Pelvic floor repair. Department of Gynaecology. Patient Information

Transcription

1 Pelvic floor repair Department of Gynaecology 2 Patient Information

2 What is pelvic floor repair? Vaginal repair is an operation usually performed under a general anaesthetic to correct weakness in the tissues that support the walls of the vagina, known as a prolapse. This is a collapse of the uterus (womb) and / or vaginal walls which occurs over a time and is often caused by damage during childbirth. Being overweight, heavy lifting, chronic constipation and a lack of hormones after the menopause can also create a prolapse. The advice of the doctor is given according to your individual problems and symptoms. Why do I need a pelvic floor repair? To improve or resolve the symptoms of prolapse such as over active bladder, urgency to pass urine, constipation, backache, and to remove the feeling of a lump or bulge within the vagina. The most common methods of repairing the vagina are: 1 Anterior repair, front wall; this should cure a Cystocele, a protrusion of the urinary bladder through the anterior wall of the vagina. 2 Posterior repair, back wall; this should cure a Rectocele, a protrusion of the rectum through the posterior wall of the vagina. 3 Sacrospinous fixation; this involves using the pelvic ligaments to lift and fix / support the top of the vagina. 4 Sacrospinous cervicopexy; this involves using the pelvic ligaments to lift and fix / support the cervix. Your doctor will discuss which method is most suitable for you. 2

3 Your What doctor can will I expect discuss before which method the operation? is most suitable for you. At your pre-op assessment and on your admission day the nurse will go through your hospital stay and explain your operation. Please do let us know about any concerns you have or if there is any information you think we should know about that will make your stay with us more comfortable. You will need to make arrangements for your family, children or any other commitments that you have prior to coming in to hospital and to cover the length of your recovery. You will see an anaesthetist and the doctor performing the surgery before you go to theatre. It is not unusual to feel anxious; the nursing staff will gladly discuss how you are feeling and talk you through your emotions. What does the treatment involve? The repair surgery is performed through the vagina so there is no need to make an excision through the abdomen. It involves repairing and re-supporting the walls of the vagina and or bowel and bladder by using a stitch to lift or elevate the vaginal vault. There are stitches inside the vagina that are tightened against the ligament so that the vagina is pulled back into place. Dissolvable stitches are then used to close the vaginal wall. What are the risks? There are risks with any operation but these are small. The main risks associated with a vaginal repair are: Common risks: Urinary infection, retention and / or frequency Vaginal bleeding Postoperative pain and difficulty and / or pain with intercourse 23

4 Wound infection Excessive bleeding Buttock pain Uncommon risks: Damage to the bladder Damage to the bowel Failure to achieve desired results; recurrence of prolapse Venous thrombosis and pulmonary embolism New or continuing bladder dysfunction In order for you to make an informed choice about your surgery please ask one of the doctors or nurses if you have any questions about the operation before signing the consent form. What can I expect after the operation? As you come round from the anaesthetic you may experience episodes of pain and / or nausea. Please let the nursing staff know and they will assess you and take appropriate action. It is not unusual to experience lower back pain and a feeling of fullness in your bowel and generalised discomfort when sitting. We use a pain score to assess your pain 0-10; 0 = No Pain, 10 = Very Strong Pain. Your nurse will be checking your blood pressure, pulse, respirations and temperature and monitor any vaginal bleeding. S/he will also ask you to move from side to side and to do leg and breathing exercises once you are able, this will help prevent any pressure damage, a DVT (deep vein thrombosis) or chest infection. Day 1 after the operation You will have a drip attached (intravenous infusion); once you are fully awake you will be able to start drinking and eating. Your drip will then be discontinued. You may also have a catheter which will drain your urine. This is normally removed 4

5 after hours. We will monitor your urine output to make sure you are emptying your bladder properly and ask to measure 2 samples after the catheter has been removed. We may scan your bladder after you have passed urine to make sure your bladder is emptying well. You may have a vaginal pack which helps prevent excess bleeding by putting pressure on the vaginal walls. This is quite uncomfortable but it is usually removed the day after your operation. The nursing staff will assist with washing as necessary and encourage early mobilisation. We would normally expect you to sit out of bed the day after your operation. Day 2 after the operation You will be able to shower and mobilise around the ward on the second day of your operation. It may be painful to open your bowels at first, we will give you mild laxatives to soften your stools and prevent constipation and straining. What about going home? Each day you will be assessed by nursing and medical staff to check on your recovery and decisions will be made about your care, this information will be shared with you. Please feel free to ask questions about your operation and recovery at any time. The average length of stay following a vaginal repair is 2 days. As you physically recover from your operation, the nursing team will discuss your convalescence. To prevent your surgery from failing you should take note of the following: Rest: During the first two weeks at home it is common to feel tired and exhausted, you should relax during the day gradually increasing the number of things you do each day. 5

6 Vaginal bleeding: You will have vaginal discharge / bleeding for up to 2-3 weeks after surgery, this will turn from red to a brownish colour and is quite normal. You will have internal stitches and occasionally red spotting or fresh bleeding may occur when these stitches start to dissolve and fall out of the vagina. Sanitary towels should be used not tampons. It is important that you keep the vaginal area as clean and dry as possible. To help reduce the risk of infection we advise daily showering. Housework: Weeks 1-2 We recommend that you do no housework, cooking, or heavy lifting (not more than 1.5 kgs in each hand). Weeks 3-4 We recommend that you gradually introduce lighter household chores, dusting, washing up, making beds and ironing. You may begin to prepare food and cook remembering not to lift any heavy saucepans. Weeks 4-6 Gradually increase lifting of weights over 3 kgs. Do not vacuum or do any heavy lifting before 6 weeks of convalescence. By 8 weeks you can carry a bag of shopping or lift a basket of washing. Exercise: Exercise is important and it is advisable to go for short walks each day, increasing the distance gradually. You may return to cycling and other light exercise after 6 weeks, swimming may also be resumed if vaginal bleeding has stopped. You will be able to manage the stairs on your arrival home. Diet: A well balanced nutritious diet with a high fibre content is essential to avoid constipation or straining. This should include at least 5 portions of fruit and vegetables per day. You should aim to drink at least 2 litres of water per day. 6

7 Sex: The operation should not stop you having a good sex life. You may even find that your sex life improves after the operation. You may wish to discuss any worries or concerns with your doctor or nurse before the operation. You should usually wait 4 6 weeks after the operation before having sex providing vaginal bleeding has stopped. If after this time you are experiencing pain or any problems with intercourse then you should see your GP. Returning to work: Depending on the surgery you will need 2 6 weeks off work. Most women are able to return to work after 2 4 weeks, please discuss this with the doctor or nurse. The hospital doctor will provide a sick certificate for this period. Driving: It is usually safe to drive between 2 4 weeks but this will depend on your level of concentration and ability to perform an emergency stop. Are there any alternatives to having a vaginal repair? You may decide not to have surgery and want to try alternative methods of improving you symptoms such as; Physiotherapy Pelvic floor exercises Vaginal pessary (a plastic device inserted into the vagina to hold the prolapse These can be discussed with your doctor. 7

8 Who Who can can I contact I contact with with any concerns any concerns or questions? or questions? If you have any problems or are worried, please do not hesitate to contact us on the gynaecology ward: Royal Sussex County Hospital Level 11 Telephone: Ext Princess Royal Hospital Horsted Keynes Telephone: Ext References/useful links 1 National Institute for Health and Clinical Excellence. (2008). Understanding Nice Guidance: Treating vaginal wall prolapse with surgery using mesh. London: NICE 2 Patient UK. (2008). Information Leaflets: Women s Health Category. ( co.uk). 3 Royal College of Obstetricians and Gynaecologists. (October 2009). Vaginal Surgery for Prolapse. Consent Advice No. 5. London : RCOG. 4 Royal College of Obstetricians and Gynecologists (July 2010). Recovering Well: information for you after a pelvic-floor repair operation. London: RCOG This information sheet has been produced by the Gynaecology Ward Sister. Brighton and Sussex University Hospitals NHS Trust Disclaimer The information in this leaflet is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner. C P I G Reference no. 267 Publish Date: September 2010 Review Date: September 2012 carer and patient information group approved