Patient Name: _ Date: _ New Jersey Urologic Institute Dr Betsy Greenleaf DO, FACOOG Pelvic Medicine and Reconstructive Surgery 10Industrial Way East, Suite 101, Eatontown, New Jersey 07724 732-963-9091 Fax: 732-963-9092 Findings: _ Post Operative Instructions (Vaginal Reconstruction/Sling Urethropexy) 1. Activity: May do as much as you feel up to. Your body will let you know when you are doing too much. Don't push yourself, however. Walking is ok and encouraged. If you sit too long you will become stiff and it will make it more difficult to move. Lying around can promote the formation of blood clots that can be life threatening. It is therefore important to move around. If you don't feel like walking, at least move your legs around in bed from time to time. Stairs are ok, just be careful of standing up too quickly and becoming light headed. Sitting still can also increase your risk of pneumonia. In addition to moving around, practice taking deep breaths ( 10 times each every hour or so) to keep your lungs properly aerated. Limitations: Avoid lifting or pushing/pulling any objects heavier than 1Olbs for at least 3 months. For patients with pelvic hernia or prolapse repairs it is recommended not to lift objects heavier than 25 Ibs for life. This may seem unrealistic. Try to put off lifting as long as possible. If you must lift, do not hold your breathe. Blow out as you lift to decrease abdominal and pelvic pressure. Also be aware that if you choose to lift objects heavier than recommended you risk forming another hernia 2. Bathing: You may shower the day after surgery. Limitations: Do not submerse until cleared by your doctor (on average 6-8 weeks) No baths, Jacuzzi, swimming ... .However, may do sitz baths ( purchase from a pharmacy). Sitz bath instructions: Place sitz basin on toilet. Add 2 tablespoons of Epson salt in warm water. Fill sitz bath and sit in for no more than 20 minutes at a time. Repeat as necessary for relief. Be sure to clean sitz bath with disinfectant between uses Epsom Bath Instructions: You may also use the bathtub to do an epsom bath for swelling relief. First take shower to rinse of skin bacteria. Make sure the tub is then disinfected with cleaner. Fill the bath with warm water and 2 cups of Epsom salt. Do no soak for longer than 20 minutes. Repeat as necessary for relief of discomfort and swelling. Page 1 : 4 3. Driving: You may drive when off pain medications (average 2-4 weeks) 4. Diet: You may return to regular diet as soon as possible. No restrictions 5. Medications: Take all medicine prescribed as directed. Prescribed medications will be checked below. __Percocet one to two pills every 4-6 hours as needed for severe pain ( may cause nausea and constipation) ____ every 4-6 hours as needed for severe pain. (may cause nausea and constipation) ___Nucynta 50 mg one pill every 4-6 hours as needed for severe pain ___ Sprix 15.75 mg one spray in nostril every 6 hours for pain and to keep down inflammation. Do not use past 5 days. ___Motrin 600mg every 6 hours for pain and to keep down inflammation. Take with food. (may cause stomach upset) ___Vimovo 375/20 mg one pill twice daily for pain and to keep down inflammation. _XX_ Miralax one tablespoon in 8 oz of liquid daily to prevent constipation. Over the counter ___Premarin cream Apply one inch of cream to vulva with finger three times a week. VERY IMPORTANT: aids in healing. __Estrace Cream Apply one inch of cream to vulva with finger three times a week. VERY IMPORTANT: aids in healing. __You have an Estring hormone ring in place. This is a hormone ring that will aid with healing. It is good for 3 months and then needs to be removed. If falls out, wash it with soap and water either replace in the vagina or notify the office to schedule an appointment to have it replaced. __Macrobid one pill twice daily ( preferably every 12 hours) if you go home with catheter. ___ Bactrim one pill twice daily ( preferably every 12 hours) if you go home with catheter. __ Pyridium one pill every 8 hours as needed for bladder irritation. May need if you go home with a catheter. Turns urine orange. Page 2: 4 __Urelle or Prosed OS one pill every 6 hours as needed for bladder irritation. May need if you go home with a catheter. Turns urine blue. ___ Other 6. Urinating: Sometimes after surgery you are too swollen to urinate and will need to go home with a catheter until some of the swelling diminishes. If you go home with a catheter you will need to follow up in office in days/weeks for removal. Call to schedule appointment. Make sure you take antibiotics while catheter in place (marked above) Difficulty urinating: If you go home without a catheter and have difficulty urinating, it is important to try and relax. Let the bladder do the pushing. Often if you try bearing down to push the urine out you will not be able to urinate. You may also try getting into the shower to pee. The warm water may stimulate you to urinate. You can also attempt to push on your lower abdomen with you hand to attempt to start the flow. If you are still unable to urinate you may need to come to the office for the placement of a catheter or if the office is closed, go to the nearest emergency room. Leaking: It is not unusual to leak after surgery. Sometimes you are too swollen for the urethra to close all the way, or sometimes the bladder is irritated after surgery and will spasm expelling urine. This is not unusual for 4-8 weeks after surgery. If it continues past 12 weeks your doctor will look into further causes of your leaking. 7. Bleeding: It is not unusual for the vagina to bleed and ooze after surgery. Sometimes the bleeding will pick up a week or two after surgery. This is commonly caused by the body dissolving any blood clots that formed at the surgery site. This dissolved blood will then leak through your incisions. It may be seen as a gush of fluid after standing or walking around. It is not unusually for this vaginal discharge to have an odor. If it is itching or burning, please notify your doctor. Change maxi pads every 2-4 hours to prevent infection. Pads hold in bacteria thus it is important to keep clean. If the bleeding is continuous and you are soaking through more than a maxi pad an hour for two hours, notify your doctor. Also call if this bleeding is associated with shortness of breath, light headedness, fainting ....... 8. Constipation: DO NOT GET CONSTIPATED. This is easier said than done. Surgery alone can cause constipation as can pain medications. You can avoid constipation by increasing your activity. The more you walk the more you will get your bowels to work properly. Stick with a high fiber (unless otherwise instructed by your doctor) diet and increase your fluid intake preferably water ( 64-96 oz a day). You may also use over the counter constipation products and combine Page 3 : 4 them if necessary. Just make sure to drink a lot of lluids. You may try Milk of Magnesia, Maalox, Dulcolax suppositories, Glycerin Suppositories, Metamucil, Fleets phosphasoda, or enemas. Stay away from Senekot or "senna" containing products: your body can become dependent on these. 9. Fever: A fever is any temperature above 100.4 F. Fever can be a normal reaction of your body to the stress of surgery. However, notify your doctor for temperatures above 101 F. 10. If you are diabetic: The stress of surgery may cause your sugars to increase. Pay close attention to your sugars and notify your endocrinologist or primary doctor if your sugars are running high. High sugars can prevent healing and can increase your risk of infection 11. Pelvic Rest: Nothing in the vagina until your doctor clears you. On average this is for 4-8 weeks. This means no vaginal sex, no tampons, no douching.......00 not receive oral sex until cleared by doctor. Other sexual activities may be engaged in as tolerated. Feel free to contact your doctor with any questions. 12.Wound care: Other than using a hormone cream or ring vaginally to aid in healing there is nothing that you need to put on your incisions. Just keep incision sites clean and dry. Clean with mild soap and water. You do not need Neosporin, Bactroban, Bacitracin, Vitamin E....or any other topical ointments. These products can actually prevent healing initially by getting into the incision and preventing it from coming together. Vitamin E can be used on external incisions after 2-4 weeks, but check with doctor before using. 13.Bruising: It is not unusual to get bruising after surgery. You may apply heat to these areas 48 hours after surgery to help your body absorb the bruising. 14.Air under skin if you had laparoscopic surgery: You can also get some leakage of air under your skin from the laparoscopic portion of the procedure. Your tissue may feel like "rice Krispies" from these air bubbles. This air will be absorbed over a period of 3-5 days. 15. Follow up appointments: Call office to make follow up appointment. You will need to be seen: __ 2-4 weeks after surgery __ 6-8 weeks after surgery __6 months after surgery __12 months after surgery __Yearly after surgery _XX_ If you have any problems or concerns Page 4: 4 8/22113 Take the Floor: Types of Surgery Types of Surgery Apical Suspensions The most important aspect of a prolapse repair (when maintaining sexual function is desired) is restoration of the support of the top of the vagina which is also called the vaginal apex or vault.