Discharge Advice Following your Surgery

Discharge Advice Following your Surgery – Gynaecology

This booklet provides some useful advice regarding what to expect when you return home and how to look after yourself during your recovery.

You should be given details about the operation you have had and who your consultant is.

If you have any worries or concerns in the 8 weeks following your discharge from the hospital, you should call the Emergency Gynaecology Assessment Unit (EGAU) for advice on the number below. After this time you should contact your GP.

EGAU Telephone: 01905 761489, we are open 24 hours a day, 7 days a week.

What happens before I go home?
The doctors and nurses will have agreed that you are fit for discharge. Before you leave hospital it is important to talk to a member of staff if you are worried about anything relating to your operation. Please do not hesitate to ask for more information. If you need a follow-up appointment, the ward clerk, booking team or your consultant’s secretary will make this appointment and the appointment will be sent to you in the post. If you are taking medicines, you will be given a supply to take home. If you need more of your medicines when you return home, you can get these from your GP. You will be given a copy of your discharge summary letter which is sent to your GP.

What to expect when I get home
When you get home, you will likely find that you get tired easily. Both being in pain and having any form of anaesthesia can make you extremely tired. Feeling tired or fatigued is not a weakness so be kind to yourself. Your body has been through a lot and it’s normal to feel physically and even mentally weaker. You may find that you feel emotional or weepy. This will improve as you recover from your surgery. There are things you can do to improve this, but we know they are easier said than done. Life is busy and resting is not always easy.

You should try to:

• Ask for help when you need it
• Sleep when your body tells you, even if it’s during the day
• Be kind to yourself
• Delegate chores – people often want to help but are not sure how to
• Take your time to build yourself back to full strength, don’t try to rush back to your normal pace of life quickly
• Find emotional/mental support for yourself – friends, family, organisations and groups
• You should not drive or operate heavy machinery for a minimum 48 hours after a general anaesthetic (more information below).

Vaginal Bleeding
It is normal for you to have some vaginal bleeding for approximately 7-14 days after any gynaecological surgery. This is not usually something to be concerned about, and the length of time depends on the surgery you have had. Some vaginal surgery can cause intermittent bleeding for several weeks after the operation. You should report any smelly, offensive or very heavy bleeding to EGAU or your GP.

What can I do to help my recovery?
You will need some help at home for the first few days, and maybe longer. You should treat your first two weeks at home as recovery time. You will need to:

• Get plenty of rest
• Go for short walks, to lessen the chance of getting complications like thrombosis (blood clot) and muscle weakness. The risk of developing blood clots in your legs or lungs can continue for up to 4 weeks after you have returned home. Make sure that you remember to walk around as much as you are able
• Eat a well-balanced diet
• Drink plenty of water (at least 2 litres a day)
• Complete simple leg exercises and deep breathing (see advice leaflet, given to you by physiotherapist),
• Wear support stockings at home if you have been asked to do so. Please wear them for the recommended time (usually 4 to 6 weeks after your operation)
• Ensure you have Enoxaparin injections if they have been prescribed for you. Some patients may be considered to be at higher risk of developing a blood clot and you may have been prescribed these anti-coagulant injections to reduce the risk of blood clots and thin your blood. Some patients or their relatives/friends are able to give this injection and others attend the practice nurses at their GP surgery. We will discuss this with you if necessary
• Take your prescribed medication and painkillers on time. It may be helpful for you to write down the timings of your doses so that you don’t take too much or too little pain relief
• Avoid smoking

How does my wound(s) heal?
All wounds go through several stages of healing and your wound(s) will change over time. It is common for people to feel:

• An unusual stretching feeling like tingling, numbness or itching
• A slight hard lumpy feeling as the skin heals
• A slight pulling around the stitches as the wound(s) heal

The vagina often heals quickly but you may experience intermittent bleeding for several weeks (see above).

The stitches used inside the vagina for gynaecological surgery can feel quite prickly to the finger. They also take a long time to be fully absorbed – at least 3 to 6 months. Please report and soreness from such stitches via the EGAU or GP.

Can I do anything to help my wound(s) to heal?
You can look after your wound by:

• Gently massaging around the wound(s)
• Shower each day, for the 7 days, then bath or shower. If you are only able to bathe, simply keep your bathing time to a minimum to prevent the wounds becoming soggy
• Shower each day, for the 7 days, then bath or shower. If you are only able to bathe, simply keep your bathing time to a minimum to prevent the wounds becoming soggy
• Drying your wound(s) carefully after washing (do not use talcum powder or creams)
• You may be given vaginal oestrogen cream or tablets to help the vaginal healing. Instructions will be given to you before you leave the ward if this is the case

Dressings

• Small dressings from laparoscopic surgery can be changed on day 2 (or if the cotton part of the dressing gets wet)
• Remove all dressings/steri strips after 5 days (in the shower if easier)

When can I start to return to everyday activities?
This will depend on the kind of surgery you have had. We have provided the table on page 6 as a rough guide. Generally, our advice is to avoid heavy lifting and straining but otherwise do what feels comfortable and not to force the pace. Please continue the physiotherapy exercises in the leaflet given to you prior to your discharge home.

How can I help myself to stay well?
Regular exercise will keep your bones healthy, and you should continue with regular pelvic floor exercises.

When can I start having sexual intercourse again?
You should avoid sexual intercourse for the first 6 weeks after your surgery (hysterectomy & vaginal wall repairs) and up to 12-14 weeks if the vagina remains tender and is obviously still healing. This will allow the stitches inside you to heal and lessen the chances of you getting an infection. Initially be very gentle and if sex is uncomfortable, you may choose to wait a while longer.

For minor surgery, sexual intercourse can be resumed when it feels comfortable to do so. It may be a good idea to discuss this with your nurse or doctor. You should also discuss with them your need to use contraception in the future and if so which method may be suitable.

What can I do at home?
The following table should be used as a general guide but you should listen to your body and do what is comfortable.

When can I get back to work?
This will depend on the type of surgery you have had.

The table below is a guide and returning to work will also be dependent on how you feel. If your job involves lifting or is very active, you may need more time. You can contact your GP if you require a sick note.

When will I be able to drive again?
You should not start driving again for at least 3-6 weeks after your surgery, depending on the surgery you had (see table on pages 6-7). Only start driving when your insurance covers you and you feel well enough in yourself to do so. You may want to contact your insurance company before you start driving again. Before you start driving, it is a good idea to practice, with no keys in the ignition. Try and see if you can do the movements you would need for an emergency stop and a turn in the road without causing yourself any discomfort or pain.

What about the long term future?
You should try to eat a well-balanced diet. This helps you to stop putting on weight and makes it less likely that you will have any complications like constipation or problems with your wound healing. You should drink plenty of liquids – at least 2 litres a day. This will also help prevent constipation, urine infections and thrombosis.

Will I need to continue with cervical screening (smear tests)?
If you have had a full hysterectomy (removal uterus including cervix) you will not usually need these, but you should check this with your nurse or doctor before you leave the hospital. If your cervix remains, then you will need to continue with cervical screening until you complete the screening programme (age 65y).

Is there anything else I need to know?
If you have had your ovaries taken out, you may need to have hormone replacement therapy (HRT). Talk to your doctor about this. If you have not had your ovaries taken out, they can sometimes work less effectively after gynaecological surgery. If you get menopausal symptoms such as hot flushes or sweats and you are below the age of 45y, your GP may consider a blood test to check whether your ovaries are working properly and whether they recommend HRT.

It is also important that you check your breasts regularly. This means knowing how your breasts look and feel normally so you can spot any changes in them. If you notice any changes, you should speak to your GP.

Is there anything that I should look out for when I go home?
You should contact EGAU or your GP if you have any of the following:

• Vaginal bleeding that is heavy or smelly
• Wound(s) that become red, swollen or starts oozing
• You feel feverish or unwell
• Pain that is not controlled with Paracetamol or Ibuprofen

NB. If a follow up call has been arranged prior to your discharge home, this call will show as a withheld number – please do answer this call if you are expecting this.

We wish you a full and speedy recovery – the EGAU staff are available to you if you need our help

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day

If you are unable to understand this leaflet, please communicate with a member of staff.

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