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Thank you for choosing Beth Israel Deaconess Medical Center for your surgery. Your care will be provided by some of the nation's finest specialists in women's health care.
The following contains information you will need as you prepare for your surgery. Please be sure to read it through carefully, especially the pamphlet, "Preparing for Surgery." This pamphlet contains critically important information about your surgery. You will receive additional information and instructions during your pre-admission testing appointment, which will occur at the hospital or over the telephone. Please ask your surgeon if you are not sure how your pre-admission appointment will be scheduled.
In addition to general information you will receive, please note that patients having pelvic and reconstructive surgery may expect the following:
Your doctor may require you to "clean out your bowels" or do a "bowel prep" the day before surgery. Please follow any instructions you receive, and ask your doctor if you have any questions. Remember to stay hydrated during your "bowel prep" and to stop drinking fluid at midnight the night before surgery, as noted in your "Preparing for Surgery" brochure.
After your surgery, you may have some nausea or vomiting. This is not unusual, and our recovery nurses will try to keep you as comfortable as possible. Other symptoms related to surgery and anesthesia can include shivering, headache, muscle soreness, sore throat, nervousness, or sleepiness. Please be sure to tell your recovery room nurse how you are feeling. Treatments are available for most common symptoms.
Please also keep your nurse informed about your level of pain. Don't try to "tough it out." Your recovery will go more smoothly if any pain is well controlled.
Recovery times vary, but most people are ready to leave the recovery area after about 1 ½ hours. Some patients go home following surgery; others are admitted to an inpatient room. Ask your doctor if you are not sure which applies to you.
If you are being admitted, you may want a small bag including toiletries, comfortable footwear, and any other personal items you may need. However, please do not bring this bag with you when you report for surgery; have someone bring it to you in your room.
Ask your surgeon about activity restrictions that may apply to you following surgery, so you can make plans for any help you may need. For example, you may be restricted from lifting items (or children) weighing more than a certain amount and you will not be allowed to drive as long as you are taking prescription pain medicine.
A suprapubic catheter is a tube that is inserted through the lower belly into the bladder where your urine is stored. Right after your surgery, the tube can be used to drain urine from the bladder.
If you go home with a suprapubic catheter, we will want you to immediately start to "train" your bladder to return to normal function and to send us information on your progress. This sheet gives information on bladder training, and also provides general information on how to care for your tube while it is in place.
Clean your hands
Clean your hands before and after you touch your suprapubic tube. Scrub with soap and water for at least 15 seconds, or, if there is no visible soil on your hands, use alcohol-based hand cleaner.
To train the bladder
Clamp your tube during the day by sliding the plastic piece to the "closed" position and plugging the end. This will ensure that the urine is not draining from the tube.
After the tube has been clamped for 2-3 hours, try to urinate on your own into a measuring container, sometimes called a "hat," that fits on your toilet. You will be given one before you leave the hospital. When you urinate, please record the amount on the chart on the inside of this sheet.
After you urinate, un-clamp the suprapubic tube, take the plug off the end, and drain any additional urine into the "hat." What comes out of the suprapubic tube is called "residual urine." Record this amount on the chart as well.
Re-clamp the tube, plug the end, and continue steps 2,3, and 4 throughout the day - urinating every 2-3 hours, measuring how much you urinate, and recording residual urine that comes out of the tube. Your goal is to have less and less residual urine over time.
At night, you may connect the suprapubic tube to a bag in order to let your bladder drain while you sleep. Remove the plug from then end of the tube, connect the tube to the bag, and unclamp the tube once the bag is connected. Restart your bladder training once you are awake in the morning by removing the bag, and plugging and clamping the tube.
When the residual is less than 3 ounces (about 100cc's) for a complete 24 hours, the suprapubic tube may be ready to be removed. When this happens, leave the catheter clamped and plugged overnight for one night and check the "residual urine" after you urinate the next morning. If it is less than the 3 ounces, call us. We will schedule you within 24 hours to have the tube removed in our office. If it is over the weekend, keep the suprapubic tube clamped and call first thing Monday. (If you start to feel pressure while waiting for your catheter removal, unclamp the tube and restart the training from step 1. Call us during business hours to report what happened.)
Remember, until you come in for tube removal, continue to urinate every 2-3 hours during the day, and continue the antibiotic we gave you.
Send us your bladder training results
Please send us the results of your bladder training (as recorded on the downloadable sheet below) once a day.
Fax to 617-667-2999, OR Call 617-667-4070
Caring for your suprapubic tube
While the tube is in place, please follow these instructions to care for your tube. For some patients, a visiting nurse may be available to help. Ask your nurse in the hospital for more information about a visiting nurse.
You may shower with the tube in place, as long as the protective dressing is intact. To keep the area dry, shower with the spray directed toward your back. Please do not take a tub bath while you still have a suprapubic tube.
Please do not remove the dressing. If the dressing falls off, call your visiting nurse agency, if one has been arranged for you. If you do not have a visiting nurse, please call our office at 617-667-4070 if your dressing falls off.
Please call us at 617-667-4070 for any of the following:
fever of 101 or more
increasing redness or swelling around the tube
drainage or pus-like material around the tube
the tube falls out
Use this chart to record your bladder training results.
Constipation is a common complication following surgery. Even if you always had regular bowel movements before your procedure, constipation could become a problem for you during your recovery. Many things contribute to the development of constipation, including the medications you received during and after surgery, changes in your diet and fluid intake, and reduced physical activity.
Please follow these instructions unless otherwise instructed by your doctor. This is important. Straining because of constipation can affect the success of your surgery.
Stool softener, laxative, and suppository
Stool softener (docusate, Colace)
Please start taking a stool softener twice daily as soon as you return home after surgery. We usually include a prescription for Colace in your discharge papers, but Colace can also be purchased over the counter at most pharmacies. (Docusate is the generic version of Colace.) Colace softens the bowel movement, making it easier to pass. You may start taking 100 mg. twice daily and may increase to a maximum of 200 mg. twice daily as needed. Colace is not habit-forming.
For the first week or so, please take the laxative Miralax as well. This will help make sure you don't become constipated. Miralax works by pulling water into your intestines, which helps your stool move along the intestinal tract. Miralax comes as a powder and is mixed in any liquid. It can be taken daily without any significant side effects.
You will have to determine whether you need to take the Miralax every day and how long you need to take it; everyone is different. Your goal is to have regular bowel movements that are easy to pass. Start with once a day; if your stools are very "watery," switch to every other day. As you go back to your usual diet and routines in the next week, and after you stop taking narcotic pain medicines, your bowel function will start to return to normal on its own and you can slowly reduce the amount of Miralax you are taking until you no longer need it.
If you don't have good results from the Colace and Miralax, you may need to replace Miralax with a stronger laxative. Milk of Magnesia can be effective, though it is a harsher laxative and should only be taken for a short time. Take Milk of Magnesia with a large (at least eight ounces) glass of very warm water for best results.
If you are still constipated after using the above methods, you may have some hard stool in your rectum, acting as a plug. To relieve the blockage, gently place a rectal suppository - such as Dulcolax - into your rectum. You may repeat the dose once, according to the package instructions. If you still do not have a movement after the second suppository, please call our office for advice at 617-667-4070.
Follow the instructions on this sheet to prevent constipation following your surgery. And remember these general tips for healthy bowel function:
Eat a well-balanced diet including plenty of fiber-rich foods (such as fruits, vegetables, beans, and whole grains).
Drink plenty of fluid.
Stay as active as you can, increasing your activity a little each day.
Use a fiber supplement (such as Metamucil or Fibercon) if stools are not well formed.
Stool softeners prevent the stools from becoming too hard, and can be safely taken daily as needed.
Laxatives can move stools through the intestines if the above measures don't work, but may be habit-forming if used for a prolonged period.*
*A mild laxative such as Miralax is okay to use daily for up to six weeks after surgery, as described on this sheet.
For ongoing or severe problems, please call your surgeon at:
Female Pelvic Medicine & Reconstructive Surgery
Please follow these instructions as you recover from your procedure. If you are going home with a suprabupic or urinary catheter to drain your urine, you will receive additional instructions regarding care of these devices.
If you have any questions about these instructions, or if you are having problems, please call us at 617-667-4070.
You have had surgery and your body needs time to heal. It is normal to feel more tired than usual. As you recover, it's important to increase your activity gradually, as outlined below. You should expect to be back to your usual level of activity in about six weeks.
Plan to stay at home for the first week after surgery.
Do not lift, push, pull, or carry anything that weighs more than five pounds until your doctor says it is okay – usually after about six weeks. Gradually increase your activity each day over the next few weeks, as your energy increases. It's okay to climb stairs once or twice a day, and to walk at a slow pace as much as you want, if you feel comfortable.
You may take a shower, but no tub baths until your doctor says it is okay.
You may ride in a car as a passenger; you may drive when you feel comfortable and you are not using a prescription pain medicine.
It's okay to travel out of town or travel by air three weeks after surgery.
Until your doctor says it is okay (usually after about six weeks), please do not:
do any heavy housework, such as vacuuming, washing floors, carrying laundry or trash, etc.
participate in exercise classes
have sexual intercourse
After any type of surgery, there is a possibility of some pain. It's very important to your recovery to keep your pain well controlled. This is not just for your comfort. Controlling your pain will help you move more easily, breathe deeply, and cough effectively. All of these things are essential in preventing complications such as pneumonia, blood clots, and psychological stress.
Your doctor may select one or more types of oral medicine to help you control your pain.
Most patients are advised to take a prescription, narcotic medicine as well as a non-prescription medicine such as ibuprofen (Motrin). The narcotic medicine is used for moderate to severe pain as directed by the doctor. Ibuprofen can then be used in between doses as needed. If the pain is more mild, ibuprofen alone may be enough to manage the pain effectively.
Do not hesitate to use your medicine as prescribed to make sure you are reasonably comfortable. This is important for your recovery.
Narcotic pain medicines can cause constipation. Be sure to read the important information you were given on preventing constipation ("Constipation after urogynecologic surgery: What you need to know") as becoming constipated could cause complications in your recovery.
If your pain does not improve or gets worse after taking your pain medicine as prescribed, please call your doctor for advice.
The incision area, including the vaginal area, may be washed with soap and water. (Remember, no tub baths until your doctor says it is okay.) After showering or gently washing the area, pat the incision dry with a clean towel.
A dressing is not usually needed, but may be used to protect clothing from any discharge.
If you have an incision in your abdomen, you may have steri-strips (thin paper strips) in place over the incision. Sometimes steri-strips become loose and fall off. This is normal. They do not need to be replaced.
Stitches do not need to be removed; they will dissolve in about six weeks.
If skin clips were used, they will be removed before you go home or at your first post-operative visit with your surgeon.
The area around your incision may itch, bruise, or feel numb. You may have a "pulling" sensation in the area. This is all normal.
If your incision becomes hot, red, swollen, or very painful, or if you develop a fever of 101 or more, please call your doctor.
Vaginal bleeding/discharge and urinary issues
Right after surgery, you may have slight vaginal bleeding, which changes to a dark brown discharge. There may be a foul odor to the discharge. This is all normal and may last for four-six weeks after surgery. The bleeding should not be heavier than a normal menstrual period.
Use sanitary pads only. Do not use tampons.
Please call the office right away if you have heavy bleeding – soaking a pad every hour.
Your doctor may ask you to use an estrogen cream in your vagina, beginning a few weeks after surgery.
Leakage of urine may occur, even if you did not have a problem with this before surgery. This may be due to swelling and should improve as the swelling goes down.
Urinary catheter care
Some patients go home with a urinary catheter - a tube that drains your urine. If you are going home with a urinary catheter, your nurse in the hospital will show you how to take care of it.
If you have a urinary catheter, please be sure to take the antibiotic you were given until the catheter is removed.
If you run out of antibiotics while the catheter is still in place, please call your doctor for a new prescription.
Call us at 617-667-4070 if you have any of the following:
temperature of 101 or more
pain that is not well controlled with the medicine you were given
pain that is getting worse instead of better
heavy vaginal bleeding or discharge (soaking a pad every hour)
your incision is hot, red, swollen, or painful, even after taking pain medicine