Laparoscopic Hysterectomy How to Navigate When Viewing This Information Online

RECOVERING WELL

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

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Who is this Physiotherapy What can slow down my information for? Starting HRT recovery? About this information (hormone replacement therapy) When should I seek medical Cervical screening (smears) What can I expect after an advice after a laparoscopic Tiredness and feeling emotional laparoscopic hysterectomy? hysterectomy? Usual length of stay Your hospital may offer an Getting back to normal in hospital Enhanced Recovery Programme Around the house After-effects of general (ERP). What is enhanced anaesthesia recovery? Exercise Catheter Driving What can help me recover? Scars Travel plans Rest Stitches and dressings Having sex A pelvic floor muscle exercise Packs 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 your family and friends Formation of blood clots - how A positive outlook to reduce the risk

This information is for you if you are about to have, or you are recovering from, a laparoscopic hysterectomy (an operation to remove your uterus (womb) by keyhole surgery). You might also find it useful to share this information with your family and friends. There are several different types of If you are having an LAVH, you might the operation itself. This information hysterectomy, including: find helpful information in Recovering gives general advice based on women’s • total hysterectomy, where both the well: information for you after a vaginal experiences and expert opinion. Every uterus and cervix (neck of the hysterectomy. woman has different needs and recovers womb) are removed The type of hysterectomy will depend on in different ways. Your own recovery will • subtotal hysterectomy, where just the your personal circumstances and will be depend on: uterus is removed and the cervix is not discussed with you by your gynaecologist • how fit and well you are before your • hysterectomy with salpingo- before your operation. operation oophorectomy (removal of one or You will need an anaesthetic for a • the reason you are having a both or your ovaries and your laparoscopic hysterectomy. This will hysterectomy fallopian tubes) at the same time. be a general anaesthetic or a regional • the exact type of hysterectomy that Some laparoscopic hysterectomies anaesthetic (spinal or epidural). you have are done entirely by keyhole surgery. About this information • how smoothly the operation goes Others are done partially through your and whether there are any You should read this information together vagina (sometimes called a laparoscopic complications. with any other information you have assisted vaginal hysterectomy or LAVH). been given about your choices and

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 one 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 You will have between two and four day after your operation. During the small scars on different parts of your first 24 hours you may feel more sleepy abdomen. Each scar will be between than usual and your judgement may be 0.5 cm and 1 cm long. If you have had impaired. You are likely to be in hospital your cervix removed, you will also have during the first 24 hours but, if not, you a scar at the top of your vagina. should have an adult with you during this time and you should not drive or More > make any important decisions.

Stitches and dressings Packs Pain and discomfort Cuts on your abdomen will be closed You may have a pack (a length of gauze You can expect pain and discomfort by stitches or glue. Glue and some like a large tampon) in your vagina in your lower abdomen for at least stitches dissolve by themselves. Other after the operation to reduce the risk the first few days after your operation. stitches may need to be removed. This of bleeding. A nurse will remove this You may also have some pain in your is usually done by the practice nurse at after your operation while you are shoulder. This is a common side effect your GP surgery about five to seven still in hospital. Check with your nurse of laparoscopic surgery. When leaving days after your operation. You will be that this has been done before you go hospital, you should be provided given information about this. home. with painkillers for the pain you are Your cuts will initially be covered with a experiencing. Sometimes painkillers dressing. You should be able to take this Vaginal bleeding that contain codeine or dihydrocodeine off about 24 hours after your operation You can expect to have some vaginal can make you sleepy, slightly sick and and have a wash or shower (see bleeding for one to two weeks after constipated. If you do need to take section on washing and showering). your operation. This is like a light period these medications, try to eat extra fruit Any stitches in your vagina will not and is red or brown in colour. Some and fibre to reduce the chances of need to be removed, as they are women have little or no bleeding becoming constipated. dissolvable. You may notice a stitch, or initially, and then have a sudden gush Taking painkillers as prescribed to part of a stitch, coming away after a few of old blood or fluid about 10 days reduce your pain will enable you to get days or maybe after a few weeks. This is later. This usually stops quickly. You out of bed sooner, stand up straight normal and nothing to worry about. should use sanitary towels rather and move around - all of which will than tampons as using tampons could speed up your recovery and help to increase the risk of infection. prevent the formation of blood clots in your legs or your lungs. More>

Trapped wind Washing and showering Following your operation your bowel You should be able to have a shower may temporarily slow down, causing air or bath and remove any dressings the or ‘wind’ to be trapped. This can cause day after your operation. Don’t worry some pain or discomfort until it is about getting your scars wet – just passed. Getting out of bed and walking ensure that you pat them dry with around will help. Peppermint water may clean disposable tissues or let them dry also ease your discomfort. Once your in the air. Keeping scars clean and dry bowels start to move, the trapped wind helps healing. will ease. More> Starting to eat and drink After your operation, you may have a drip in your arm to provide you with fluids. When you are able to drink again, the drip will be removed. You will be offered a drink of water or cup of tea and something light to eat. If you are not hungry initially, you should drink fluid. Try eating something later on.

Formation of blood clots - how to particularly if you are overweight or There is a small reduce the risk have other health issues. These may include: risk of blood clots You can reduce the risk of clots by: • being as mobile as you can as early • daily heparin injections (a blood- forming in the veins as you can after your operation thinning agent) - you may need to in your legs and • doing exercises when you are continue having these injections daily resting, for example: when you go home; your doctor will pelvis (deep vein advise you on the length of time you pump each foot up and down should have these for thrombosis) after briskly for 30 seconds by moving your ankle • graduated compression stockings, any operation. which should be worn day and night These clots can move each foot in a circular until your movement has improved motion for 30 seconds and your mobility is no longer travel to the bend and straighten your significantly reduced lungs (pulmonary legs - one leg at a time, three • special boots that inflate and deflate times for each leg. to wear while in hospital. embolism), which You may also be given other measures could be serious. to reduce the risk of a clot developing, More>

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 with you about how to progress with Cervical screening (smears) feelings can seem worse. For many getting out of bed and mobilising. Some women who have had a women this is the last symptom to The physiotherapist will also advise laparoscopic hysterectomy will need to improve. you on how to do pelvic floor muscle continue to have smears from the top exercises. of the vagina. Check with your GP or gynaecologist whether this applies to you.

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

Being in the best possible shape before operation. You may be offered special your operation will help. Stopping carbohydrate drinks and you should be smoking, losing weight, cutting the able to continue drinking water up to 2 More>

• You will have a personal programme pain relief to allow you to do your to get you mobile as soon as activities comfortably. possible. As soon as it is safe to do Your individual needs will be considered so, you will be helped out of bed so and you will not be discharged from you can sit in a chair. You will then hospital until you are ready. This will be encouraged to walk short be when you are mobile, able to eat distances. You may be given a diary and drink, and can control your pain by with daily goals and space for you to taking tablets. Before you leave hospital, write 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 embolism) activities faster than with traditional and you are less likely to develop a recovery. By following an enhanced chest infection. Your bowel will recovery programme, there are fewer recover faster and you are less likely complications after surgery and lower to suffer from trapped wind. rates of re-admission to hospital than • The team will make sure you get with traditional care.

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

Start with what is comfortable and You should do pelvic floor muscle A daily routine then gradually increase, aiming for 10 exercises at least three times a day. At Establish a daily routine and keep it up. long squeezes, up to 10 seconds each, first you may find it easier to do them For example, try to get up at your usual followed by 10 short squeezes. when you are lying down or sitting. As time, have a wash and get dressed, your muscles improve, aim to do your move about and so on. Sleeping in exercises when you are standing up. It and staying in bed can make you is very important to tighten your pelvic feel depressed. Try to complete your floor muscles before you do anything routine and rest later if you need to. that may put them under pressure, such as lifting, coughing or sneezing. Eat a healthy balanced diet Make these exercises part of your Ensure that your body has all the daily routine for the rest of your life. nutrients it needs by eating a healthy Some women use triggers to remind balanced diet. A healthy diet is a high- themselves such as, brushing their teeth, fibre diet (fruit, vegetables, wholegrain washing up or commercial breaks on bread and cereal) with up to two litres television. per day of fluid intake, mainly water. Straining to empty your bowels Remember to eat at least five portions (constipation) may also weaken your of fruit and vegetables each day! As pelvic floor muscles and should be long as you are exercising enough and avoided. If you suffer from constipation don’t eat more than you need to, you or you find the pelvic floor muscle don’t need to worry about gaining exercises difficult, you may benefit weight. from seeing a specialist women’s health More> physiotherapist.

Keep your bowels working anaesthetic. By not smoking - even replacements for use during your Your bowels may take time to return if it is just while you are recovering - hospital stay. You will not be able to to normal after your operation. Your you will bring immediate benefits to smoke in hospital. If you would like motions should be soft and easy your health. If you are unable to stop information about a smoking cessation to pass. You may initially need to smoking before your operation, you clinic in your area, speak with the nurse take laxatives to avoid straining and may need to bring nicotine in your GP surgery. constipation. You may find it more More> comfortable to hold your abdomen (provide support) the first one or two times your bowels move. If you do have problems opening your bowels, it may help to place a small footstool under your feet when you are sitting on the toilet so that your knees are higher than your hips. If possible, lean forward and rest your arms on top of your legs to avoid straining.

Stop smoking Stopping smoking will benefit your health in all sorts of ways, such as lessening the risk of a wound infection or chest problems after your

Support from your family and friends A positive outlook Whatever your situation and however You may be offered support from your Your attitude towards how you are you are feeling, try to continue to do family and friends in lots of different recovering is an important factor in the things that are helpful to your long- ways. It could be practical support with determining how your body heals and term recovery. things such as shopping, housework how you feel in yourself. You may want or preparing meals. Most people are to use your recovery time as a chance only too happy to help - even if it to make some longer term positive means you having to ask them! Having lifestyle choices such as: company when you are recovering • starting to exercise regularly if you gives you a chance to say how you are are not doing so already and feeling after your operation and can gradually building up the levels of help to lift your mood. If you live alone, exercise that you take plan in advance to have someone stay with you for the first few days when • eating a healthy diet - if you are you are at home. overweight, it is best to eat healthily without trying to lose weight for the first couple of weeks after the operation; after that, you may want to lose weight by combining a healthy diet with exercise.

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

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

Around the house after your operation as this may affect If you are unsure, start with short While it is important to take enough how you heal internally. Try getting steady walks close to your home a rest, you should start some of your down to your children rather than couple of times a day for the first few normal daily activities when you get lifting them up to you. days. When this is comfortable, you home and build up slowly. You will find Remember to lift correctly by having can gradually increase the time while you are able to do more as the days your feet slightly apart, bending your walking at a relaxed steady pace. Many and weeks pass. If you feel pain, you knees, keeping your back straight and women should be able to walk for 30- should try doing a little less for another bracing (tightening or strengthening) 60 minutes after two or three weeks. your pelvic floor and stomach muscles few days. Swimming is an ideal exercise that can as you lift. Hold the object close to you usually be resumed within two to three It is helpful to break jobs up into and lift by straightening your knees. smaller parts, such as ironing a couple weeks provided that vaginal bleeding of items of clothing at a time, and to Exercise and discharge has stopped. If you build take rests regularly. You can also try While everyone will recover at a up gradually, the majority of women sitting down while preparing food or different rate, there is no reason why should be back to previous activity sorting laundry. For the first one to you should not start walking on the levels within four to six weeks. two weeks, you should restrict lifting day you return home. You should be to light loads such as a one litre bottle able to increase your activity levels Contact sports and power sports of water, kettles or small saucepans. quite rapidly over the first few weeks. should be avoided for at least six You should not lift heavy objects such There is no evidence that normal weeks, although this will depend on as full shopping bags or children, or physical activity levels are in any way your level of fitness before surgery. do any strenuous housework such as harmful and a regular and gradual build- vacuuming until three to four weeks up of activity will assist your recovery. More>

Driving • able to comfortably look over your • how comfortable you will be during shoulder to manoeuvre. your journey, particularly if you are You should not drive In general, it can take two to four wearing a seatbelt for 24 hours after a weeks before you are able to do all of • overseas travel: the above. It is a good idea to practise Would you have access to general anaesthetic. without the keys in the ignition. See appropriate medical advice at Each insurance whether you can do the movements you your destination if you were to have would need for an emergency stop and a a problem after your operation? company will have its three-point turn without causing yourself Does your travel insurance cover any any discomfort or pain. When you are own conditions for necessary medical treatment in the ready to start driving again, build up event of a problem after your when you are insured gradually, starting with a short journey. to start driving again. operation? Travel plans • whether your plans are in line with Check your policy. the levels of activity recommended If you are considering travelling during in this information. Before you drive you should be: your recovery, it is helpful to think about: If you have concerns about your travel • the length of your journey - journeys • free from the sedative effects of any plans, it is important to discuss these with over four hours where you are not painkillers your GP or the hospital where you have able to move around (in a car, coach, • able to sit in the car comfortably and your operation before travelling. train or plane) can increase your risk work the controls of deep vein thrombosis (DVT); this • able to wear the seatbelt comfortably is especially so if you are travelling • able to make an emergency stop soon after your operation More>

Having sex You should usually allow four to six weeks after your operation to allow your scars to heal. It is then safe to have sex - as long as you feel comfortable. If you experience any discomfort or dryness (which is more common if your ovaries have been removed at the time of the hysterectomy), you may wish to try a vaginal lubricant. You can buy this from your local pharmacy.

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

Time after operation How might I feel? What is safe to do? Fit to work? • Get up and move about • You are likely to be in hospital during this time • Go to the toilet • You will have some pain and discomfort in 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 will slowly be reducing in intensity and • Continue with exercises 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 sleep or rest in the afternoon if you need to • Build up your activity slowly and steadily • There will be less pain as you move about and you • You are encouraged to go for longer and more 1 - 2 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, • There will be even less pain now as you move • Continue to build up the amount of activity you are possibly on reduced 2 - 4 more and more doing towards your normal levels hours or lighter duties at first. Some • You will find your energy levels returning to normal • You can start to do low-impact sport 3 women will be fit for weeks • You should feel stronger every day • Make a plan for going back to work full-time work after 4 weeks

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