What to do before and after gynecological surgery
In this section we provide general guidelines for preoperative and postoperative care. Please take a few minutes to make yourself familiar with the information and contact your provider’s office with your questions or concerns.
Preoperative Preparations for Hospital Surgery: How to Improve the Outcome of Your Surgery
Preoperative preparation is designed to improve the outcome of your surgery, decrease your risk for complications, and make your surgery as safe and effective as possible.
In general, no food or drink for at least eight hours before your surgery in the hospital. Most instructions indicate that nothing is to be taken by mouth after midnight, on the night before the procedure. It may seem harsh, not to be able to have a sip of water, but this precaution minimizes the risk for complications such as vomiting during surgery.
If you have diabetes or other pre-existing medical conditions, especially to do with your heart or lungs, let your doctor know and there may be specific instructions on what you should do the day of surgery.
Discontinuing prescription and over-the-counter medications that "thin" the blood, such as aspirin or anti-inflammatories, is necessary prior to surgery. Whether a drug is held or administered is based on the patient's medical condition, the type of drug, and the scheduled surgical procedure. Patients who take prescription medications on a regular basis must discuss this with the surgeon.
If a pain reliever is needed in the week prior to surgery, acetaminophen is recommended over aspirin, ibuprofen, or naproxen, to reduce the risk for heavy bleeding during surgery. If you regularly take any herbal supplement, it may need to be discontinued before surgery.
In many cases, patients are advised to quit smoking 2 to 6 weeks before surgery. Smoking may cause breathing problems during surgery and has been shown to delay healing.
In some cases, a laxative or enema is indicated to empty the bowels before surgery.
If you have any unexpected medical problems before your scheduled surgery, such as a fever, cold, cough or flu please contact the office immediately as your surgery may have to be rescheduled.
General Postoperative Care Instructions:
The goal of postoperative care is to ensure that patients have good outcomes after surgical procedures. A good outcome includes recovery without complications and adequate pain management. Another objective of postoperative care is to assist patients in taking responsibility for regaining optimum health.
After surgery in the hospital
- If you have had general anesthetic, you may have a sore throat for the first 24 hours due to the airway placed in your windpipe. You may also experience dizziness, drowsiness or lightheadedness after anesthesia or sedation.
- If you leave the hospital with bandages over your incision(s) — these bandages can be removed the next day. If you have steristrips (adhesive strips) over your incision(s), they can be removed 7 to 10 days after surgery. If the strips get dog-eared, clip the edges with scissors. Try to keep your incision(s) clean and dry. You may shower 24 hours after surgery. If you get the incision(s) wet, then pat it/them dry. A slight to moderate vaginal flow may be normal for 2-5 days.
- If you have staples in your incision, make an appointment to have them removed within 7 days following your surgery or as directed by your physician. If your stitches are underneath the skin, they will dissolve on their own; you may see a knot at the end and if it is still there at your followup appointment, your doctor will pull it out for you.
You may return to a normal diet as quickly as you are comfortable doing so. If nauseated, start slowly with clear liquids (jello, tea, broth) and advance gradually to more solid foods.
Activity / Bathing / Driving
If you had a hysterectomy:
- In the first 24 hours after your surgery: do not drive or operate power equipment and do not engage in activities that require coordination for the ability to respond quickly.
- You may walk, ride in a car, climb stairs after your surgery.
- Rest the first day home. You may resume light activity the next day. You may feel weak or tired for a few days after your surgery. Increase your activity as tolerated. Do not do any heavy lifting or vigorous exercise for a week or two if you had a laparoscopy; for 4-12 weeks if you had a hysterectomy or prolapse surgery (as directed by your surgeon). There are no restrictions on activity after a D&C or ablation.
- You may drive when you can control the car fully and are not taking any narcotic pain medication. Please abstain from sexual intercourse until your two followup appointment where further activity instructions will be given. No tub baths, hot tubs or swimming until you see your doctor for your 2-3 week postoperative check. Showers are okay. Activity, such as walking, can help bowel function return to normal and decreases chance of postoperative blood clots.
- Avoid tampon use until you see your doctor for your 2-3 week postoperative visit. No douching.
- You may return to work when you are released to do so by your surgeon.
Full recovery can take from 4 to 8 weeks for open abdominal hysterectomy, and from 1 to 2 weeks for vaginal and laparoscopic hysterectomies. During this time, patients should get plenty of rest. Also avoid heavy lifting, tub baths, and intercourse for a full 6 weeks. Depending on the type of procedure used and on the patient's rate of recovery, light chores, some driving, and even returning to work during this period of time may be possible.
Preventing and Treating Constipation
- You will usually be given a prescription for a narcotic pain medication (such as Percocet or Vicodin). You may use this if necessary, however, narcotics are constipating and may make your bowel movements more painful. No driving or drinking alcoholic beverages while taking pain medications.
- Options for non-constipating pain medications include products that include Ibuprofen or Tylenol (acetamininophen).
Preventing and Treating Gas Pains
- Include fiber in your diet (fresh fruits and vegetables and/or fiber supplements such as Metamucil or Citrucel). Drink at least 6-8 glasses of water each day. Avoid foods that cause you to have gas for upset stomach. Increase activity as tolerated - activity helps bowel function return to normal.
- Take stool softeners as necessary. You may consider using a stool softener (such as Colace) up to 3 times each day if you are taking a narcotic pain medication and/or feel you are constipated. If you have not had a bowel movement within two to three days following your surgery, you may take over-the-counter Milk of Magnesia or Senokot over the counter as directed on the packaging. If you still do not have a bowel movement within 4 days, please call our office.
- Increase activity as tolerated - activity helps bowel function return to normal. Avoid gas-forming foods, such as broccoli, cabbage, beans, salads, sweet potatoes. If gas pain persists, you may take over-the-counter Simethicone (Mylicon, Gas-X, Maalox-Gas, Mylanta-Gas)
- You will be given a prescription for a narcotic pain medication (usually Percocet or Dilaudid). You may use this if necessary, however, narcotics are constipating and may make your bowel movements more painful. Options for non-constipating pain medications include products that include Ibuprofen or Tylenol.
- You should have a follow-up appointment at our office within 2-4 weeks following your surgery. If you don't already have that appointment, please call us at (503) 229-7353 to make it.
Postoperative Care Instructions #1: Colposcopy | LEEP | Cryotherapy
- It is normal to have some mild cramping after your procedure. You may take medications such as ibuprofen (eg Advil — up to 600mg every 6 hours) and/or acetaminophen (eg. Tylenol - take as directed on the bottle) to help reduce the discomfort from cramping.
- You will have some vaginal spotting or bleeding after your procedure. If you had a LEEP you may have a dark coffee grind discharge after that and may pass some tissue in 1-2 weeks. If you had cryotherapy, you may will most likely have a clear vaginal discharge for 4-6 weeks (and may well not have any bleeding or spotting).
- If you had colposcopy and a biopsy, then you are advised to abstain from intercourse, tampon use, baths, and swimming for 1 week. If you had a LEEP or cryotherapy, then you are advised to abstain from intercourse, tampon use, bath, and swimming for 4 weeks. After a LEEP, avoid vigorous physical activity (heavy lifting, etc) for 48 to 72 hours.
- You should have a followup visit in 2 to 4 weeks after your LEEP or cryotherapy (unless otherwise instructed by your doctor). Your followup care after a colposcopy alone will depend on the results from the colposcopy and any biopsies done that day - your physician will call you with the results of biopsies as soon as they are available and review with you whether further action or surveillance is needed (if you have not heard from the office within 2 weeks, please call the office).
Postoperative Care Instructions #2: D&C | Endometrial Ablation | Essure
- You may experience mild to moderate cramping (like menstrual cramps) and pinkish to red vaginal bleeding. This may last approximately 2 to 3 weeks. You may pain medications prescribed by your doctor as needed. In addition you may use ibuprofen (eg. Advil — 600mg up to every 6 hours).
- Use pads for any bleeding. No tampons nor sexual activity for 2 to 3 weeks post procedure.
- Please make sure you continue to use effective birth control.
- Make a followup appointment in the office in 2 to 4 weeks.
Postoperative Care Instructions #3: Hysterectomy
- Full recovery can take from 4 to 8 weeks for open abdominal hysterectomy, and from 1 to 2 weeks for vaginal and laparoscopic hysterectomies. During this time, patients should get plenty of rest.
- Avoid heavy lifting, tub baths, and intercourse for a full 6 weeks.
- Depending on the type of procedure used and on the patient's rate of recovery, light chores, some driving, and even returning to work during this period of time may be possible.
A list of symptoms and complications that can occur after ANY obstetric or gynecologic procedure or surgery
The following symptoms and complications may indicate a medical emergency and should be reported to our office (503) 413-7353 as soon as possible (or proceed to the nearest Emergency Room if necessary):
- Fever of 100.4°F or higher
- Severe abdominal pain not relieved by your pain medication (After laparoscopy, it is not unusual to have shoulder, chest, stomach or lower abdominal pain for 2-5 days. Your pain medication should relieve this.)
- Persistent nausea and/or vomiting and are unable to keep down fluids or food or experience diarrhea for more than 24-48 hours or you do not have a bowel movement within three or four days of your surgery.
- Bright red vaginal bleeding that soaks more than 2 pads in an hour and/or large/painful blood clots
- Increased redness, swelling, or pain around any incision(s)
- Pain with swelling, heat or redness around an IV site
- Pain or tenderness and swelling in the legs, especially back of the calf
- Difficulty urinating or have any signs of a urinary tract infection such as painful or frequent urination, urgency, foul odor or low back pain.
- Difficulty breathing, unusual shortness of breath or chest pain