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Instructions After Surgery

postoperative careThe physicians at Cherokee Women’s Health Specialists are committed to ensuring that your experience after surgery is as comfortable as possible. The following information will help answer frequently asked questions and will help you understand some of the common experiences that may occur after your surgery. Please do not hesitate to call the office with any additional questions about your recovery.

  • Call the office to schedule a post-operative appointment two to four weeks after your surgery.
  • If an ER visit is necessary post-operatively, go to Northside Hospital Cherokee if possible, but if you are an out of town patient or live in another state, then your closest hospital is appropriate.

Call the office at 770-720-7733 right away if you experience:

  • Fever higher than 100.4 degrees
  • Shortness of breath
  • Dizziness
  • Heavy vaginal bleeding
  • Severe pain not relieved with your pain medication
  • Persistent nausea or vomiting
  • Increased pain, redness, or swelling at the incision

IF THE SYMPTOMS ARE SEVERE, GO TO THE EMERGENCY ROOM OR CALL 911 FOR AN AMBULANCE IF NECESSARY.

How Much Activity Can I Do After Surgery?

General – There are no standard limitations with regards to activity after gynecological surgery except for driving and sexual activity (see below). If you stayed in the hospital overnight, you should plan to rest with minimal activity for at least a week. If you were sent home the same day you should plan to rest with minimal activity for three days. If you had a procedure with no incisions (such as a D and C or endometrial ablation) then you probably only need to rest for a day. Use common sense and listen to your body. Every patient is different, and different patients will have differing degrees of recovery. Gradually advance your activity. If the activity you are doing increases your discomfort, then STOP. If you are feeling well during increased activity but have increased pain the next day you need to decrease your activity.

Adequate rest and nutrition is required to heal from surgery. LISTEN TO YOUR BODY.

Stairs – Apprehension about stairs or weakness in mobility may require help when climbing up and down stairs. You are allowed to use the stairs if you feel you are able. It’s a good idea to put both feet on each step to not lessen the strain on your body for a week or longer after surgery.

Exercise – If you had incisions on your body wait until you get clearance from your surgeon. Use common sense when starting an exercise routine after surgery. Start out slowly and gradually increase time, distance and speed. Once you are cleared to exercise a general recommendation is to start out at 25% of what you were doing before surgery for a week or two and increase by 25% at each one or two week interval.

Driving – Driving should only begin only after you have stopped taking narcotics, and if you feel strong enough to be able to stop the vehicle in an emergency. At this point you should be able to walk up and down stairs comfortably and sit down and stand up without experiencing discomfort. Have someone drive you if you are still experiencing discomfort.

What Should I Eat After Surgery?

After surgery, your body needs enough calories and nutrients to fully recover from the procedure. Eating the right foods after surgery can decrease risk of infection, speed healing of the incision and increase strength and energy. The best post-surgery foods to eat are packed full of vitamins and minerals.

Here are some foods and nutrients you should focus on in your post-surgery diet:

Fiber – A common complaint after surgery is constipation. To avoid this uncomfortable post-surgery complication, eat plenty of fiber. Some high-fiber foods include fresh fruit and vegetables. Whole grain breads and oatmeal are other great sources of fiber. To prevent constipation, avoid foods like dried or dehydrated foods, processed foods, cheese and dairy products, red meats and sweets.

Protein – The amino acids in protein help with wound healing and tissue regeneration. Protein can also help with strength and energy following surgery. Lean meats such as chicken, turkey, pork and seafood are excellent sources of protein. You can also get protein from eggs, nuts, beans and tofu. Dairy also contains protein, but if you’re struggling with constipation, go for the other sources of protein instead of dairy options. If you have trouble getting enough protein in your diet after surgery, try adding protein powder to drinks or smoothies. Several Physicians at Cherokee Women’s recommend a Vegan diet which is absence of animal products including meat, dairy and eggs. Eat to Live by Joel Furman MD gives excellent recipes and recommendations for those inclined.

Carbohydrates – Fatigue is common following any surgical procedure, but eating the right kinds of carbs can help restore your energy levels. Get carbs from high-fiber foods like whole grains, fruits and veggies, and beans and legumes. These foods will boost energy levels without causing constipation.

Fat – Healthy fats from olive oil, avocados, coconut oil, nuts and seeds will improve immune response and aid the body’s absorption of vitamins. Fat will also help increase energy levels after surgery.

Vitamins and Minerals – Perhaps the most important nutrients in your post-surgery diet are vitamins and minerals. Vitamin A (found in orange and dark green veggies like carrots, sweet potatoes, kale and spinach) and vitamin C (found in citrus fruits, berries, potatoes, tomatoes, melons, and sweet bell peppers) help with wound healing. Vitamin D (found in milk, fish, eggs, and fortified cereals) promotes bone health. Vitamin E (found in vegetable oils, nuts, beef liver, milk and eggs) protects the body from free radicals. Vitamin K (found in green leafy veggies, fish, liver and vegetable oils) is necessary for blood clotting.

Zinc – (found in meat, seafood, dairy and beans) and Iron (found in meat and poultry, beans, apricots, eggs, whole grains and iron-fortified cereals) are also helpful for wound healing and energy following surgery.

Water – In addition to eating foods that are rich in fiber, protein, healthy fats, carbohydrates, vitamins and minerals, you must stay hydrated after surgery. Proper hydration isn’t only necessary for healing, but may also be necessary to help your body absorb medications following surgery. Be sure to drink at least eight glasses of water every day after surgery to stay hydrated.

The foods you should and shouldn’t eat can vary depending on the type of surgery and any medications you may be on so speak with your surgeon about your specific post-surgery dietary questions.

When Can I Take a Shower?

You may take a shower the day after surgery. Baths are typically fine the day after surgery if you desire. Make sure you have someone around to help you should you need assistance. If you are experiencing discomfort a sponge bath is a fine substitute.

How Should I Care For My Incisions?

Keep your abdominal incisions clean and dry. No special creams or ointments are needed. Your incisions are closed with a suture underneath your skin, which will dissolve on its own. It is then covered with a surgical-grade liquid band-aid. This protects the incision and will stay in place for up to two weeks or longer. The glue can be removed after two weeks by applying some Vaseline to the glue for several minutes and then using soap and water and gentle scrubbing with a washcloth after two weeks. A small amount of bleeding at the incision sites is not uncommon. If it persists, call your doctor. Once the glue is removed it is OK to apply Neosporin to the incisions if they are red or inflamed. If you notice sutures poking through the skin you can trim them with nail clippers and/or see your surgeon.

How Long Will I Have Bleeding After Surgery?

Vaginal spotting may last for several weeks after gynecological surgery. Call the office if you have heavy bleeding, increasing bleeding, a foul odor, or if you have urinary or rectal bleeding. Removal of ovarian cysts or other gynecological procedures may cause your period to come within a few days after surgery.

I Have Large Bruise Near My Incision, Is That Normal?

Some patients will develop bruises at the incision sites. The incision sites are made by “trocars”, a plastic sleeve that is used for access during the surgery for the camera and for instruments. Sometimes these trocars cut tiny vessels just beneath the skin that cause limited bleeding. Even under the best of circumstances, it is sometimes impossible to see these small vessels. A bruise will develop that will resolve. Those patients with very large masses or fibroids may also develop bleeding at the incisions that can be more extensive due to longer manipulation of the trocar sites. Rarely, this bleeding can be very extensive, leading to a large bruise that tracts to the groin area. Please note that this type of bleeding almost always resolves. Pain or warmth may develop from the blood under the skin. Use Motrin 600 mg every six hours or 800 mg every eight hours to relieve the pain.

How Much Pain Will I Have After Surgery?

Incision – Pain around the incision sites is not uncommon, and will resolve over several days. Most patients describe pain as minimal or moderate, and will improve daily.

Pelvic and Rectal – Some patients describe pressure and pain with urination or with bowel movements. These symptoms resolve and are due to irritation to the rectum and bladder from the surgical procedure, and will resolve with time.

Chest and Shoulder – If you had laparoscopic surgery, the carbon dioxide gas used to insufflate the abdomen during the procedure (so the surgeon can see) will irritate the phrenic nerve in some patients, leading to mild to severe pain. This nerve tracks pain impulses from the lining of the chest cavity. The pain can occur during deep breaths. This resolves within two to three days, and is not worrisome. If the pain is extreme or does not resolve, a visit to the local ER is important to rule out other causes of chest pain, such as heart or lung issues.

Sore Throat – Some patients will have a sore throat from the tube that is placed during anesthesia. Throat lozenges or warm tea will help soothe the discomfort, and this will resolve within a few days.

General – Pain should resolve over time, and will get better every day. If pain persists or becomes worse, a visit to the ER at the hospital where the procedure was performed is recommended.

How Should I Manage My Pain After Surgery?

You will be given a prescription for Motrin and a narcotic (Percocet, Norco or Dilaudid) at the hospital prior to your discharge. To be effective, Motrin should be used in doses of 600 mg every six hours, or 800 mg every eight hours. Narcotics should be used sparingly since they will cause constipation. The first several days following surgery, most patients use mainly Motrin during the day, with use of a narcotic sometimes at night to help with sleep. Using a heating pad on the lower abdomen is safe. Coughing can be uncomfortable initially because of abdominal discomfort. Placing a pillow on the abdomen to support your abdomen while coughing can be helpful.

Is It Normal to Have Swelling?

Abdominal – Some degree of abdominal distension (swelling) is to be expected after surgery. This is due to distension of the intestines, and resolves over time. It is usually mild to moderate only.

Extremities – Swelling of the legs and sometimes arms is not uncommon after surgery. This is due to increased fluid given during the procedure. This will resolve over several days. If you notice persistent or increasing swelling, tenderness to the calf or calf pain, please call the office immediately. If one leg is more swollen and red than the other you should be evaluated by your surgeon or in the emergency room because of the risk of a blood clot in your leg (DVT) that can be life threatening.

I Have Constipation, What Should I Do?

Constipation is common after surgery and usually resolves with time and/or treatment. Constipation means that you do not have a bowel movement regularly or that stools are hard or difficult to pass. Constipation can be made worse by narcotic pain medications or decreased activity or decreased fluid intake.

If you are having vomiting in addition to constipation, or if your surgery involved the stomach or intestines, call your surgeon before using medications to treat constipation.

A common approach to constipation after surgery is to take a laxative (eg, magnesium hydroxide [milk of magnesia]) or fiber supplement (eg, psyllium [Metamucil, Hydrocil] or methylcellulose [Citrucel]); this can be taken with a stool softener (eg, docusate [Colace]).

If the initial treatment does not produce a bowel movement within 24 to 48 hours, the next step is to take a stimulant laxative that contains senna (e.g,, Black Draught, Ex-lax, Fletcher’s Castoria, Senokot) or bisacodyl (e.g,, Correctol, Doxidan, Dulcolax). Read the directions and precautions on the package before using these treatments.

If these treatments do not produce a bowel movement within 24 hours, you should call your healthcare provider for further advice.

Once the bowels begin to move, you may want to continue using a stool softener (e.g., docusate (Colace) or a non-stimulant laxative (e.g., MiraLAX/GlycoLax) on a daily basis to keep the stools soft. This treatment may be taken for as long as needed.

I Have Diarrhea, What Should I Do?

Diarrhea sometimes is caused by antibiotics and will resolve once the antibiotics are stopped. A probiotic such as lactobacillus can help with this process. Rarely, severe diarrhea can develop. Call your doctor if you have severe diarrhea, bloody diarrhea, or if your diarrhea is accompanied by fever or worsening pain.

I’m Nauseated, What Can I Do?

Anesthesia is the main cause for nausea immediately after surgery. After the first 24 hours, nausea is more likely caused by either your narcotic pain medication or your antibiotics. You will be sent home with nausea medication such as Phenergan or Zofran. If you are experiencing severe nausea, please call your doctor.

Will I Have Problems With My Bladder?

Is it normal if it hurts when I urinate? — If you have had vaginal surgery, you may feel a pulling sensation during urination or you may feel sore if the urine falls on vaginal stitches. It can be normal to urinate frequently after surgery. Call your surgeon if you have any of the following:

  • Burning with urination
  • Needing to urinate frequently or urgently and then urinating only a few drops
  • Temperature greater than 101ºF or 38ºC (measure with a thermometer)
  • Pain on one side of your upper back that continues for more than one hour or keeps coming back
  • Blood in your urine (you can check to see if this is just vaginal blood falling into the toilet by holding toilet tissue over your vagina)

What Should I Do if it is Difficult to Urinate?

Most women urinate at least every four to six hours, and sometimes more frequently. If you have not urinated for six or more hours (while you are awake) or if you feel the need to urinate and it will not come out, you should call your healthcare provider. Urinary retention is the inability to pass urine through the bladder.

A very small number of patients will develop this problem due to the anesthetic used for the surgery or if they had incontinence surgery. If you are sent home and are not able to pass urine, please go to a local emergency room. A catheter may be placed to allow the bladder to “rest” after the surgery, and will be removed several days later in the office. It is important to have this catheter placed to avoid injury to the bladder. If you have a self cath kit and instructions how to use it, you may do this instead of seeking medical care. (You can look at a video by Bard on Youtube called “Female Self-Cath Instructional video (animated) Magic3” or watch other available videos on cherokeewomenshealth.com or on YouTube.)

When Can I Resume Sex?

Intercourse should be avoided until cleared by your surgeon. If your surgery did not involve the vagina or cervix, intercourse can typically resume in two to three weeks. If you had a hysterectomy or surgery in the vagina, you should avoid intercourse for a minimum of eight weeks to allow the top of the vagina to fully heal. Make sure you are examined by your surgeon and cleared. Avoid deep penetration initially until you are completely comfortable. Clitoral orgasm (stimulating the clitoris without vaginal penetration) is typically fine after gynecological surgery if you desire unless you had surgery on your labia minora or majora (in which case you need to get clearance from your surgeon.)

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“Dr. Litrel was a fantastic doctor. I had my first exam with him, although at first I was skeptical about a male doctor for my GYN. But after I met him I’m glad I kept an open mind, and I couldn’t have dreamed up a better doctor. He cares about you as a person and not just a patient. The front desk ladies and nurses were very friendly and it’s a great office, very clean and not intimidating. I highly recommend Cherokee Women’s Health.”
- Vicki