Incontinence

Urinary incontinence  (any involuntary leakage of urine) can be a common and distressing problem that can profoundly impact quality of life. Bladder symptoms are much more common in women than men, and more common in older women than younger women. Urinary incontinence almost always results from an underlying treatable medical condition. Different types of incontinence include, stress, urge, mixed and overflow.

Workup

Dilation and Curettage

INSTRUCTIONS FOR HOME CARE FOLLOWING DILATION AND CURETTAGE SURGERY

ACTIVITY:  Rest in bed the day you are dismissed from the hospital.  You may want to decrease your activities and take short rest periods for the next few days.  No strenuous activities for 3-7 days.  This includes lifting or vigorous activities.

VAGINAL DISCHARGE:  You will have some bleeding from the vagina and you may experience mild cramps after your surgery.  By the time you go home, the bleeding should be light in amount and may last 2 to 3 weeks.  Your next menstrual period may occur at any time after this.

BATHING:  You may take a shower or wash your hair at any time you desire after you go home provided you do not feel too weak or tired.  It is advisable that you take a shower rather than a tub bath for the first week.

DOUCHING AND INTERCOURSE:  You should not douche, use tampons or have intercourse for one week after your surgery.

MEDICATIONS:  You may have mild cramping after surgery.  You may take Tylenol or Ibuprofen and use a heating pad if needed.

PATHOLOGY:  You will be notified of a pathology report within 7 working days.  If you have not heard from your doctor, please call.

SPECIAL INSTRUCTIONS:  If your D&C has been scheduled because of a miscarriage there are a few special instructions you need to follow.  Refrain from anything entering the vagina for 2 weeks.  This includes bathtub water, douching, tampons, and intercourse.  You may or may not have tissue analysis with this procedure.  If you do, this analysis can take several weeks.  Our office will call you with results as soon as your physician has reviewed them.

AFTER LEAVING THE HOSPITAL,  call the doctor for any of the following problems:

  • Bleeding heavier that usual menstrual (period) flow
  • Any fever over 100.4 degrees or severe chills
  • Frequency or burning with urination (difficulties emptying your bladder)
  • Any red, hard, tender, or hot areas along the calf or groin of the legs
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms

Laparoscopy

INSTRUCTIONS FOR HOME CARE FOLLOWING LAPAROSCOPIC EXAM

ACTIVITY:  You may want to decrease your activities and take short rest periods for the next few days.  No strenuous activities for one week.  This includes lifting over 10 pounds or vigorous exercise.

OPERATIVE WOUND:  The sutures holding the small incision will dissolve by themselves in one to three weeks after surgery and will not need to be removed.  The incision should be treated as an ordinary skin cut and should be kept dry for three to four days to assure good healing.  You may cleanse your incision with soap and water.

VAGINAL CARE:  You may have minimal bleeding from the vagina (birth canal) after your surgery.  You should not douche, use tampons, or have intercourse for one week after your surgery.  You may take a shower or wash your hair any time you desire after you go home provided you do not feel too weak or tired.  It is advisable that you take a shower rather than a tub bath for the first week.

MEDICATIONS:  You may have cramping and/or discomfort.  You may take Tylenol or Ibuprofen or any medication ordered by your physician, and use a heating pad if needed.

NUTRITION:  Your diet should be balanced with the essential vitamins and minerals. Unless otherwise advised you may eat a regular diet.  Adequate amounts of lean meat, fish, poultry, eggs, green and yellow vegetables, citrus fruits and juices, melon, whole grain bread, cereals, and mild products should help with the healing process.

CONSTIPATION:  If you re-establish the proper dietary habits, constipation should not be a problem.  Increase water/fluid intake.  Any food product that currently works in aiding to decrease problems with constipation can be tried.  You may also purchase Colace over the counter for constipation problems unresolved by the suggestions listed above.

AFTER LEAVING THE HOSPITAL:  Call the doctor for any of the following problems:

  • Bleeding heavier than usual menstrual (period) flow.
  • Any fever over 100.4 degrees or severe chills.
  • Frequency or burning with urination (difficulties emptying your bladder).
  • Any red, hard, tender or hot area along the calf or groin areas of the legs.
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms

Anti-incontinence Surgery

INSTRUCTIONS FOR HOME CARE FOLLOWING ANTI INCONTINENCE SURGERY

ACTIVITIY: No intercourse, lifting, or exercise for three weeks.  You may resume all other activities as comfort allows.

OPERATIVE WOUND:  The sutures holding the small incisions will dissolve by themselves in one to three weeks after surgery and will not need to be removed.  The incision should be treated as an ordinary skin cut and should be kept dry for 3 to 4 days to ensure good healing.  You may cleanse your incision with soap and water or hydrogen peroxide.

PAIN:  You may experience bruising and tenderness in the incision areas.  Tylenol, Ibuprofen, and a heating pad should help resolve the discomfort.

MEDICATIONS:  A stool softener should be used after surgery until you are able to have a bowel movement without straining.  Colace may be purchased over the counter.  You may or may not receive a prescription for an antibiotic.  If so, please take the prescription in its entirety.

NUTRITION:  Your diet should be balanced with the essential vitamins and minerals.  Unless otherwise advised you may eat a regular diet.  Adequate amounts of lean meat, fish, poultry, eggs, green and yellow vegetables, citrus fruits and juices, melon, whole grain bread, cereals, and mild products should help with the healing process.

CONSTIPATION:  If you re-establish the proper dietary habits, constipation should not be a problem.  Increase water/fluid intake.  Any food product that currently works in aiding to decrease problems with constipation can be tried.  You may also purchase Colace over the counter for constipation problems unresolved by the suggestions listed above.

AFTER LEAVING THE HOSPITAL, call the doctor for any of the following problems:

  • Bleeding heavier than usual menstrual (period) flow.
  • Any fever over 100.4° or severe chills.
  • Frequency or burning with urination (difficulties emptying your bladder).
  • Any red, hard, tender or hot area along the calf or groin areas of the legs.
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms

Laparoscopic Vaginal Hysterectomy

INSTRUCTIONS FOR HOME CARE FOLLOWING
LAPAROSCOPIC ASSISTED HYSTERECTOMY SURGERY

Now that your operation is over, you will soon be thinking about going home.  Because the four to six weeks after your hospital dismissal is an important part of your recovery, you should follow your doctor’s instructions very carefully.  The goal of these instructions is to reduce the risks of surgical infection, upper respiratory infection and blood clots.

ACTIVITY:   You may be dismissed the night of surgery or the next day depending on your post-surgical status.  During your first week home, you should spend your day resting and caring for your personal needs.  The best exercise for you during this time is walking and you may be up for several hours each day.  It is better however, to have short periods of activity rather than to remain on your feet continuously.  To obtain the best type of rest, you should lie down.  Avoid sitting in a chair for long periods or crossing your legs at the knees or ankles as it slows the return flow of blood from your legs.  You may rest in a reclining chair.  Your second week at home your may take longer walks or ride a short distance in the car.  If long distance travel is required, you should try to stop, get out, and walk about every 60 minutes.  Before driving, the use of prescription pain medications must be ceased. We also recommend that you have tried to use the brakes, forcefully in your vehicle with the vehicle in park.  We want to make sure you are comfortable using the brakes of your vehicle in an emergent situation after surgery.  During this time it is important that you avoid lifting over 10 pounds, strenuous exercise, excessive social activities and you should keep stairs to a minimum.  It is important to be sensible about your care and do things in moderation.  When healing is complete, you may expect to resume a normal active life.  The return to ordinary employment usually takes about 4 weeks after surgery.  Normal fatigue may last anywhere from 6-8 weeks due to caloric requirements of surgery healing.

OPERATIVE WOUND:  The sutures from the laparoscope will dissolve by themselves in a week to ten days after surgery and will not need to be removed.  The incision should be treated as an ordinary skin cut and should be kept dry for three to four days to assure good healing.  You may cleanse your incision with soap and water.

VAGINAL DISCHARGE:  Frequently after surgery involving the tubes, ovaries, or uterus, you will have minimal bleeding from the vagina (birth canal), which may last several weeks or longer. Your doctor should be called however, if excessive amounts of bright red bleeding are present. An external pad, rather than a tampon, should be used for any vaginal bleeding.  Because of the hysterectomy, you will no longer menstruate (have periods).  If you had a vaginal hysterectomy, stitches in your vagina will dissolve in the next 2-6 weeks.  You may have bright red spotting; it will turn to a yellowish discharge. You might have a slight odor-this is normal and will resolve. The odor should seem different, but not offensive.

PAIN:  You may be given a prescription for pain medication prior to dismissal, or you may take Tylenol or Ibuprofen for pain.  You may use a heating pad.  You will not be free from pain during your recovery.  You should however, expect tolerable pain.  If your pain is intolerable after trying the previous methods call your doctor.

BATHING: You may take a shower or wash your hair at anytime you desire after you go home providing you do not feel too weak or tired.  Refrain from taking tub baths for 2 weeks.

DOUCHING:  No douching, intercourse, or tampons until you see your physician and he/she indicates resuming any of these activities.  You may use vaginal medication as instructed by your physician.

NUTRITION:  It is essential that your diet be high in protein and Vitamin C.  Unless otherwise instructed you may eat whatever you wish.  Adequate amounts of lean meat, fish, poultry, eggs, green vegetables, whole grain cereals/breads, and citrus fruits/juices must be included in your diet.  Stay away from spicy foods or foods you know cause gas.  You may need to eat frequent, snack size meals initially.

CONSTIPATION:  If you re-establish proper dietary habits, constipation should not be a problem. This includes six to eight glasses of water daily, as well as the information provided above in the nutrition section of these instructions.  Walking will also help promote movement in the colon to help reduce the risk of constipation.  You may try home remedies such as prunes or hot drinks. You may try over the counter remedies such as Colace or Milk of Magnesia. It is important for you to understand that pain medications taken during your hospitalization and home recovery can and frequently does cause constipation problems.  We suggest a minimum of one bowel movement every two days with out strain.  If all of your efforts are not getting this effect, call your physician.

BLADDER FUNCTION:  You will receive full instructions and necessary prescriptions before leaving the hospital if special measures or medications are indicated.  Burning, frequency, and urgency with urination are normal the first few times you urinate while you are hospitalized.  If these symptoms occur after you have been dismissed, please call your doctor.

MEDICATIONS:  Your nurse or physician will instruct you on medications as needed.  This includes hormone replacement if indicated.

AFTER LEAVING THE HOSPITAL:  Call you doctor if you have:

  1. Frequency or burning with urination (difficulties emptying your bladder).
  2. Excessively heavy vaginal bleeding (from the birth canal).
  3. Severe chills or fever over 100.4 degrees.
  4. Abnormal redness and tenderness around the incision.
  5. Any red, hard, tender or hot area along the calf or groin areas of the legs.
  6.  Chest pain, trouble breathing, or any other unexplained signs or symptoms.

Abdominal/Vaginal Surgery

INSTRUCTIONS FOR HOME CARE FOLLOWING ABDOMINAL AND VAGINAL SURGERY

Now that your operation is over, you will soon be thinking about going home.  Because the four to six weeks after your hospital dismissal is an important part of your recovery, you should follow your doctor’s instructions very carefully.  The goal of these instructions is to reduce the risks of surgical infection, upper respiratory infection and blood clots.

ACTIVITY:   You may be dismissed the night of surgery or the next day depending on your post-surgical status.  During your first week home, you should spend your day resting and caring for your personal needs.  The best exercise for you during this time is walking and you may be up for several hours each day.  It is better however, to have short periods of activity rather than to remain on your feet continuously.  To obtain the best type of rest, you should lie down.  Avoid sitting in a chair for long periods or crossing your legs at the knees or ankles as it slows the return flow of blood from your legs.  You may rest in a reclining chair.  Your second week at home your may take longer walks or ride a short distance in the car.  If long distance travel is required, you should try to stop, get out, and walk about every 60 minutes.  Before driving, the use of prescription pain medication must be ceased. We also recommend that you have tried to use the brakes, forcefully in your vehicle with the vehicle in park.  We want to make sure you are comfortable using the brakes of your vehicle in an emergent situation after surgery.  During this time it is important that you avoid lifting over 10 pounds, strenuous exercise, excessive social activities and you should keep stairs to a minimum.  It is important to be sensible about your care and do things in moderation.  When healing is complete, you may expect to resume a normal active life.  The return to ordinary employment usually takes about 4 weeks after surgery.  Normal fatigue may last anywhere from 6-8 weeks due to caloric requirements of surgery healing.

OPERATIVE WOUND:  The abdominal incision should be healing well by the time you go home.  You will either have a running stitch or staples placed to hold the incision during your recovery.  Individual doctors will decide wound closure based on your needs as an individual.  If steri-strips are used, they are in place to help keep the wound edges together.  You may shower with steri-strips, just dry the area thoroughly.  The steri-strips will begin to curl toward the wound.  If they are still in place after 12 days you may remove them.  The vaginal incision for a hysterectomy and or vaginal repairs is much different.  The incisions in this case are in the vagina and will not be visible to you. Cautery or dissolvable sutures can be used.  Dissolvable sutures in the vagina dissolve within 2-6 weeks.

VAGINAL DISCHARGE:  Frequently after surgery involving the tubes, ovaries, or uterus, you will have minimal bleeding from the vagina (birth canal), which may last several weeks or longer.  Your doctor should be called however, if excessive amounts of bright red bleeding are present.  An external pad, rather than a tampon, should be used for any vaginal bleeding.  Because of the hysterectomy, you will no longer menstruate (have periods).  If you had a vaginal hysterectomy, stitches in your vagina will dissolve in the next 2-6 weeks.  You may have bright red spotting; it will turn to a yellowish discharge. You might have a slight odor-this is normal and will resolve.  The odor should seem different, but not offensive.

PAIN:  You may be given a prescription for pain medication prior to dismissal, or you may take Tylenol or Ibuprofen for pain.  You may use a heating pad.  You will not be free from pain during your recovery.  You should however, expect tolerable pain.  If your pain is intolerable after trying the previous methods call your doctor.

BATHING: You may take a shower or wash your hair at anytime you desire after you go home providing you do not feel too weak or tired.  Refrain from taking tub baths for 2 weeks.

DOUCHING:  No douching, intercourse, or tampons until you see your physician and he/she indicates resuming any of these activities.  You may use vaginal medication as instructed by your physician.

NUTRITION:  It is essential that your diet be high in protein and Vitamin C.  Unless otherwise instructed you may eat whatever you wish.  Adequate amounts of lean meat, fish, poultry, eggs, green vegetables, whole grain cereals/breads, and citrus fruits/juices must be included in your diet.  Stay away from spicy foods or foods you know cause gas. You may need to eat frequent, snack size meals initially.

CONSTIPATION:  If you re-establish proper dietary habits, constipation should not be a problem.  This includes six to eight glasses of water daily, as well as the information provided above in the nutrition section of these instructions.  Walking will also help promote movement in the colon to help reduce the risk of constipation.  You may try home remedies such as prunes or hot drinks.  You may try over the counter remedies such as Colace or Milk of Magnesia. It is important for you to understand that pain medications taken during your hospitalization and home recovery can and frequently does cause constipation problems.  We suggest a minimum of one bowel movement every two days with out strain.  If all of your efforts are not getting this effect, call your physician.

BLADDER FUNCTION:  You will receive full instructions and necessary prescriptions before leaving the hospital if special measures or medications are indicated.  Burning, frequency, and urgency with urination are normal the first few times you urinate while you are hospitalized.  If these symptoms occur after you have been dismissed, please call your doctor.

MEDICATIONS:  Your nurse or physician will instruct you on medications as needed. This included hormone replacement if indicated.

AFTER LEAVING THE HOSPITAL:  Call you doctor if you have:

  • Frequency or burning with urination (difficulties emptying your bladder).
  • Excessively heavy vaginal bleeding (from the birth canal).
  • Severe chills or fever over 100.4 degrees.
  • Abnormal redness and tenderness around the incision.
  • Any red, hard, tender or hot area along the calf or groin areas of the legs.
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms.

Bowel Prep

INSTRUCTIONS FOR PRE OPERATIVE BOWEL PREP

Your doctor has decided you need rigorous bowel preparation before surgery. This bowel preparation will be a very important step for you to complete.  The bowel preparation assists in decreasing surgical risk factors associated with your upcoming surgery.  Your surgery may be cancelled if the bowel preparation is not completed.

The day prior to surgery you will consume clear liquids the entire day.  You may have water, 7-Up, Sprite, Gatorade, chicken or beef broth, Popsicles, Jell-o, and coffee and tea.  It is vital that all dairy and citrus products be avoided.  This includes fruit and/or toppings with Jell-o, pulps and/or cream in Popsicles, and creamer in coffee.

Magnesium Citrate is an over-the-counter, pre-mixed solution you will need to purchase.  The day prior to surgery, at 12:00 noon, you need to drink the Magnesium Citrate.  This solution will cause diarrhea.  The solution can be consumed later in the day, however the later you begin, the later the solution begins to work.

You can continue to consume liquids after taking the Magnesium Citrate.  At 12:00 midnight you will begin fasting.  Continue this fasting the morning of surgery.  Your surgery may be cancelled if you are not able to maintain a fasting status.

Endometrial Ablation

INSTRUCTIONS FOR HOME CARE FOLLOWING ENDOMETRIAL ABLATION SURGERY

ACTIVITY:  Rest in bed the day you are dismissed from the hospital.  You may want to decrease your activities and take short rest periods for the next few days.  No strenuous activities for one week.  This includes lifting over 10 pounds or vigorous exercise.

VAGINAL DISCHARGE:  You may have some bleeding from the vagina (birth canal) and you may experience cramps after your surgery.  You may experience a yellowish, watery discharge that may last for several weeks.  Your menstrual period may occur at any time after this.  You may find your periods much lighter or none at all.

BATHING:  You may take a shower or wash your hair any time you desire after you go home provided you do not feel too weak or tired.  It is advisable that you take a shower rather than a tub bath for the first week.

DOUCHING & SEXUAL RELATIONS:  You should not douche, use tampon, or have sexual intercourse for one week after your surgery.

MEDICATIONS:  You may have cramping and/or discomfort.  You may take Tylenol or Ibuprofen or any medication ordered by your physician, and use a heating pad if needed.

AFTER LEAVING THE HOSPITAL, call the doctor for any of the following problems:

  • Bleeding heavier than usual menstrual (period) flow.
  • Any fever over 100.4° or severe chills.
  • Frequency or burning with urination (difficulties emptying your bladder).
  • Any red, hard, tender or hot area along the calf or groin areas of the legs.
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms.

 

If an endometrial sample is taken, you will be notified of the pathology report after 4-7 working days.  Call the office if you have not been notified by then.

Birth Control Pills

More than 60 million women take the pill worldwide and it is the most popular form of contraception in the United States. Most pills contain estrogen and progestin and work by preventing ovulation. Used correctly (taking it at about the same time every day), it is 99% effective. Pills available today are a much lower dose than the original birth control pill of the 1960’s and have fewer side effects.
Side Effects

There are some minor side effects associated with the birth control pill. These include: breakthrough bleeding (bleeding between periods), nausea, headaches, and breast tenderness. Many of these side effects decrease during the first three months of usage.
Advantages

The advantages of the pill are that it does not interrupt sexual activity and allows for spontaneity. It offers protection against ovarian, endometrial, and colo-rectal cancers. The pill decreases menstrual bleeding and cramping. The pill also decreases the risk of PID (pelvic inflammatory disease) and can shrink some benign ovarian cysts. It is an easily reversible method.
Disadvantages

The disadvantages are that it offers no protection against sexually transmitted diseases (STD’s). It can be expensive, it must be taken consistently every day and can cause mood changes. It can also cause rare, but dangerous complications.

Not all women are good candidates for the birth control pill. You should not take the pill if you are over 35 and smoke. You should not take the pill if you begin getting SEVERE migraine headaches after starting the birth control pill. Women who have a history of blood clots or stroke, have heart disease, or high blood pressure, have had breast cancer, have liver problems, have kidney problems or have active gallbladder disease should not take the pill.

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Intercourse

Unless you’ve been told to refrain or there is a specific problem with the pregnancy, such as bleeding, leaking bag of water, or preterm contractions, sexual intercourse is safe during pregnancy. It may be necessary to experiment to avoid discomfort. If intercourse is painful or causes bleeding or prolonged contractions (it is normal to have some contractions following intercourse), please talk with your physician or midwife.

Treatment

Treatment options range from conservative treatment, behavior management, neuromodulation (Interstim, PTNS), bladder retraining, pelvic floor therapy, medications and surgery.

Dilation and Curettage

INSTRUCTIONS FOR HOME CARE FOLLOWING DILATION AND CURETTAGE SURGERY

ACTIVITY:  Rest in bed the day you are dismissed from the hospital.  You may want to decrease your activities and take short rest periods for the next few days.  No strenuous activities for 3-7 days.  This includes lifting or vigorous activities.

VAGINAL DISCHARGE:  You will have some bleeding from the vagina and you may experience mild cramps after your surgery.  By the time you go home, the bleeding should be light in amount and may last 2 to 3 weeks.  Your next menstrual period may occur at any time after this.

BATHING:  You may take a shower or wash your hair at any time you desire after you go home provided you do not feel too weak or tired.  It is advisable that you take a shower rather than a tub bath for the first week.

DOUCHING AND INTERCOURSE:  You should not douche, use tampons or have intercourse for one week after your surgery.

MEDICATIONS:  You may have mild cramping after surgery.  You may take Tylenol or Ibuprofen and use a heating pad if needed.

PATHOLOGY:  You will be notified of a pathology report within 7 working days.  If you have not heard from your doctor, please call.

SPECIAL INSTRUCTIONS:  If your D&C has been scheduled because of a miscarriage there are a few special instructions you need to follow.  Refrain from anything entering the vagina for 2 weeks.  This includes bathtub water, douching, tampons, and intercourse.  You may or may not have tissue analysis with this procedure.  If you do, this analysis can take several weeks.  Our office will call you with results as soon as your physician has reviewed them.

AFTER LEAVING THE HOSPITAL,  call the doctor for any of the following problems:

  • Bleeding heavier that usual menstrual (period) flow
  • Any fever over 100.4 degrees or severe chills
  • Frequency or burning with urination (difficulties emptying your bladder)
  • Any red, hard, tender, or hot areas along the calf or groin of the legs
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms

Laparoscopy

INSTRUCTIONS FOR HOME CARE FOLLOWING LAPAROSCOPIC EXAM

ACTIVITY:  You may want to decrease your activities and take short rest periods for the next few days.  No strenuous activities for one week.  This includes lifting over 10 pounds or vigorous exercise.

OPERATIVE WOUND:  The sutures holding the small incision will dissolve by themselves in one to three weeks after surgery and will not need to be removed.  The incision should be treated as an ordinary skin cut and should be kept dry for three to four days to assure good healing.  You may cleanse your incision with soap and water.

VAGINAL CARE:  You may have minimal bleeding from the vagina (birth canal) after your surgery.  You should not douche, use tampons, or have intercourse for one week after your surgery.  You may take a shower or wash your hair any time you desire after you go home provided you do not feel too weak or tired.  It is advisable that you take a shower rather than a tub bath for the first week.

MEDICATIONS:  You may have cramping and/or discomfort.  You may take Tylenol or Ibuprofen or any medication ordered by your physician, and use a heating pad if needed.

NUTRITION:  Your diet should be balanced with the essential vitamins and minerals. Unless otherwise advised you may eat a regular diet.  Adequate amounts of lean meat, fish, poultry, eggs, green and yellow vegetables, citrus fruits and juices, melon, whole grain bread, cereals, and mild products should help with the healing process.

CONSTIPATION:  If you re-establish the proper dietary habits, constipation should not be a problem.  Increase water/fluid intake.  Any food product that currently works in aiding to decrease problems with constipation can be tried.  You may also purchase Colace over the counter for constipation problems unresolved by the suggestions listed above.

AFTER LEAVING THE HOSPITAL:  Call the doctor for any of the following problems:

  • Bleeding heavier than usual menstrual (period) flow.
  • Any fever over 100.4 degrees or severe chills.
  • Frequency or burning with urination (difficulties emptying your bladder).
  • Any red, hard, tender or hot area along the calf or groin areas of the legs.
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms

Anti-incontinence Surgery

INSTRUCTIONS FOR HOME CARE FOLLOWING ANTI INCONTINENCE SURGERY

ACTIVITIY: No intercourse, lifting, or exercise for three weeks.  You may resume all other activities as comfort allows.

OPERATIVE WOUND:  The sutures holding the small incisions will dissolve by themselves in one to three weeks after surgery and will not need to be removed.  The incision should be treated as an ordinary skin cut and should be kept dry for 3 to 4 days to ensure good healing.  You may cleanse your incision with soap and water or hydrogen peroxide.

PAIN:  You may experience bruising and tenderness in the incision areas.  Tylenol, Ibuprofen, and a heating pad should help resolve the discomfort.

MEDICATIONS:  A stool softener should be used after surgery until you are able to have a bowel movement without straining.  Colace may be purchased over the counter.  You may or may not receive a prescription for an antibiotic.  If so, please take the prescription in its entirety.

NUTRITION:  Your diet should be balanced with the essential vitamins and minerals.  Unless otherwise advised you may eat a regular diet.  Adequate amounts of lean meat, fish, poultry, eggs, green and yellow vegetables, citrus fruits and juices, melon, whole grain bread, cereals, and mild products should help with the healing process.

CONSTIPATION:  If you re-establish the proper dietary habits, constipation should not be a problem.  Increase water/fluid intake.  Any food product that currently works in aiding to decrease problems with constipation can be tried.  You may also purchase Colace over the counter for constipation problems unresolved by the suggestions listed above.

AFTER LEAVING THE HOSPITAL, call the doctor for any of the following problems:

  • Bleeding heavier than usual menstrual (period) flow.
  • Any fever over 100.4° or severe chills.
  • Frequency or burning with urination (difficulties emptying your bladder).
  • Any red, hard, tender or hot area along the calf or groin areas of the legs.
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms

Laparoscopic Vaginal Hysterectomy

INSTRUCTIONS FOR HOME CARE FOLLOWING
LAPAROSCOPIC ASSISTED HYSTERECTOMY SURGERY

Now that your operation is over, you will soon be thinking about going home.  Because the four to six weeks after your hospital dismissal is an important part of your recovery, you should follow your doctor’s instructions very carefully.  The goal of these instructions is to reduce the risks of surgical infection, upper respiratory infection and blood clots.

ACTIVITY:   You may be dismissed the night of surgery or the next day depending on your post-surgical status.  During your first week home, you should spend your day resting and caring for your personal needs.  The best exercise for you during this time is walking and you may be up for several hours each day.  It is better however, to have short periods of activity rather than to remain on your feet continuously.  To obtain the best type of rest, you should lie down.  Avoid sitting in a chair for long periods or crossing your legs at the knees or ankles as it slows the return flow of blood from your legs.  You may rest in a reclining chair.  Your second week at home your may take longer walks or ride a short distance in the car.  If long distance travel is required, you should try to stop, get out, and walk about every 60 minutes.  Before driving, the use of prescription pain medications must be ceased. We also recommend that you have tried to use the brakes, forcefully in your vehicle with the vehicle in park.  We want to make sure you are comfortable using the brakes of your vehicle in an emergent situation after surgery.  During this time it is important that you avoid lifting over 10 pounds, strenuous exercise, excessive social activities and you should keep stairs to a minimum.  It is important to be sensible about your care and do things in moderation.  When healing is complete, you may expect to resume a normal active life.  The return to ordinary employment usually takes about 4 weeks after surgery.  Normal fatigue may last anywhere from 6-8 weeks due to caloric requirements of surgery healing.

OPERATIVE WOUND:  The sutures from the laparoscope will dissolve by themselves in a week to ten days after surgery and will not need to be removed.  The incision should be treated as an ordinary skin cut and should be kept dry for three to four days to assure good healing.  You may cleanse your incision with soap and water.

VAGINAL DISCHARGE:  Frequently after surgery involving the tubes, ovaries, or uterus, you will have minimal bleeding from the vagina (birth canal), which may last several weeks or longer. Your doctor should be called however, if excessive amounts of bright red bleeding are present. An external pad, rather than a tampon, should be used for any vaginal bleeding.  Because of the hysterectomy, you will no longer menstruate (have periods).  If you had a vaginal hysterectomy, stitches in your vagina will dissolve in the next 2-6 weeks.  You may have bright red spotting; it will turn to a yellowish discharge. You might have a slight odor-this is normal and will resolve. The odor should seem different, but not offensive.

PAIN:  You may be given a prescription for pain medication prior to dismissal, or you may take Tylenol or Ibuprofen for pain.  You may use a heating pad.  You will not be free from pain during your recovery.  You should however, expect tolerable pain.  If your pain is intolerable after trying the previous methods call your doctor.

BATHING: You may take a shower or wash your hair at anytime you desire after you go home providing you do not feel too weak or tired.  Refrain from taking tub baths for 2 weeks.

DOUCHING:  No douching, intercourse, or tampons until you see your physician and he/she indicates resuming any of these activities.  You may use vaginal medication as instructed by your physician.

NUTRITION:  It is essential that your diet be high in protein and Vitamin C.  Unless otherwise instructed you may eat whatever you wish.  Adequate amounts of lean meat, fish, poultry, eggs, green vegetables, whole grain cereals/breads, and citrus fruits/juices must be included in your diet.  Stay away from spicy foods or foods you know cause gas.  You may need to eat frequent, snack size meals initially.

CONSTIPATION:  If you re-establish proper dietary habits, constipation should not be a problem. This includes six to eight glasses of water daily, as well as the information provided above in the nutrition section of these instructions.  Walking will also help promote movement in the colon to help reduce the risk of constipation.  You may try home remedies such as prunes or hot drinks. You may try over the counter remedies such as Colace or Milk of Magnesia. It is important for you to understand that pain medications taken during your hospitalization and home recovery can and frequently does cause constipation problems.  We suggest a minimum of one bowel movement every two days with out strain.  If all of your efforts are not getting this effect, call your physician.

BLADDER FUNCTION:  You will receive full instructions and necessary prescriptions before leaving the hospital if special measures or medications are indicated.  Burning, frequency, and urgency with urination are normal the first few times you urinate while you are hospitalized.  If these symptoms occur after you have been dismissed, please call your doctor.

MEDICATIONS:  Your nurse or physician will instruct you on medications as needed.  This includes hormone replacement if indicated.

AFTER LEAVING THE HOSPITAL:  Call you doctor if you have:

  1. Frequency or burning with urination (difficulties emptying your bladder).
  2. Excessively heavy vaginal bleeding (from the birth canal).
  3. Severe chills or fever over 100.4 degrees.
  4. Abnormal redness and tenderness around the incision.
  5. Any red, hard, tender or hot area along the calf or groin areas of the legs.
  6.  Chest pain, trouble breathing, or any other unexplained signs or symptoms.

Abdominal/Vaginal Surgery

INSTRUCTIONS FOR HOME CARE FOLLOWING ABDOMINAL AND VAGINAL SURGERY

Now that your operation is over, you will soon be thinking about going home.  Because the four to six weeks after your hospital dismissal is an important part of your recovery, you should follow your doctor’s instructions very carefully.  The goal of these instructions is to reduce the risks of surgical infection, upper respiratory infection and blood clots.

ACTIVITY:   You may be dismissed the night of surgery or the next day depending on your post-surgical status.  During your first week home, you should spend your day resting and caring for your personal needs.  The best exercise for you during this time is walking and you may be up for several hours each day.  It is better however, to have short periods of activity rather than to remain on your feet continuously.  To obtain the best type of rest, you should lie down.  Avoid sitting in a chair for long periods or crossing your legs at the knees or ankles as it slows the return flow of blood from your legs.  You may rest in a reclining chair.  Your second week at home your may take longer walks or ride a short distance in the car.  If long distance travel is required, you should try to stop, get out, and walk about every 60 minutes.  Before driving, the use of prescription pain medication must be ceased. We also recommend that you have tried to use the brakes, forcefully in your vehicle with the vehicle in park.  We want to make sure you are comfortable using the brakes of your vehicle in an emergent situation after surgery.  During this time it is important that you avoid lifting over 10 pounds, strenuous exercise, excessive social activities and you should keep stairs to a minimum.  It is important to be sensible about your care and do things in moderation.  When healing is complete, you may expect to resume a normal active life.  The return to ordinary employment usually takes about 4 weeks after surgery.  Normal fatigue may last anywhere from 6-8 weeks due to caloric requirements of surgery healing.

OPERATIVE WOUND:  The abdominal incision should be healing well by the time you go home.  You will either have a running stitch or staples placed to hold the incision during your recovery.  Individual doctors will decide wound closure based on your needs as an individual.  If steri-strips are used, they are in place to help keep the wound edges together.  You may shower with steri-strips, just dry the area thoroughly.  The steri-strips will begin to curl toward the wound.  If they are still in place after 12 days you may remove them.  The vaginal incision for a hysterectomy and or vaginal repairs is much different.  The incisions in this case are in the vagina and will not be visible to you. Cautery or dissolvable sutures can be used.  Dissolvable sutures in the vagina dissolve within 2-6 weeks.

VAGINAL DISCHARGE:  Frequently after surgery involving the tubes, ovaries, or uterus, you will have minimal bleeding from the vagina (birth canal), which may last several weeks or longer.  Your doctor should be called however, if excessive amounts of bright red bleeding are present.  An external pad, rather than a tampon, should be used for any vaginal bleeding.  Because of the hysterectomy, you will no longer menstruate (have periods).  If you had a vaginal hysterectomy, stitches in your vagina will dissolve in the next 2-6 weeks.  You may have bright red spotting; it will turn to a yellowish discharge. You might have a slight odor-this is normal and will resolve.  The odor should seem different, but not offensive.

PAIN:  You may be given a prescription for pain medication prior to dismissal, or you may take Tylenol or Ibuprofen for pain.  You may use a heating pad.  You will not be free from pain during your recovery.  You should however, expect tolerable pain.  If your pain is intolerable after trying the previous methods call your doctor.

BATHING: You may take a shower or wash your hair at anytime you desire after you go home providing you do not feel too weak or tired.  Refrain from taking tub baths for 2 weeks.

DOUCHING:  No douching, intercourse, or tampons until you see your physician and he/she indicates resuming any of these activities.  You may use vaginal medication as instructed by your physician.

NUTRITION:  It is essential that your diet be high in protein and Vitamin C.  Unless otherwise instructed you may eat whatever you wish.  Adequate amounts of lean meat, fish, poultry, eggs, green vegetables, whole grain cereals/breads, and citrus fruits/juices must be included in your diet.  Stay away from spicy foods or foods you know cause gas. You may need to eat frequent, snack size meals initially.

CONSTIPATION:  If you re-establish proper dietary habits, constipation should not be a problem.  This includes six to eight glasses of water daily, as well as the information provided above in the nutrition section of these instructions.  Walking will also help promote movement in the colon to help reduce the risk of constipation.  You may try home remedies such as prunes or hot drinks.  You may try over the counter remedies such as Colace or Milk of Magnesia. It is important for you to understand that pain medications taken during your hospitalization and home recovery can and frequently does cause constipation problems.  We suggest a minimum of one bowel movement every two days with out strain.  If all of your efforts are not getting this effect, call your physician.

BLADDER FUNCTION:  You will receive full instructions and necessary prescriptions before leaving the hospital if special measures or medications are indicated.  Burning, frequency, and urgency with urination are normal the first few times you urinate while you are hospitalized.  If these symptoms occur after you have been dismissed, please call your doctor.

MEDICATIONS:  Your nurse or physician will instruct you on medications as needed. This included hormone replacement if indicated.

AFTER LEAVING THE HOSPITAL:  Call you doctor if you have:

  • Frequency or burning with urination (difficulties emptying your bladder).
  • Excessively heavy vaginal bleeding (from the birth canal).
  • Severe chills or fever over 100.4 degrees.
  • Abnormal redness and tenderness around the incision.
  • Any red, hard, tender or hot area along the calf or groin areas of the legs.
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms.

Bowel Prep

INSTRUCTIONS FOR PRE OPERATIVE BOWEL PREP

Your doctor has decided you need rigorous bowel preparation before surgery. This bowel preparation will be a very important step for you to complete.  The bowel preparation assists in decreasing surgical risk factors associated with your upcoming surgery.  Your surgery may be cancelled if the bowel preparation is not completed.

The day prior to surgery you will consume clear liquids the entire day.  You may have water, 7-Up, Sprite, Gatorade, chicken or beef broth, Popsicles, Jell-o, and coffee and tea.  It is vital that all dairy and citrus products be avoided.  This includes fruit and/or toppings with Jell-o, pulps and/or cream in Popsicles, and creamer in coffee.

Magnesium Citrate is an over-the-counter, pre-mixed solution you will need to purchase.  The day prior to surgery, at 12:00 noon, you need to drink the Magnesium Citrate.  This solution will cause diarrhea.  The solution can be consumed later in the day, however the later you begin, the later the solution begins to work.

You can continue to consume liquids after taking the Magnesium Citrate.  At 12:00 midnight you will begin fasting.  Continue this fasting the morning of surgery.  Your surgery may be cancelled if you are not able to maintain a fasting status.

Endometrial Ablation

INSTRUCTIONS FOR HOME CARE FOLLOWING ENDOMETRIAL ABLATION SURGERY

ACTIVITY:  Rest in bed the day you are dismissed from the hospital.  You may want to decrease your activities and take short rest periods for the next few days.  No strenuous activities for one week.  This includes lifting over 10 pounds or vigorous exercise.

VAGINAL DISCHARGE:  You may have some bleeding from the vagina (birth canal) and you may experience cramps after your surgery.  You may experience a yellowish, watery discharge that may last for several weeks.  Your menstrual period may occur at any time after this.  You may find your periods much lighter or none at all.

BATHING:  You may take a shower or wash your hair any time you desire after you go home provided you do not feel too weak or tired.  It is advisable that you take a shower rather than a tub bath for the first week.

DOUCHING & SEXUAL RELATIONS:  You should not douche, use tampon, or have sexual intercourse for one week after your surgery.

MEDICATIONS:  You may have cramping and/or discomfort.  You may take Tylenol or Ibuprofen or any medication ordered by your physician, and use a heating pad if needed.

AFTER LEAVING THE HOSPITAL, call the doctor for any of the following problems:

  • Bleeding heavier than usual menstrual (period) flow.
  • Any fever over 100.4° or severe chills.
  • Frequency or burning with urination (difficulties emptying your bladder).
  • Any red, hard, tender or hot area along the calf or groin areas of the legs.
  • Chest pain, trouble breathing, or any other unexplained signs or symptoms.

 

If an endometrial sample is taken, you will be notified of the pathology report after 4-7 working days.  Call the office if you have not been notified by then.

Birth Control Pills

More than 60 million women take the pill worldwide and it is the most popular form of contraception in the United States. Most pills contain estrogen and progestin and work by preventing ovulation. Used correctly (taking it at about the same time every day), it is 99% effective. Pills available today are a much lower dose than the original birth control pill of the 1960’s and have fewer side effects.
Side Effects

There are some minor side effects associated with the birth control pill. These include: breakthrough bleeding (bleeding between periods), nausea, headaches, and breast tenderness. Many of these side effects decrease during the first three months of usage.
Advantages

The advantages of the pill are that it does not interrupt sexual activity and allows for spontaneity. It offers protection against ovarian, endometrial, and colo-rectal cancers. The pill decreases menstrual bleeding and cramping. The pill also decreases the risk of PID (pelvic inflammatory disease) and can shrink some benign ovarian cysts. It is an easily reversible method.
Disadvantages

The disadvantages are that it offers no protection against sexually transmitted diseases (STD’s). It can be expensive, it must be taken consistently every day and can cause mood changes. It can also cause rare, but dangerous complications.

Not all women are good candidates for the birth control pill. You should not take the pill if you are over 35 and smoke. You should not take the pill if you begin getting SEVERE migraine headaches after starting the birth control pill. Women who have a history of blood clots or stroke, have heart disease, or high blood pressure, have had breast cancer, have liver problems, have kidney problems or have active gallbladder disease should not take the pill.

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Intercourse

Unless you’ve been told to refrain or there is a specific problem with the pregnancy, such as bleeding, leaking bag of water, or preterm contractions, sexual intercourse is safe during pregnancy. It may be necessary to experiment to avoid discomfort. If intercourse is painful or causes bleeding or prolonged contractions (it is normal to have some contractions following intercourse), please talk with your physician or midwife.