General Surgery Information

Your Surgery

WHAT TO EXPECT WITH PELVIC RECONSTRUCTIVE SURGERY

You have opted to undergo surgery for vaginal prolapse, bladder control problems, or both. You have been informed of the risks and benefits of the surgery. We want you to have a clear idea of what to expect during the recovery phase of your surgery.

Pelvic Reconstructive Surgery is an art. Multiple factors affect the surgery’s success rates. Healing is a very important aspect of the surgical procedure. You will be asked to not exert yourself for at least 6 weeks following surgery because healing continues beyond six weeks and is actually not fully completed until at least 3 months after surgery.

Since the surgery will affect bladder, bowel and sexual function, each of those factors might change following reconstructive surgery. Although these surgeries carry high success rates, unfortunately, they are not 100% successful. This has been discussed with you previously.

Pain and energy. These will be variable from day to day. Pain will progressively decrease and energy will gradually increase. You will likely require pain medications. We expect you to use your pain medications as pain may be detrimental to your recovery.

Bladder function. Any changes in bladder anatomy or location will likely result in a change in bladder function. This may result in urinary frequency, hesitancy, interrupted flow, urinary retention, persistent urine loss, and bladder over activity. It may take 6 weeks or longer for bladder function to normalize. You may need medicines in order to help bladder function improve post-operatively. Less than satisfactory bladder function during the initial 6-8 weeks after surgery should not been seen as a sign of failure of a surgical procedure. It is merely a response to changing bladder position, nerve, or muscle injury during surgery, or associated healing from the surgical procedure. Patience is very important in allowing normal bladder function to resume. Bladder infections are very common during the recovery period. You may require antibiotics on more than one occasion.

Bowel function. Bowel function will also be variable following surgery. Avoidance of constipation is an extremely important goal. It is important not to push down strongly for bowel movements. This may result in damage to stitch lines. We advise you to use stool softeners daily such as Colase twice a day to prevent damage to the surgical site.

Vaginal bleeding and/or discharge. It is normal to have vaginal discharge and bleeding during the entire post-operative recovery. The bleeding will likely decrease over time, but a discharge may persist for the full 6 weeks, or longer. Sometimes patients confuse the dampness from vaginal discharge with urinary leakage, but this usually resolves in 6 weeks.

Sexual activity. You will be asked not to have any intercourse for the 6 weeks following surgery. You should not have intercourse until told it is appropriate. At that point, you may expect sex to feel different, as changes in your anatomy will result in changes in sensation, vaginal diameter, and length.

The operation may take a few hours. Reconstructive surgery is a complex process with many variables. It is important for you to allow your body to heal properly and be patient with return of normal bladder, bowel and sexual function. Realize that we will help guide your recovery and adjust your therapy in hopes of achieving the best successful long-term result.

Preop

Once you have decided on surgery and have discussed the surgical procedure with us, our office will contact you to schedule your operation. You will be given specific preoperative preparation instructions at that time. You will be given a list of medication and vitamins that you should not take for one week prior to your surgery, but you should review this with your primary care physician at the time of your medical clearance appointment. Information concerning your arrival time the day of surgery will be given to you also. Usually you will receive a phone call from the hospital a day or two prior to the surgery, and they will give you instructions on when to arrive at the hospital and what to bring. We require a pre-operative medical clearance by your primary care doctor. At that appointment you will have a physical examination, blood tests, and any other studies deemed necessary. Some patients will need to have an anesthesia consultation prior to their surgery. Your primary care physician may ask you to see a specialist, like a cardiologist for example, prior to authorizing your clearance for surgery.

Postoperative Suprapubic Catheter

Some women undergoing surgery for urinary incontinence and prolapse will require a temporary suprapubic catheter during the postoperative period. This is a small tube that is placed into the bladder in a similar method that an IV is inserted into a vein. It is secured to the skin just above the pubic hair in the lower abdominal area. We prefer this method to a Foley catheter that is worn between the legs and attached to a bag which continually drains urine. The suprapubic catheter is flexible and can be tucked into your underwear. It allows you to urinate normally and allows us to assess how well your bladder is emptying after surgery. Once you are urinating well, we will remove the catheter in our office.

Instructions for bladder training
If you go home with a suprapubic catheter, we will want you to keep track of how your bladder is functioning and train your bladder to return to normal function.

Try to void on your own every 2-3 hours. When you do, please record the amount below in cc’s by placing a “hat” on the toilet. After you void, open the suprapubic tube to drain any additional urine. What comes out of the suprapubic tube is called the residual. Record this amount below in cc’s. If there are only a few drops, just write “drops”. When the residual is less than 100cc after 2 or 3 voids in a row, the suprapubic tube may be ready to be removed. When this happens, please call our office or fax this paper to us.

We will schedule you within 24 hours to have it removed. If it is over the weekend, call first thing Monday morning. Remember, continue to void every 2-3 hours on your own, and continue the antibiotic until the tube is removed in the office.

If you wish, you can connect the suprapubic tube to the urine drainage bag at night. This allows your bladder to drain while you sleep. Restart bladder training once you awake in the A.M. If you do not want to connect the bag, you must void 2-3 times during the night.