoms, an operation may be required. There are various surgical procedures and approaches to treat urinary incontinence:

  • Mid urethral sling procedure. These procedures (TVT, Sparc, and Monarc) are the current standard treatments for urinary stress incontinence. They are performed under local, regional or general anaesthetic. Small incisions are made in the vagina and the abdomen/groin and a permanent tape is introduced into the vagina to sit under the urethra. Most women (85 to 90 per cent) are cured by this operation but there is less data of its success in the longer term (>10 years)
  • Burch colposuspension. This is the traditional operation for incontinence. A 15 to 20 centimetre cut is made in the lower abdomen, usually below the bikini line from one side to the other, similar to the cut made for a caesarean birth. Sutures are used to suspend the vagina from the pelvic side wall, creating a cradle of threads, like a hammock, from back to front of the pelvic area to provide support for the neck of the bladder. This operation has a proven long-term success rate of 85 per cent. This procedure is also sometimes performed via keyhole surgery.

What are the risks of undergoing these procedures?

Although the risks associated with surgical procedures for incontinence are low, you should be aware that every surgical procedure has some risk.

Specific risks to be aware of for prolapse surgery

  • Severe bleeding may occur from large blood vessels around the uterus or top of vagina. This is not common. Emergency surgery may be required to repair the damaged blood vessels. A blood transfusion may be required to replace blood loss. A vaginal pack may be used to control the bleeding.
  • Infection in the operation site or pelvis or urinary tract may occur. Treatment may include wound dressings and antibiotics.
  • Rarely, a connection (fistula) may develop between the bladder and the vagina. This causes uncontrollable leakage of urine into the vagina. This would require further corrective surgery.
  • In rare cases, the vaginal walls may stick together and require surgery to separate them.
  • The bowels may not work after the operation. This is usually temporary and treatment may be a drip to give fluids into a vein and no food or fluids by mouth.
  • Pain is common following an operation. Short term pain in your perineum, which is the tissue between your vagina and anus, is common following a sacrospinous colpopexy and you may experience pain in your buttock for some days to weeks. Sex may be painful following prolapse surgery and this can sometimes be permanent.
  • A prolapse operation may fail. Operations for prolapse are not perfect and prolapse can recur or a different prolapse can arise over time. Numerous factors influence the rate of recurrence which your doctor will talk to you about.
  • You may experience incontinence. While you may not have been incontinent before the operation, you may leak some urine when you cough, sneeze or strain after the operation. Often a large prolapse is physically stopping the leak of urine and symptoms of incontinence only becoming apparent when the bulge is fixed. Further surgery may be required later to attend to this problem.
  • You may feel a frequent need to pass urine. A small number of women will find that they now have to rush to the toilet quickly whenever they have an urge to pass urine. This does usually settle but it may require some ongoing therapy.
  • If mesh is used there is a risk of infection which may require removal of the mesh.
  • If mesh is used you may experience mesh erosion. This is where part of the mesh wears through a gap that develops in the vaginal skin so that it pokes out. This can cause discharge or bleeding or pain to you, and your partner, during sex. This will usually require surgery to trim the loose portion and to close the gap in the skin.

Specific risks to be aware of for urinary incontinence surgery

  • Operations for treating stress incontinence have an 85 to 90 per cent success rate; however these procedures are less effective if you have had surgery for incontinence before.
  • Around 10 to 15 out of every 100 women will find that, although dry, they now have to rush to the toilet quickly whenever they have an urge to pass urine. This does usually settle but it may require some ongoing therapy to improve this.
  • In rare cases, the body may reject the sling, or stitches can get infected or may wear away.
  • Some women get bladder infections after surgery. If this occurs, it can be treated with antibiotics.

Common risks inherent to these operations

  • Nearby organs such as the ureter(s) (tube leading from kidney to bladder), bladder or bowel may be injured. This would be expected to happen to about one in 140 women. Further surgery will be needed to repair the injuries. For bladder injuries, a catheter may be put into the bladder to drain the urine away until the bladder is healed. For ureter injury, a plastic tube (stent) is placed in the ureter for some weeks. If the bowel is injured, part of the bowel may be removed, with a possibility of a temporary or permanent colostomy (bag on the abdomen to collect faeces).
  • Following an open operation there may be bleeding into the wound from surrounding blood vessels:
    • the layers of the wound may not heal well and the wound open up
    • the scar can be thickened, red and may be painful
    • numbness may develop under or around the wound
  • You may experience difficulty emptying your bladder. About five to ten in every 100 women have trouble emptying their bladder properly following surgery. For a short time it may be necessary to re-insert the catheter. Sometimes we may need to teach you how to insert a catheter yourself to completely empty the bladder. This generally resolves within a few weeks.

General risks inherent to all operations

  • Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
  • Clots may form in the legs leading to pain and swelling. In rare cases, part of this clot may break off and go to the lungs which can be fatal.
  • You may suffer a heart attack or stroke because of strain on the heart. In extremely rare cases, death is a possibility in anyone undergoing an operation. Some women however, are at an increased risk of complications
  • Women who are very overweight have an increased risk of wound infection, chest infection, heart and lung complications and blood clots.
  • Smokers have an increased risk of wound and chest infections, heart and lung complications and blood clots

Our expectations

Prior to discharge:

  • your temperature will be within normal limits
  • your vaginal loss will be minimal
  • your wound/s will be clean with no signs of infection, inflammation or unexpected bleeding
  • you will be comfortable and your pain will be managed with oral medication
  • you will understand all education provided and your plan of care after leaving hospital
  • you are able to walk independently to an appropriate level for home activity
  • you are able to tolerate fluids and food.
  • if you have had incontinence surgery you will EITHER be passing urine normally OR you will be managing a catheter.

Procedure planning day

When you had your appointments with your specialist, the case manager and the preadmission clinic, planning for your surgery began, including:

  • an explanation of your surgery
  • signing the consent form
  • booking the date of your surgery
  • estimation of the day you will be going home
  • booking your post-operative six week follow up appointment, or phone call
  • the provision of information regarding your preoperative physiotherapy appointment
  • discussion of your patient information booklet and its contents.

The content of this booklet covers surgeries which have an estimated length of stay from overnight to three days.

The length of stay is dependent on the type of surgery you will be having.

Below is a summary of your procedure plan and follow-up appointments:

Planning Schedule

The assessments taken during your time with the case manager and the preadmission, service provide important information on your health and social status allowing your particular needs to be identified and managed. Appropriate referrals will be made for those needs identified, either prior to, or following, your surgery.

Things to do before you come to hospital

  • It is important for you to have all the tests ordered at your outpatient clinic appointment completed prior to coming to hospital. Please bring X-rays, any ECG reports and all your blood test results with you to hospital along with your medications. Your medications need to be in their labelled containers or Webster pack.
  • If you are taking any blood thinning or arthritis medications please follow the instructions provided by your preadmission nurse or pharmacist, as sometimes it is important that these medications be stopped in preparation for your surgery. You should continue your regular medications, unless advised otherwise. If you are a smoker it is also important for you to stop smoking.
  • It is important for you to be familiar with, and start practising, your breathing and leg exercises which you will need to commence once you have woken up from your operation, and getting in and out of bed— please refer to diagram page?.
  • You may be required to have a bowel preparation, which will empty your bowel prior to the surgery. If this is required, you should only have fluids (clear soups, jellies, cordials, juices or similar drinks) in the 24 hours prior to the surgery. The bowel preparation medication should be taken as prescribed.
  • In some circumstances your surgery may need to be rescheduled or cancelled. If you are feeling unwell or have developed an illness we advise you to make an appointment with your GP who can then inform you if you are well enough to have surgery. If your surgery needs to be rescheduled or cancelled due to advice from a medical practitioner or due to unforseen personal circumstances please notify Bookings at Mater Health Services on telephone 07 3163 8244 as soon as possible and provide them with the following information:
    • your name
    • your surgery date
    • reason for cancellation of surgery
    • if you require your surgery to be rescheduled.
  • You should stop eating and drinking at the following times on the day of your surgery unless otherwise notified:
    • at midnight if your procedure is in the morning
    • at 6 am if your procedure is in the afternoon.
  • You will need to shower and dress into clean clothes prior to coming into hospital. While showering it is important to include cleaning your naval area well. No skin products such as deodorant, perfume, body lotion or powder are to be used following your shower. It is important that you DO NOT SHAVE your operation site as this increases the risk of wound infection.
  • Please remove all body jewellery.
  • As Mater is unable to accept liability for losses it is highly recommended that you leave your valuables at home for safety and security purposes. Please bring essential items only. While Mater does not take responsibility for your personal belongings our Security Office will hold any lost property that is handed in.

What to bring to hospital:

  • toiletries
  • comfortable sleep wear
  • underwear
  • sanitary pads
  • all usual medications
  • all X-rays
  • Medicare card
  • patient information booklet.

The day of your surgery

Before your surgery

  • When you come to hospital proceed to the Day Procedure Unit, Level 5, Mater Adult Hospital, where you will be admitted and prepared for surgery unless otherwise arranged.
  • The assessment form completed at the preadmission service will be reviewed and your health team will plan for your individualised care while in hospital, discuss any concern you may have and support you may require after discharge. If any changes to your circumstances have occurred since the preadmission interview, please notify your nurse. Your nurse will also check that your consent form has been signed or organise for it to be signed before your operation.
  • It is an infection control requirement at Mater that you will be required to have swabs taken if you have transferred from, or worked at, another health care facility or you have had previous resistant infections. This is usually identified, and attended to, at the preadmission clinic. Your admission nurse will check if these three swabs have been taken and will complete the test if there are further swabs required.
  • The medications you brought to hospital will be collected. Please remember to ask for these to be returned to you when you leave the hospital. Please inform the nurse admitting you if you have been taking any blood thinning, arthritis medication or aspirin prior to your admission,as these may have needed to be stopped before your operation day. It is usual for you to continue taking your other prescribed medications.
  • You will have an identification armband applied. This will stay on for the duration of your stay for identification and safety reasons. If you have any known allergies, you will have an allergy armband applied.
  • Your nurse will take a set of baseline observations, weigh you and may ask you to provide a urine sample for routine testing.
  • It may be necessary to clip any hair in the surgical area.
  • You will be asked to dress into theatre clothing.
  • You will be measured for special stockings (TEDS) and will need to have these put on prior to going to theatre. Also a compression device will be applied to your legs approximately two hours prior to your operation. These assist with blood flow through your legs and decrease the risk of blood clot formation while you have decreased mobility.
  • You may be prescribed a pre-anaesthetic medication before you go to surgery.
  • Before you leave for theatre a preoperative checklist will be completed with you by your nurse. This checklist will be repeated in the operating reception area. Apart from your wedding band, which will be covered with tape, no jewellery or metal is to be worn to theatre.
  • It is important to continue practising your breathing and leg exercises which you will need to commence once you have woken up from your operation.

After your surgery

  • When you wake from the anaesthetic, you will be ready to be transferred, in your bed, from recovery to your hospital room.
  • It is important for you to start your breathing and leg exercises. These exercises help prevent complications such as chest infections and blood clots in your legs:

Breathing exercises—every hour you are awake and while resting in bed take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs. Taking a deep breath may trigger a cough.

  • If you had an abdominal incision: support your wound with your hands and forearms, perhaps use a pillow over your tummy, to protect as you cough. Bent knees help to reduce further strain on your wound.
  • If you had vaginal surgery, support your perineum (the area behind the vagina) by placing your hand over the perineum and apply gentle upward pressure while you cough.
  • Try to clear any secretions that you have.

Circulation ExercisesCirculation exercises—these exercises improve the blood circulation and may help prevent blood clots from forming in your legs. Start doing this exercise in bed and then once you start sitting out of bed.

  • Move your feet up and down briskly from your ankles.
  • While your leg is straight, push your knee gently into the bed and pull your toes towards your head. Hold this stretch for a few seconds and then relax.
  • Repeat five times with each leg if comfortable.
  • Squeeze your buttocks tightly and then relax. Repeat a few times.
  • Having an anaesthetic can make you feel sick and cause vomiting. You will have a drip in your arm which is necessary to maintain fluid intake and pain relief. This will remain in until you are tolerating food and fluids and your pain control is changed to oral medication.
  • Your nurse will take frequent observations of your vital signs (eg temperature, pulse, blood pressure etc) wound dressing and drain for several hours after the surgery. As you become fully recovered, these become less frequent but remain regular until you leave hospital. Vaginal bleeding will also be monitored.
  • You will receive oxygen while you are waking from the anaesthetic and receiving your pain medication through your drip.
  • Immediately following your surgery, you will be resting in bed. When you feel well enough you will be assisted the first time you get out of bed. Your nurse will assist you to freshen-up following your surgery.
  • You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated.
  • If you have pain or nausea, please tell your nurse as there are medications which can be given to relieve this. Good analgesia is important. When you have pain, you are less likely to breath deeply and more likely to withhold coughing and movement.
  • You may have a catheter in place. The catheter will normally be removed the day following your surgery when you are able to move around comfortably.
  • Wound Care:
    • Abdominal Surgery —a dressing will cover your wound which is closed with either stitches or staples. You may also have a drain inserted closes to your wound which will remove excess blood and fluid from the surgical area.
    • Vaginal Surgery— you may have a vaginal pack in place. This acts as a large tampon. It can cause discomfort and is usually removed after 24 hours. It is not painful when it is removed.
    • Laparoscopic Surgery— small dressings may cover your key-hole incision sites which will be closed with either glue or sutures. You may also have a drain inserted close to your wound. The purpose of the drain is to remove blood and fluid from your wound.
    • Vaginal / laparoscopic surgery— day one post-operatively (For minor incontinence surgery this is also discharge day)
    • Abdominal surgery—day one to two post-operatively

Post-operative aims:

  • Your pulse, blood pressure and temperature will be within the normal range. Nurses will continue to take your observations regularly (temperature, pulse, blood pressure) and monitor your wound, dressing, drain and vaginal bleeding.
  • Your pain will be controlled. You will be given your regular medications, plus any required for pain relief. Please let the nursing staff know when you have pain. REMEMBER when you have pain, you are less likely to breath deeply and more likely to withhold coughing and movement.
  • You may have a blood test to check your Haemoglobin level.
  • Your IV treatment will be discontinued if you are tolerating your diet and fluids and your blood tests are normal.
  • You will have progressed to and be tolerating a normal diet. Once you are tolerating 500mls or more of fluid you will be able to commence eating your normal diet.
  • Wound care
    • Abdominal surgery—your dressing will remain intact as this reduces the risk of infection. Your drains will be removed upon your doctor's instruction. Your vaginal loss will be scant.
    • Vaginal surgery—if you have a pack insitu, your vaginal pack will be removed and your blood loss will be similar to a light period.
    • Laparoscopic surgery—your vaginal loss will be scant.
  • You will have your catheter removed and your bladder function will be monitored.

Why do I have a catheter?

A catheter is in place for several reasons. There may be swelling preventing the bladder from working properly; it may be necessary to rest the bladder so healing can occur; your surgery prevents you from being able to get out of bed to pass urine.

Passing urine after removal of your catheter

When you have had surgery near your bladder it is important to monitor the way it is working after your catheter has been removed. Sometimes after passing urine, large amounts can still remain in your bladder. This is very common after such surgery and usually resolves in a very short time.

Each time you pass urine it is important for your nurse to measure the amount and then scan your bladder using an ultrasound device. This is called "Trial of Void" and is done to ensure your bladder is emptying sufficiently.

What you need to do.

  • ensure you drink adequate fluid. A normal amount most people should drink is one to two litres per day
  • to measure your urine it is important to pass urine into a pan. Once you have passed urine notify your nurse so your nurse can measure it and scan your bladder (checking the amount of urine remaining)
  • notify the staff if you are having pain or difficulty passing.

What is a double and triple void?

After you have tried to pass urine, if there is a large amount of urine left in the bladder, you will be asked to pass urine again. This can be repeated two to three times.

What happens next?

When we measure you are passing an adequate amount of urine and there is a minimal amount remaining in your bladder we no longer need to monitor your bladder function. If the amount of urine left in your bladder continues to be large the team will advise you what to do next. This may include:

  • continued with voiding, measuring and monitoring
  • a catheter being re-inserted for a period of time and on removal you will begin another 'trial-of-void'
  • being taught how to empty your bladder yourself with a catheter.

You will be encouraged to gradually increase your activity

  • you will have the compression stockings on your legs removed once you are getting out of bed. You will continue to wear the special stockings if ordered. Some women will receive an injection of heparin to reduce the risk of developing blood clots in the legs.
  • following instructions provided by your surgical team, your movement in and out of bed and around the ward will increase slowly each day. When moving in and out of bed follow the physiotherapist's instructions as outlined in section 'Getting in and out of bed through side-lying.'
  • Showering/bathing
    • abdominal Surgery – You may be well enough to be assisted with having a shower on the first day following your surgery. Alternatively you will be given a sponge in bed. On the second day following your surgery you will be encouraged to shower independently.
    • vaginal surgery—you will be assisted as needed with having a shower.

Emotional Support.

Please take the opportunity to discuss with your nurse any concerns you have.

A member of our pastoral care team may visit with you.

Patient Education

Getting in and out of bed through side-lying

  • Remember to gently brace as demonstrated by the physiotherapist preoperatively. Bracing involves gentle activation of pelvic floor muscles and deep tummy muscles.
  • Making sure the bed is flat. Draw in the pelvic floor as you bend both knees up
  • Roll over to your side without twisting too much and keep your knees bent.
  • With your top arm well in front of you, push your upper body forward and up, as you allow your legs to go down at the same time.
  • Remember to keep breathing, keep your knees bent, and come forward and up to sitting in one smooth action.
  • Always try to stand tall, with your shoulders relaxed as you walk.

It is important for you to remember to do your breathing and circulation exercises regularly while resting in bed.

Exercising your pelvic floor muscles

The pelvic floor muscles support the bladder, bowel and uterus. Strong pelvic floor muscles are important for control of both the bladder and bowel. It also plays a part in sexual function and stability of the spine.

Soon after a prolapse repair or continence surgery you can do gently pelvic floor pulses to enhance blood supply and healing of the operation site.

How to do pelvic floor contractions:

  • gently draw the muscles up around the urethra (front passage) as if you are trying to stop the flow of urine AND/OR
  • gently draw the muscles up around the anus (back passage) as if you are trying to stop passing wind.

You should also become aware of the automatic gentle drawing in (bracing) of your lower tummy as you are tightening your pelvic floor muscles.

While activating the pelvic floor muscles, do NOT:

  • squeeze your buttocks or draw your tummy in strongly
  • hold your breath
  • push down/strain.

If you have any symptoms of pelvic floor weakness or are unsure of how to activate these muscles, phone the physiotherapy department via 07 3163 8787 and arrange to see a Continence and Women's Health Physiotherapist.

Day of discharge

The aims are that:

  • your temperature will be within normal limits
  • your vaginal loss will be minimal
  • there will be no signs of infection, inflammation or unexpected bleeding
  • you will be comfortable and you pain will be managed with oral medication
  • you will understand all education provided and your plan of care after leaving hospital
  • you are able to walk independently to an appropriate level for home activity
  • you are able to tolerate fluids and diet.

Discharge planning

To ensure that you have a smooth discharge from hospital, planning is initiated early. If your recovery has been without complications your discharge day will be planned as being the second or third day following surgery depending on your type of surgery. Your doctor will confirm this with you.

Things that need to be organised

Your discharge destination …………………………………………………..

Your discharge transport ……………………………………………………..

Confirmation of time of discharge (as close to 10 am as possible)……………

If you are unable to be picked up by 10 am you will be transferred to the transit lounge where you will be cared for until your transport arrives.

Services needed at home………………………………………………………

Recovering at home

What to expect:

  • It is expected you will be mobilising independently to an appropriate level for 'home activity'. At home mobilise around the house and yard initially, then go for short walks. Aim to gradually increase your activity every day. By four weeks you should be fully mobile.
  • You may have a blood stained vaginal discharge. This should be lighter than a normal period and should settle within a fortnight
  • You may have foods and fluids as desired. A diet promoting tissue healing, including protein, iron and vitamin C is recommended. A high fibre diet along with two–three litres of fluid each day will encourage bowel regularity.
  • You may have a blood stained vaginal discharge. This should be lighter than a normal period and should settle within a fortnight.
  • You may need to take some simple analgesia for pain/discomfort, especially on waking and settling at night.
  • You may feel fatigued.
  • It is normal to experience some depression after this procedure.
  • Your bowel and bladder functions should continue to return to normal.
  • Take a shower rather than a bath
  • You will need to continue to wear your stockings - especially overnight – for one to two weeks.
  • Wound Care: Abdominal/Laparoscopic Prolapse / Incontinence Surgery— if your dressing/s are removed you may leave your wound exposed. If your dressing/s are left intact, instructions will be given you as to when you can remove then and how to do so. As part of your discharge plan you will be advised to make an appointment with your GP to have a wound check two weeks after your surgery.

What to avoid:

  • lift nothing greater than two kilograms for the first two to three weeks. Increase gently as tolerated over six weeks
  • driving the car—it will take about three weeks before you should drive a car. Only when you know you can act confidently with emergency breaking should you attempt driving the car
  • avoid sexual intercourse for six weeks to allow healing to take place
  • avoid inserting anything into the vagina for six to eight weeks to allow time for healing to take place e.g. use sanitary pads - not tampons
  • Avoid straining when opening your bowels.

The following position has been shown to assist in opening the bowels with more ease and help to prevent straining:

  • sit forward, don't hover
  • lean forward from your hips, with your forearms resting on your knees
  • keep the curve of your spine
  • get your knees slightly higher than your hips by coming up onto the balls of your feet if comfortable
  • allow your tummy to relax
  • do NOT hold your breath
  • ensure bowel motions are soft and easy to pass. Eating a diet high in fibre and drinking up to two litres of fluid a day avoids constipation.

Please note: it is important to avoid constipation and straining immediately after your surgery as this will assist healing and improve your comfort. Maintaining your bowel motion consistency (soft and easy to pass) long term, will lessen the chance of prolapse and incontinence in the future.

Contact details

  • for all general hospital enquiries please phone 07 3163 8664
  • for any queries related to your up-coming surgery please contact the Women's Health Unit Case Manager via 07 3163 3729 or 0434 607 821 (Monday to Friday between 8 am and 4 pm)
  • for any post operative complications as listed below please contact:
  • Mater Adult Hospital Emergency Department via 07 3163 8111 or your GP.

Complications:

  • your wound becomes red or inflamed, painful
  • you have heavy vaginal bleeding—heavier than a normal period
  • you have offensive vaginal discharge
  • you develop a fever (temperature above 38 degrees) or you are feeling unwell
  • you have pain that is not relieved by simple analgesia
  • you have nausea and vomiting that is difficult to manage
  • you are having difficulty passing urine or opening your bowels.

For general enquiries contact reception on 07 3163 8664

Acknowledgments:

Staff of Mater Mother's Hospital Women's Health Unit, Raymond Terrace, South Brisbane, Q 4101

Reference: Milliman Care Guidelines: Inpatient and Surgical Care/Ambulatory surgery /Home Care, 13th Edition, 1990 - 2009

Copyright © 2014 Misericordiae Health Services Brisbane Limited ACN 096 708 922

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430020
Last modified 08/8/2017.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 28/2/2014
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