Activities following incontinence, prolapse and major pelvic surgery
You will either be preparing for or have just gone through surgery for urinary incontinence, pelvic organ prolapse surgery or hysterectomy. The following gives you a general overview of activities you can do after surgery.
Once you go home:
At the time of discharge you will have some painkillers to go home with. You should use these to remain comfortable and not wait until your pain, if any, increases. Protection of your pelvic floor is essential. It is in your interest to do all that you can to allow this to heal in the short term and also protect it in the future.
You may have seen the physiotherapist prior to surgery, immediately after surgery whilst in hospital or in the weeks following surgery. The physiotherapist will guide you as to appropriate protection of your pelvic floor and return to exercise.
Recovering after going home:
If possible, do not lift or push heavy weights of more than 10kg (upper limit) for 12 weeks.
– Very light ironing, cooking and shopping can commence about 2 weeks after surgery.
– No lifting baskets of washing or hanging out washing on a line for at least 4 weeks after surgery.
– Try not to lift children but rather to sit down and let them climb onto your lap.
– When coughing/sneezing/laughing try to contract your pelvic floor muscles beforehand.
– Do not persist with any activity that causes pain or pressure in your abdomen or pelvic floor.
– Avoid straining on the toilet.
– Avoid constipation.
– Drink plenty of water.
– Go for a walk each day, starting around the house and garden. Increase to longer distances based on your level of fitness and comfort.
The first 2 weeks after your operation:
– Get plenty of rest.
– Start gentle walking around the house and garden.
– Keep any housework light.
– Gradually increase your pelvic floor and abdominal exercises.
– Don’t lift anything heavier than 2 Yellow Pages phonebooks.
– Gradually increase exercise.
– Remember to rest if you feel tired.
– When you first begin to drive (refer to Admission Guide) it may be sensible to take a short trip with a friend or relative in the car with you.
Protecting your pelvic floor
Position for sitting on the toilet:
Rest elbows on knees and raise feet either by raising heels or putting feet on a small raise. As you lean forwards from the hips the back remains flat. Relax your pelvic floor. Remain in this position until bladder or bowels are completely empty. Don’t be in a hurry. Try not to strain.
Constipation can usually be avoided by:
– Drinking about 2 litres of water each day.
– Eating plenty of fresh fruit, vegetables and cereals.
– Moderate exercise – i.e. walking.
– Correct positioning on the toilet – as described above.
– Using laxatives as required in the short term.
– No gardening that involves digging for 10-12 weeks after a pelvic floor repair (6 weeks if you have had incontinence surgery without any prolapse surgery).
– The timing of return to sporting activities will be determined by the nature of your surgery, your level of fitness, your postsurgery recovery and the type of sport. You will need to discuss this in more detail with Dr Onuma at the time of your consents for surgery or at your postoperative assessment.
– You can recommence penetrative sexual intercourse 6 weeks after your surgery; this will be usually after your 6-week postoperative check-up.
Trial of Void (Emptying Bladder) After Incontinence &/or Prolapse Surgery
Following incontinence or pelvic reconstructive surgery it is necessary to ensure that your bladder is emptying effectively.
You will be asked to use a pan placed over the toilet every time you empty your bladder so that the nursing staff can measure the amount of urine that you have passed.
The nurse will then measure the amount of urine left in your bladder (residual volume) using the bladder scanner. This is a non-invasive, non-painful method of estimating the residual.
This protocol will be repeated until either you have passed urine leaving less than 100mls on two consecutive occasions or alternative instructions are given by Dr Onuma.
- When voiding, remember to sit comfortably on the toilet, raising your heels or putting your feet on a small raise. Lean forwards.
- Try and relax.
- If necessary run a tap whilst trying to void.
- Drink normal (for you) amounts of fluid (usually about 1.5 – 2 litres/day).
- Avoid going to the toilet ‘just in case.’
- If at any time you have difficulty emptying your bladder or feel your bladder is uncomfortably full, please tell a member of the nursing staff as soon as possible.
- If you are unable to void or there are large volumes of urine left in your bladder after you have attempted to void, it may be necessary to manually empty the bladder with a catheter. Sometimes a decision will be made (by Dr Onuma) to leave a catheter in the bladder overnight or longer to ‘rest’ the bladder. On removal of the catheter, another ‘trial of void’ will be conducted.
- Don’t be disappointed if your ‘trial of void’ is initially unsuccessful. It may take a little more time for your bladder to regain its tone and function. The more stressed you become, the more likely that your bladder will delay returning to its normal function!