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Abdominal and vaginal colpopexy

Our expectations

Prior to discharge:

  1. You will be independently mobile, attending to your daily needs.
  2. You will be able to pass urine normally OR you will be managing self catheterisation.
  3. Your pain will be controlled with oral analgesia.
  4. You will return to and tolerate your usual diet.
  5. Should you require community services, these will be organised for you.

Your expectations and goals

What are your expectations of your hospital stay?

What are your goals regarding this hospital experience and your recuperation?

What community services (if any) do you anticipate you will need (e.g. community nurses)?

Preadmission information

Prior to your admission to hospital, you will be provided with a preadmission form. Please complete this form and return to the hopsital as soon as possible. Please provide as much information as possible. If you currently use a CPAP machine, please ensure that you bring this to hospital with you.

Day of admission and surgery

Admission

On admission you will be taken to the ward.

You will be prepared for surgery and will be asked to sign your carepath to acknowledge your understanding and involvement of your daily care.

You will have an armband applied which will stay on for the duration of your stay for identification and safety reasons. From the ward you will be transferred to theatre.

A safe is provided in the cupboard of your post-op room to store any valuables you have brought to hospital. It is highly recommended that you leave your valuables at home for safety and security purposes.

Discharge planning

You can expect to be in hospital for two to three days or until you have met the expected outcomes for your procedure. Your nurse will discuss with you any needs that you may have following your discharge home (such as home help, blue nurses, etc.).

Please inform staff if you are currently using a Community service e.g. Blue Nurses.

Teaching and emotional support

Abdominal-and-vaginal-colpopexyYour nurse will explain to you the pre-op/surgical/post-op routine.

Any questions you may have in regards to your surgery or recovery will be answered.

If you would like pastoral care to visit you, please let the staff know and this can be arranged.

Following your operation you will be transferred to the recovery room where you will be observed closely for approximately 30 minutes. You will then be transferred back to your room on your bed once you are fully awake and stable.

Your physiotherapist will visit to explain exercises that will help with your post-op recovery. Deep breathing, coughing and leg exercises are important for you to do while you are resting in bed after your surgery. These exercises help your circulation and prevent the possibility of clots foring in your veins.

To facilitate the deep breathing and coughing, a device known as a TRI-FLO may be given to you.

Deep breathing and leg exercises

Once each hour take five or six deep, slow breaths—relax your shoulders as you breathe out. Bend ankles up and down 10 times every 30 minutes.

Supporting your wound when coughing, sneezing or vomiting

Sit forward in a chair if possible. If in bed, bend your knees up. Place both hands over your wound, with your forearms resting firmly across the abdomen. It may help you to use a pillow across your abdomen as you cough, sneeze or vomit.

Mobilising correctly using your deep abdominal muscles

When you move from sitting to standing, and when you walk, try to gently activate your deep abdominal muscles. Gently draw in the abdominal muscles below your underwear. Placing your hands on your lower abdomen beneath your navel will help you to check the activity of these muscles.

Moving in bed correctly

Slide one heel at a time along the bed towards your buttocks to bend both your knees. Keep your head flat on the pillow. Lift your bottom off the bed as you push through your heels and elbows to move yourself up the bed.

Positioning yourself to avoid straining your repair

When going to the toilet, remember to keep the curve in your back as you lean forward at the hips. Lean your forearms or hands onto your knees (refer to picture on right).

Tests/procedures

Any blood tests, x-rays, ECG or other procedures that your surgeon may have ordered for you will be taken care of before you come to hospital or soon after your arrival.

Consults

Your surgeon may visit and discuss your surgical procedure.

Your anaesthetist may also visit. They will also discuss your anaesthetic and pain relief following surgery. It is important that you raise any concerns with them.

A pharmacist may visit with you. You may ask them any questions about your medications. If you have any family or significant other who you would like the surgeon to speak with after the operation, this will be noted and they can wait in your room or a waiting area. If required, your surgeon can telephone them at home or work to update them on your condition. Please provide the nurse with the relevant telephone numbers.

Hygiene

If you are having abdominal surgery you will be required to have your pubic hair clipped.

Once you have showered (at home or on admission) you will be required to dress in a theatre gown and some paper pants in preparation for your surgery. Apart from your wedding band, no jewellery or metal is to be worn to theatre. Some tape will be wrapped around your wedding band to cover it.

After you return to the ward you will be given an assisted wash and be dressed in a clean gown.

Mobility

Immediately following surgery you will be resting in bed. You will be encouraged to practice your post-op deep breathing and circulation exercises.

Nutrition

It is necessary that you have nothing to eat or drink for six hours before the operation. Following surgery you may have small sips of water or ice to suck on. You will also be given fluids via your I.V. drip.

Elimination

On admission you may be asked for a urine sample for testing. You may require a small enema if your bowels have not opened. After surgery you will have a catheter in place to drain urine from your bladder.

Observations

On admission your nurse will take your observations (e.g. temperature, pulse, blood pressure and weight).

After surgery the nurse will observe your vital signs for several hours. These observations will become less frequent as you stabilise post-op.

Your wound, dressing and vaginal discharge will also be observed. You will return from your operation with a vaginal pack. This will remain in place until post-op day one.

Medications

Following surgery you will have an I.V. drip to maintain your fluid intake, pain relief and antibiotic coverage during your post-op period.

You must let your nurse know if you have any pain or nausea, as your medications can be adjusted accordingly.

Following surgery you may have oxygen in place via a mask or nasal prongs. This will be removed in time, according to your observations.

You may need a special injection daily to thin your blood and prevent clotting (e.g. Clexane) if your surgeon orders one.

Treatments

You will be measured for Anti-embolic stockings (TEDS) and will need to have these put on prior to going to theatre.

A sequenced pressure device (SCDS) will be applied to both your legs before surgery. This helps circulate the blood from your legs back to the heart while you are immobile, reducing the risk of clot formation.

Post-op - day one

Consults

Your surgeon will visit you today and discuss your operation.

Your anaesthetist may also visit to check your progress.

The pharmacist may also visit to check your medication supply.

The physiotherapist may also visit you today.

Mobility

You are encouraged to increase your mobility today as ordered by your doctor. Your mobility level will depend on when you had your operation. If you had a morning operation—you will be encouraged to mobilise this morning. If you had an afternoon operation—you may be advised to take it a little slower and not mobilise until the afternoon of day one post-op.

It is important that each time you sit out of bed—limit your sitting time to 15 to 20 minutes.

It is important to sit at 15 to 45° while in bed. Lying flat may compromise your breathing and sitting up higher than 45° will put strain on the repair.

Hygiene

You are free to shower independently. Assistance will be provided if necessary—especially if you had afternoon surgery.

Nutrition

You may have clear fluids progressing to a light diet as tolerated. A record will be kept of your oral fluid intake.

Continence state

Your catheter will remain in-situ today and the amount of urine will be measured.

Observations

Your temperature, pulse, respirations and blood pressure will continue to be monitored regularly.

Your vaginal discharge will be noted and your vaginal pack may be removed today. Removing the pack is similar to the removal of a tampon. You may experience some mild discomfort and there may be some small blood loss. It is important to inform your nurse if the bleeding becomes bright and heavy.

If you have an abdominal wound, your wound and dressing will be monitored regularly.

Medications

Your I.V. drip may be removed. This is determined by the completion of the antibiotics and whether you are tolerating oral fluids.

If you have any pain it will be controlled with oral analgesia. Remember to let your nurse know if you have any pain.

You may be ordered Movicol for your bowel. This comes in a sachet and is mixed with water. Its action is to soften the bowel motion to avoid strain on the sutures.

Treatments

You need to continue to wear your stockings as ordered. The SCDs will be removed when you are able to walk around.

Teaching, counselling

You will be encouraged to perform your deep breathing, coughing and leg exercises while resting in bed.

Remember: It is important not to do any pelvic floor exercises for a minimum of four weeks post-op.

You will be reminded to use the information provided by your physiotherapist.

Post-op - day two

Consults

Your surgeon, physiotherapist and pharmacists may visit you today.

Mobility

You may walk around the ward as tolerated.

It is important that each time you sit out of bed—limit your sitting time to 15 to 20 minutes.

Maintain the elevated position of 15 to 45° while resting in bed.

Hygiene

You are free to shower independently. Assistance will be given if needed.

Nutrition

Today you may increase your diet from a light diet to eating food as you desire.

Continence state

Your catheter will be removed today.

When your catheter is removed:

Each time you want to pass urine PLEASE notify your nurse. It is important for your nurse to measure the amount of urine passed and then scan your bladder with an ultrasound device. This is called “Trial of Void” and is done to ensure your bladder is emptying sufficiently.

Observations

Your temperature, pulse, respirations and blood pressure will continued to be monitored regularly and your vaginal discharge will be noted.

If you have had abdominal surgery your wound dressing will be monitored regularly.

Medications

If you have any pain it will be controlled with oral analgesia.

Your medications on discharge will be summarised for you on a discharge advice form which will be given to you.

Treatments

Continue to wear your stockings.

The vaginal pack that has been in place will be removed today and blood loss will be monitored.

If you have an abdominal wound, your dressing will be removed today after your shower and your wound will be left open to dry.

Teaching/counselling

You will be encouraged to perform your deep breathing, coughing and leg exercises while resting in bed. Remember to use the information provided by your physiotherapist.

Remember: it is important not to do any pelvic floor exercises for a minimum of four weeks post-op.

Day of discharge - day three

Discharge

It is expected you will be going home today. Discuss any concerns you may have with the staff.

You will need to organise a follow-up appointment following discharge.

Consults

Both your surgeon and the pharmacist may visit you today.

Mobility

You may walk as much as your comfort levels tolerate.

It is important that each time you sit out of bed—limit your sitting time to 15 to 20 minutes.

While in bed maintain the elevated position of 15 to 45°.

Do not sit up using your abdominal muscles or pull your body up with your arms.

Hygiene

You are free to shower independently. Assistance will be given if needed.

Nutrition

Today you may eat food and fluids as desired.

Continence state

It is expected that you will be passing urine normally today.

Please notify your nursing staff if you are:

  • Having difficulty passing urine
  • Passing urine frequently
  • Experiencing pain or burning when you pass urine

medication may be ordered to help you move your bowels if you are having difficulty.

Observations

Your temperature, pulse, respirations and blood pressure will be monitored prior to going home and you will be asked if you have any vaginal discharge. Your discharge should be scant to minimal.

Medications

Your medications on discharge will be summarised for you on a discharge advice form which will be given to you. If you have any pain it will be controlled with oral pain relief tablets.

Treatments

You will need to wear your stockings—especially overnight for ONE to TWO weeks.

Teaching/counselling

A discharge advice form will be given to you prior to discharge.

Discharge planning

It is expected you will be going home today.

Discuss any concerns you may have with the staff.

You will need to organise a follow-up appointment following discharge.

A copy of your discharge summary (information on your surgery and follow-up care) will be sent to your GP.

You will be confident with managing self catheterisation at home, if applicable.

Advice following colpopexy

What to expect

You may have a watery blood stained discharge for the first couple of weeks. As healing takes place you may experience some dark spotting as the internal sutures dissolve.

It is important to sit at 15 to 45° while in bed. Lying flat may compromise your breathing and sitting up higher than 45° will put strain on the repair.

You may feel fatigued.

You may need to take some simple analgesia (e.g. Panadol for pain or discomfort—especially on waking and settling at night).

What to avoid

It is important NOT TO do any pelvic floor exercises for a minimum of four weeks post-operatively. This is to allow time for the mesh to adhere and the wounds to heal.

Avoid strenuous activity and heavy lifting for three months.

Limit prolonged standing for the first six weeks.

At first, restrict your activity to walking around the house and yard and then increase to short walks—increasing your activity every day as you can tolerate it.

Avoid sexual activity for six weeks to allow time for healing to take place.

Avoid straining when opening your bowels or when emptying your bladder.

Avoid constipation by eating a diet high in fibre and drinking 1.5 to 2 litres of fluid each day.

When to notify your doctor

  • if your vaginal discharge increases and becomes offensive.
  • if you develop a fever (temperature 38° C).
  • if you experience persistent or an increase in pain.
  • if you show signs of a urinary tract infection:
    • temperature over 38° C
    • passing urine frequently
    • burning and pain when passing urine
    • passing blood when passing urine.

Acknowledgments

Staff of Mater Private Hospital Redland PCU2 and Physiotherapy.

References

Milliman Care Guidelines 11th Edition, 2007.

© 2010 Mater Misericordiae Ltd. ACN 096 708 922

Mater acknowledges consumer consultation in the development of this patient information.
Last modified 13/11/2015.
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