Helpful Info After All Types Of Surgery

What to look out for (these are NOT part of a normal recovery):

Severe pain or pain that worsens over time after using analgesia
A fever > 38.5 °C or are feeling unwell
Heavy vaginal bleeding or discharge
If the wound becomes hot, painful, or has offensive fluid / blood draining from it
Unable to empty your bladder
Swelling in the calf or leg pain
Vomiting and nausea which do not settle
Bowels stop working and you are no longer passing wind.

You should seek medical attention straight away. This may mean you need to call 000 or go directly to ED. You can also contact the rooms on 0478 570 901 during business hours.

Discharge medication

You will receive some medication on discharge from the hospital. You should take regular simple analgesia (e.g. paracetamol and anti-inflammatories) and then use stronger opioid (morphine) based drugs as needed. You should need less and less of those over time.
Strong pain relief can lead to significant constipation. Please take a bowel softening agent (e.g. movicol, coloxyl, lactulose) until you have ceased strong pain relief, are eating normally, and have normal bowel function. If you need chemotherapy, you should consider continuing medication to help your bowels stay regular. Additional water is helpful as are some fruits (e.g. kiwi fruit and pears).

Follow-up appointment.

Standard follow-up appointments would be at two weeks post-operatively. The details of this will typically be in the email you receive with your operation booking details. If this has not been arranged, or your operation was in a public hospital, please call the rooms to book this appointment. If you have concerns prior to this appointment, please contact us to make an earlier appointment.

Recovery

After you leave the hospital, you should feel better day by day. There won’t be a straight line to well but a gradual improvement back to normal. The type of operation will have a major impact. If you do feel worse, please contact 0478 570 901 during business hours. After hours options are the emergency department of your local hospital, a walk-in centre or after hours GP or to call an ambulance. Please remember to take your discharge summary with you.

Blood clots

You may be asked to take a blood thinner post-operatively. There is a risk of blood clots after major surgery especially when you have cancer. The blood thinners are mostly in the form of an injection of enoxaparin (Clexane). You will receive instruction on this post-operatively on the ward before you leave.

Driving and traveling

Once you are pain free, not limited by any post-operative issues, and no longer taking opioid (morphine based) medication you can drive. Your insurance company may have an issue with covering you in case of an accident if you drive too soon after your operation. I suggest you check with them before you hit the road.
If you travel long distances while on blood thinners, please stop and move every hour (or regularly). Remember when traveling to take the medication with you.

Lifting

After an open operation or a hysterectomy you should avoid heavy lifting for 6 weeks.
If you need to think about lifting it then it is too heavy.

Exercise and around the house

You should gradually be able to increase your activity as time passes. Moving is good for your post-operative recovery so I recommend you try to move regularly. Fatigue tends to be as big an issue as pain. Your body will rob you of energy to heal. Start slowly and listen to your body. Moving will reduce the risk of chest infections, blood clots, and constipation and is good for your mental health.

Supporting your mental health

Please take it easy on yourself. There is a significant mental burden leading up to and after a big operation, regardless of how well it goes or why you had it. I am happy to put you in touch with a psychologist/counselor if you don’t have one. Cancer Australia can link you to support services in the ACT. There are also support groups available for women with cancer, menopausal symptoms, and endometriosis.

Returning to work

This will vary depending on several factors including what type of work you do, whether you work full or part-time, the type of operation you had, and whether you will need more treatment post-operatively. It is worthwhile discussing this before the operation and before you head home from the hospital.

Vaginal Discharge

After a hysterectomy or surgery on your cervix, it is normal to have some vaginal discharge or bleeding. It will lessen over time. If the bleeding is heavy with clots or flooding this is NOT normal, and you should seek medical attention. An odour in the discharge may signify an infection. In this case, you should contact the CNC if you had an operation in a public hospital, or the rooms number during business hours if private. You can also see your GP or present to the emergency department.

Menopause Symptoms

If you were still menstruating before the operation and both of your ovaries were removed, you will experience surgical menopause. The Australian menopause society has multiple fact sheets on menopausal symptoms and treatment. There are a range of treatment options to try. We can discuss these with you and commence appropriate treatment as needed.

Sexual Intercourse

Sexual intercourse is not recommended for 8 weeks following a hysterectomy. You should discuss any issues or anxiety about returning to intercourse with your partner. Purchase and use of a water-based lubricant, until you are comfortable, is an option. There may be vaginal dryness and a small amount of bleeding with the first episode of intercourse so do not be alarmed. If there is heavy bleeding seek medical attention. The Sex & Libido page goes into this in more detail.

Leg Swelling

If lymph nodes were removed during your surgery you are at risk of developing swelling in your legs. This is called lower limb lymphoedema.
There are several measures that can assist you to manage this issue. Please speak to us if this happens.
The Cancer Australia information sheet on lymphoedema is a very useful resource. The Memorial Sloan Kettering Cancer Centre handout is also useful.

Pain and Bowel Management

Paracetamol may be used to relieve mild to moderate pain. Ensure you follow the directions on the pack unless advised otherwise.
If you are able to take anti-inflammatories take them regularly for the first week post-op as per the instruction on the box.
Stronger pain relievers may be taken as prescribed but can cause constipation. If unsure, ask for more specific advice about what medicines have been prescribed for you.
Take laxatives prescribed to ensure bowel motions are soft and easy to pass without straining.
It may sting whilst passing urine whilst the wound is healing. Ways to relieve that are to pass urine in the shower (whilst washing the area), take Ural and drink more, rather than less, water.
Drink plenty of water.