Vaginal Hysterectomy How to Navigate When Viewing This Information Online

RECOVERING WELL

Information for you after a Vaginal Hysterectomy How to navigate when viewing this information online

Contents Occasionally information on a topic From the contents page you can quickly will cover more than one page. The and easily access all the topics listed. more button will show you further information on the topic. To view a topic, simply tap/click the title of the information you want to see. Where other online information is available which might be useful to you a web link is given. Provided you have Within individual pages internet access, simply tap/click the link Simply tap/click on contents, found on to be taken to this information. These the bottom right of all pages, to return additional resources are highlighted to the contents page. You can then throughout. choose information on another topic. Swiping/click left or right will take you Next to the contents button is a to the previous or next page within the previous view option which will take publication. you back to the previous page you looked at.

Who is this Physiotherapy What can slow down my information for? Starting HRT (hormone recovery? About this information replacement therapy) When should I seek Cervical screening (smears) What can I expect after a medical advice after a vaginal Tiredness and feeling emotional vaginal hysterectomy? hysterectomy? Usual length of stay in hospital Your hospital may offer an Getting back to normal After-effects of general enhanced recovery programme Around the house anaesthesia (ERP). What is enhanced Exercise Catheter recovery? Driving Scars What can help me recover? Travel plans Stitches and dressings Rest Having sex Packs A pelvic floor muscle exercise Drain programme Returning to work Vaginal bleeding A daily routine Recovery tracker Pain and discomfort Eat a healthy balanced diet Trapped wind Keep your bowels working Starting to eat and drink Stop smoking Washing and showering Support from your family and Formation of blood clots - friends how to reduce risk A positive outlook

About this information This information is for you if you are about to You should read this information have, or you are recovering from, a vaginal together with any other information you have been given about your hysterectomy (an operation to remove your uterus choices and the operation itself. This (womb) through your vagina). You might also find information gives general advice based on women’s experiences and expert it useful to share this information with your family opinion. Every woman has different and friends. needs and recovers in different ways. Your own recovery will depend on: • how fit and well you are before your You may be having, or have had, a may find helpful information in operation vaginal hysterectomy in conjunction Recovering well: information for you • the reason you are having a with a: after a laparoscopic hysterectomy. hysterectomy • pelvic floor repair operation - if • the exact type of hysterectomy that so, you may find helpful information The type of hysterectomy will depend you have in Recovering well: information on your personal circumstances and for you after a pelvic floor repair will be discussed with you by your • how smoothly the operation operation. gynaecologist before your operation. goes and whether there are any complications. • salpingo-oophorectomy (removal You will need an anaesthetic for a of one or both of your ovaries and vaginal hysterectomy. This may be your fallopian tubes), which may a general anaesthetic or a regional involve keyhole surgery - if so, you anaesthetic (spinal or epidural).

Usual length of stay in hospital Catheter In most instances, you will be admitted You may have a catheter (tube) in your to hospital on the day of your bladder to allow drainage of your urine. operation. You may be able to go home This is usually for up to 24 hours after within 24 hours or, depending on your your operation until you are easily able circumstances, you may need to stay in to walk to the toilet to empty your hospital for two to three days. bladder. If you have problems passing urine, you may need to have a catheter After-effects of general anaesthesia for a few days. Most modern anaesthetics are short lasting. You should not have, or suffer Scars from, any after-effects for more than a A vaginal hysterectomy is carried out day after your operation. During the through your vagina so your scar first 24 hours you may feel more sleepy will be out of sight. However, if you than usual and your judgement may be have keyhole surgery as part of your impaired. You are likely to be in hospital operation, you will have between two during the first 24 hours but, if not, you and four small scars on different parts should have an adult with you during of your abdomen. Each scar will be this time and you should not drive or between 0.5 cm and 1 cm long. make any important decisions.

More>

Stitches and dressings Packs The stitches in your vagina will not You may have a pack (a length of gauze need to be removed, as they are like a large tampon) in your vagina after dissolvable. You may notice a stitch, or the operation to reduce the risk of part of a stitch, coming away after a few bleeding. A nurse will remove this after days or maybe after a few weeks. This is your operation while you are still in normal and nothing to worry about. hospital. Check with your nurse that this If you have keyhole surgery, your cuts has been done before you go home. may be closed by stitches or glue. Glue and some stitches dissolve by Drain themselves. Other stitches may need Occasionally, a drain (small tube) to be removed, usually by the practice is inserted through your vagina to nurse at your GP surgery about five drain off any blood or fluid that may to seven days after your operation. You accumulate immediately after your will be given information about this. operation. This will be removed by a Your cuts will initially be covered with a nurse after your surgery while you are dressing. You should be able to take this still in hospital. off about 24 hours after your operation and have a wash or shower (see section on washing and showering). More>

Vaginal bleeding slightly sick and constipated. If you do Starting to eat and drink You can expect to have some vaginal need to take these medications, try to After your operation, you may have a bleeding for one to two weeks after eat extra fruit and fibre to reduce the drip in your arm to provide you with your operation. This is like a light period chances of becoming constipated. fluids. When you are able to drink again, and is red or brown in colour. Some Taking painkillers as prescribed to the drip will be removed. You will be women have little or no bleeding reduce your pain will enable you to get offered a drink of water or cup of tea initially, and then have a sudden gush out of bed sooner, stand up straight and something light to eat. If you are of old blood or fluid about 10 days and move around – all of which will not hungry initially, you should drink later. This usually stops quickly. You speed up your recovery and help to fluid. Try eating something later on. should use sanitary towels rather prevent the formation of blood clots in than tampons as using tampons could your legs or your lungs. increase the risk of infection. Trapped wind Pain and discomfort Following your operation your bowel You can expect pain and discomfort may temporarily slow down, causing air More> in your lower abdomen for at least or ‘wind’ to be trapped. This can cause the first few days after your operation. some pain or discomfort until it is When leaving hospital, you should passed. Getting out of bed and walking be provided with painkillers for the around will help. Peppermint water may pain you are experiencing. Sometimes also ease your discomfort. Once your painkillers that contain codeine or bowels start to move, the trapped wind dihydrocodeine can make you sleepy, will ease.

Washing and showering • being as mobile as you can as early as when you go home; your doctor will If you have had keyhole surgery and you can after your operation advise you on the length of time you have scars on your abdomen, you • doing exercises when you are resting, should have these for should be able to have a shower or for example: • graduated compression stockings, bath and remove any dressings the pump each foot up and down which should be worn day and night day after your operation. Don’t worry briskly for 30 seconds by moving until your movement has about getting your scars wet - just your ankle improved and your mobility is no ensure that you pat them dry with longer significantly reduced move each foot in a circular clean disposable tissues or let them dry motion for 30 seconds • special boots that inflate and deflate in the air. Keeping scars clean and dry to wear while in hospital. bend and straighten your legs - helps healing. one leg at a time, three times for Formation of blood clots - how to each leg. reduce the risk You may also be given other measures There is a small risk of blood clots to reduce the risk of a clot developing, More> forming in the veins in your legs and particularly if you are overweight or pelvis (deep vein thrombosis) after any have other health issues. These may operation. These clots can travel to the include: lungs (pulmonary embolism), which • daily heparin injections (a blood- could be serious. You can reduce the thinning agent) - you may need to risk of clots by: continue having these injections daily

Physiotherapy Starting HRT Tiredness and feeling emotional You will be given advice and (hormone replacement therapy) You may feel much more tired than information about exercises to help If your ovaries have been removed usual after your operation as your body you recover and about ways to move during your operation, you may be is using a lot of energy to heal itself. You easily and rest comfortably. You should offered hormone replacement therapy may need to take a nap during the day be given written information on this. (HRT). This will be discussed with you for the first few days. A hysterectomy The ward physiotherapist may also visit by your gynaecologist and together you can also be emotionally stressful and you after your operation to show you can decide the best way forward. many women feel tearful and emotional some exercises and have a discussion at first - when you are tired, these Cervical screening (smears) with you about how to progress with feelings can seem worse. For many getting out of bed and mobilising. Some women who have had a vaginal women this is the last symptom to The physiotherapist will also advise hysterectomy will need to continue to improve. have smears from the top of the vagina. you on how to do pelvic floor muscle Check with your GP or gynaecologist exercises. whether this applies to you.

Enhanced recovery is a programme Before your operation, your health will • You will be encouraged to drink and that aims to get you back to full health be checked and a care plan for your to eat as soon as possible, as quickly as possible after a planned stay in hospital and discharge home maybe even while you are in the operation. If you take an active role in will be made. Your views will be taken recovery room before you return your treatment and are supported by into account. Following this plan means to the ward. Eating early after surgery your GP and the hospital enhanced that you are likely to go home sooner, is safe and, you are less likely to feel recovery team, stresses caused by an so it is important to prepare for this. sick. If you have a drip in your arm, operation are reduced and you will get The plan aims to keep you at home this will be removed once you are better faster. for as long as possible before your eating and drinking. Without a drip, it Being in the best possible shape before operation. You may be offered special will be easier for you to walk about. your operation will help. Stopping carbohydrate drinks and you should be smoking, losing weight, cutting the able to continue drinking water up to 2 hours before your operation to make amount of alcohol you drink and More> increasing the amount of exercise you sure your body stays properly hydrated. do every day will make your recovery faster and safer. It is important that After your operation: medical conditions such as high blood • If you have had a catheter, drain or pressure and asthma are controlled vaginal packs inserted, they will be before your operation. Your GP will removed as soon as possible. help you with this.

• You will have a personal •The team will make sure you get pain programme to get you mobile as relief to allow you to do your soon as possible. As soon as it is activities comfortably. safe to do so, you will be helped Your individual needs will be considered will be helped out of bed so you can and you will not be discharged from sit in a chair. You will then be hospital until you are ready. This will encouraged to walk short distances. be when you are mobile, able to eat You may be given a diary with daily and drink, and can control your pain by goals and space for you to write taking tablets. Before you leave hospital, what you have managed to do. you will be given instructions about There are good reasons for getting who to contact if you have any worries. up and about as soon as safely Enhanced recovery programmes help possible. You are less likely to suffer patients get better more quickly after from blood clots in your legs and major surgery. Patients spend less time pelvis (deep vein thrombosis) or in in hospital and get back to their normal your lungs (pulmonary embolis and activities faster than with traditional you are less likely to develop a chest recovery. By following an enhanced infection. Your bowel will recover recovery programme, there are fewer faster and you are less likely to suffer complications after surgery and lower from trapped wind. rates of re-admission to hospital than ● with traditional care.

lying down. Rest does not mean doing vagina. When you do this, you should It takes time for your nothing at all throughout the day, as it is feel your muscles ‘lift and squeeze’. body to heal and for important to start exercising and doing It is important to breathe normally light activities around the house within while you are doing pelvic floor muscle you to get fit and well the first few days. exercises. You may also feel some gentle again after a vaginal tightening in your lower abdominal A pelvic floor muscle exercise muscles. This is normal. Women used hysterectomy. There programme to be told to practise their pelvic floor are a number of Your pelvic floor muscles span the base muscle exercises by stopping the flow of your pelvis. They work to keep your of urine mid-stream. This is no longer positive steps you can pelvic organs in the correct position recommended, as your bladder function take at this time. The (prevent prolapse), tightly close your could be affected in the longer term. bladder and bowel (stop urinary or following will help anal incontinence) and improve sexual you recover. satisfaction. More> It is important for you to get these muscles working properly after your Rest operation, even if you have stitches. Rest as much as you can for the first To identify your pelvic floor muscles few days after you get home. It is imagine you are trying to stop yourself important to relax, but avoid crossing from passing wind, or you could think your legs for too long when you are of yourself squeezing tightly inside your

You can begin these exercises gently pressure, such as lifting, coughing or once your catheter has been removed sneezing. and you are able to pass urine on Make these exercises part of your your own. You need to practise short daily routine for the rest of your life. squeezes as well as long squeezes: Some women use triggers to remind • short squeezes are when you tighten themselves, such as brushing their teeth, your pelvic floor muscles for one washing up or commercial breaks on second, and then relax television. • long squeezes are when you tighten Straining to empty your bowels your pelvic floor muscles, hold for (constipation) may also weaken your several seconds, and then relax. pelvic floor muscles and should be Start with what is comfortable and avoided. If you suffer from constipation then gradually increase, aiming for 10 or find the pelvic floor muscle exercises long squeezes, up to 10 seconds each, difficult, you may benefit from seeing a followed by 10 short squeezes. specialist women’s health physiotherapist. You should do pelvic floor muscle A daily routine exercises at least three times a day. At Establish a daily routine and keep it up. first you may find it easier to do them For example, try to get up at your usual when you are lying down or sitting. time, have a wash and get dressed, move As your muscles improve, aim to do about and so on. Sleeping in and staying your exercises when you are standing in bed can make you feel depressed. Try up. It is very important to tighten to complete your routine and rest later your pelvic floor muscles before you if you need to. do anything that may put them under More>

Eat a healthy balanced diet Keep your bowels working If you do have problems opening your Ensure your body has all the nutrients Your bowels may take time to return bowels, it may help to place a small it needs by eating a healthy balanced to normal after your operation. Your footstool under your feet when you are diet. A healthy diet is a high-fibre diet motions should be soft and easy sitting on the toilet so that your knees (fruit, vegetables, wholegrain bread and to pass. You may initially need to are higher than your hips. If possible cereal) with up to two litres per day of take laxatives to avoid straining and lean forwards and rest your arms on fluid intake, mainly water. Remember constipation. You may find it more top of your legs to avoid straining. to eat at least five portions of fruit and comfortable to hold your abdomen vegetables each day! As long as you are (provide support) the first one or two exercising enough and don’t eat more times your bowels move. than you need to, you don’t need to worry about gaining weight.

More>

Stop smoking or preparing meals. Most people are • eating a healthy diet - if you are Stopping smoking will benefit your only too happy to help - even if it overweight, it is best to eat healthily health in all sorts of ways, such means you having to ask them! Having without trying to lose weight for the as lessening the risk of a wound company when you are recovering first couple of weeks after the infection or chest problems after your gives you a chance to say how you are operation; after that, you may want anaesthetic. By not smoking - even feeling after your operation and can to lose weight by combining a if it is just while you are recovering help to lift your mood. If you live alone, healthy diet with exercise. - you will bring immediate benefits plan in advance to have someone stay Whatever your situation and however to your health. If you are unable to with you for the first few days when you are feeling, try to continue to do stop smoking before your operation, you are at home. the things that are helpful to your long- you may need to bring nicotine term recovery. replacements for use during your A positive outlook hospital stay. You will not be able to Your attitude towards how you are smoke in hospital. If you would like recovering is an important factor in information about a smoking cessation determining how your body heals and clinic in your area, speak with the nurse how you feel in yourself. You may want in your GP surgery. to use your recovery time as a chance to make some longer term positive Support from your family and friends lifestyle choices such as: You may be offered support from your • starting to exercise regularly if family and friends in lots of different you are not doing so already and ways. It could be practical support with gradually build up the levels of things such as shopping, housework exercise that you take

It can take longer to recover from a hysterectomy if: Recovering after an • you had health problems before your operation; for example, women with operation is a very diabetes may heal more slowly and personal experience. may be more prone to infection • you smoke - smokers are at If you are following increased risk of getting a chest or all the advice that you wound infection during their recovery, and smoking can delay the have been given but healing process do not think that you • you were overweight at the time of are at the stage you your operation - if you are overweight, it can take longer to ought to be, talk with recover from the effects of the your GP. anaesthetic and there is a higher risk of complications such as infection and thrombosis • there were any complications during your operation.

You should seek medical advice from • Red and painful skin around your While most women your GP, the hospital where you had scars if you have had keyhole your operation, NHS 111 or NHS 24 if surgery: This may be due to a recover well after an you experience: wound infection. Treatment is vaginal hysterectomy, • Burning and stinging when you with a course of antibiotics. pass urine or pass urine frequently: • Increasing abdominal pain: If you also complications can This may be due to a urine infection. have a temperature (fever), have lost occur - as with any Treatment is with a course of your appetite and are vomiting, this antibiotics. may be due to damage to your operation. • Vaginal bleeding that becomes bowel or bladder, in which case you heavy or smelly: If you are also will need to be admitted to hospital. feeling unwell and have a • A painful, red, swollen, hot leg or temperature (fever), this may difficulty bearing weight on be due to an infection or a small your legs: This may be due to collection of blood at the top of a deep vein thrombosis (DVT). the vagina called a vault If you have shortness of breath or haematoma. Treatment is usually chest pain or cough up blood, with a course of antibiotics. it could be a sign that a blood Occasionally, you may need to clot has travelled to the lungs be admitted to hospital for the (pulmonary embolism). If you have antibiotics to be administered these symptoms, you should seek intravenously (into a vein). Rarely, this medical help immediately. blood may need to be drained.

Around the house For the first one to two weeks, you Remember to lift correctly by having While it is important to take enough should restrict lifting to light loads such your feet slightly apart, bending your rest, you should start some of your as a one litre bottle of water, kettles or knees, keeping your back straight and normal daily activities when you get small saucepans. You should not lift heavy bracing (tightening or strengthening) home and build up slowly. You will find objects such as full shopping bags or your pelvic floor and stomach muscles you are able to do more as the days and children, or do any strenuous housework as you lift. Hold the object close to you weeks pass. If you feel pain, you should such as vacuuming until three to four and lift by straightening your knees. try doing a little less for another few weeks after your operation as this may days. affect how you heal internally. Try getting It is helpful to break jobs up into smaller down to your children rather than lifting parts, such as ironing a couple of items them up to you. of clothing at a time, and to take rests regularly. You can also try sitting down while preparing food or sorting laundry. More>

will assist your recovery. If you are unsure, start with short steady walks close to your home a couple of times a day for the first few days. When this is comfortable, you can gradually increase the time while walking at a relaxed steady pace. Many women should be able to walk for 30-60 minutes after two or three weeks. Swimming is an ideal exercise that can usually be resumed within two to three weeks provided that vaginal bleeding and discharge has stopped. If you build up gradually, the majority of women should be back to previous activity levels within four to six weeks. Contact sports and power sports Exercise increase your activity levels quite rapidly should be avoided for at least six weeks, While everyone will recover at a over the first few weeks. There is no although this will depend on your level different rate, there is no reason why evidence that normal physical activity of fitness before surgery. you should not start walking on the day levels are in any way harmful and a you return home. You should be able to regular and gradual build-up of activity More>

Driving In general, it can take two to four You should not drive for 24 hours after weeks before you are able to do all of You should not drive a general anaesthetic. Each insurance the above. It is a good idea to practise for 24 hours after a company will have its own conditions without the keys in the ignition. See general anaesthetic. for when you are insured to start driving whether you can do the movements you again. Check your policy. would need for an emergency stop and a three-point turn without causing yourself Each insurance Before you drive you should be: any discomfort or pain. When you are company will have its • free from the sedative effects of any ready to start driving again, build up own conditions for painkillers gradually, starting with a short journey. • able to sit in the car comfortably and when you are insured to work the controls start driving again. • able to wear the seatbelt comfortably Check your policy. • able to make an emergency stop • able to comfortably look over your shoulder to manoeuvre.

Travel plans • whether your plans are in line with If you are considering travelling during the levels of activity recommended in your recovery, it is helpful to think about: this information. • the length of your journey – journeys If you have concerns about your travel over four hours where you are not plans, it is important to discuss these with able to move around (in a car, coach, your GP or the hospital where you have train or plane) can increase your risk your operation before travelling. of deep vein thrombosis (DVT); this is especially so if you are travelling Having sex soon after your operation You should usually allow four to six • how comfortable you will be during weeks after your operation to allow your journey, particularly if you are your scars to heal. It is then safe to have wearing a seatbelt? sex - as long as you feel comfortable. If you experience any discomfort or • overseas travel: dryness, you may wish to try a vaginal ○ Would you have access to lubricant. You can buy this from your appropriate medical advice at your local pharmacy. destination if you were to have a problem after your operation? Does your travel insurance cover any necessary medical treatment in the event of a problem after your operation?

Everyone recovers at a different rate, Returning to work can help your pressurised by family, friends or your so when you are ready to return to recovery by getting you back into your employer to return to work before you work will depend on the type of work normal routine again. Some women feel ready. You do not need your GP’s you do, the number of hours and how who are off work for longer periods permission to go back to work. The you get to and from work. start to feel isolated and depressed. decision is yours. You may experience more tiredness You do not have to be symptom than normal after any operation, so free before you go back to work. It your return to work should be like is normal to have some discomfort your return to physical activity, with as you are adjusting to working life. It a gradual increase in the hours and might be possible for you to return to activities at work. If you have an work by doing shorter hours or lighter occupational health department, they duties and building up gradually over will advise on this. a period of time. Consider starting partway through your normal working Some women are fit to work after two week so you have a planned break to three weeks and will not be harmed quite soon. by this if there are no complications from surgery. You might also wish to see your GP or your occupational health department Many women are able to go back to before you go back and do certain normal work after four to six weeks if jobs – discuss this with them before they have been building up their levels your operation. You should not feel of physical activity at home.

Time after operation How might I feel? What is safe to do? Fit to work? • Get up and move about • You are still likely to be in hospital during this time • Go to the toilet • You will have some generalised aches in your abdomen • Get yourself dressed 1 - 2 No days • You may feel sore moving in and out of bed • Start eating and drinking as usual 7 • You may have some bleeding like a light period • You may feel tired and perhaps feel like a sleep in the afternoon • Continue as for days 1 - 2 • You should be at home by now • Go for short walks • Your pains should be slowly be reducing in intensity and • Continue with excercises that have been 3 - 7 No days you will be able to move about more comfortably recommended to you 7 • You will still tire easily • Wash and shower as normal • Have a rest or sleep in the afternoon if you need to

• Build up your activity slowly and steadily • There will be less pain as you continue to move about • You are encouraged to go for longer and more 1 - 2 and you will find your energy levels slowly returning Not just yet frequent walks weeks • Bleeding should have settled or be very little 7 • Restrict lifting to light loads

Yes, • Continue to build up the amount of activity you are possibly on reduced • There will be even less pain as you move more and more 2 - 4 doing towards your normal levels hours or lighter • You will find your energy levels are returning to normal duties at first. Some • You can start to do low-impact sport 3 women will be fit for • You should feel stronger every day weeks • Make a plan for going back to work full-time work after 4 weeks

• All daily activities including lifting Yes, but if you don’t feel 4 - 6 • Almost back to normal • Usual exercise ready to go to work, • You may still feel tired and need to rest more than usual • Driving talk to your GP or weeks 3 employer about the • Have sex if you feel ready reasons for this

© Royal College of Obstetricians and Gynaecologists 2015 Contents Previous view Acknowledgements This information was developed by a multidisciplinary working party on recovery following gynaecological surgery and was peer reviewed by experts in the field and by patients and the public.

The production of this PDF has been funded by an Ethicon Educational Grant. All content has been independently developed by the RCOG (Registered charity no. 213280).