Deep Infiltrated Endometriosis : simplebooklet.com

Contents Individual Patient Notes 2 Information About Gynaecological Surgery 4 Preparing For Admission Pre Op 5 How Should I Prepare For Surgery 5 Hospital Stay 6 General Hospital Information 6 Planning Your Discharge 7 Post Op 8 12 Vaginal Surgery 12 Bowel Surgery No Colostomy Bag 13 What To Expect At Home 15 19 Formation Of Blood Clots How To Minimise The Risk 19 Post Op Recovery Timeline 20 3

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Deep Infiltrated Endometriosis Patient Information Booklet Information About Gynaecological Surgery This information is for you if you are about to have or recovering from a laparoscopy keyhole surgery for deep infiltrated endometriosis You might also find it useful to share this information with your family and friends 4

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Deep Infiltrated Endometriosis Patient Information Booklet Preparing For Admission Pre Op You are required to sign a consent form before your surgery You and your Consultant will previously have discussed the benefits and risks of your surgery at your consultation in clinic It is important that you understand the surgery you are having If you have any questions please call the Women s Centre and speak with a nurse You may have been given a form to send back to the Women s Center stating your preferred surgery Shortly before your planned surgery the hospital will contact you with an admission time You also may get a call from the pre operative assessment clinic if this is necessary for you Please note not all patients are required to attend the pre operative assessment clinic How Should I Prepare For Surgery Good health before your surgery will reduce your risk of developing complications and speed up your recovery As soon as you know you re going to have a surgery Stop smoking vaping Eat a healthy balanced diet Exercise regularly 5

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Deep Infiltrated Endometriosis Patient Information Booklet Hospital Stay What to bring to hospital Comfortable and loose nightgown or pyjamas shorts rather than long ones to change into The hospital will provide hospital gowns but you may be more comfortable in your own clothes after a couple of days Comfortable cotton underwear and a bathrobe Slippers Toiletries Toothbrush and toothpaste Any regular medication Book magazines and electronic devices incl charger and headphones Andrex washlets moist toilet tissue can be very useful after surgery General Hospital Information After your surgery you will be looked after by experienced doctors nurses and carers at Beacon Hospital Please ensure to declare your regular medication to the nursing sta so they can ensure you take all your medications at the right time Depending on the type of surgery you may receive IV fluids and may be fitted with a drain and a catheter Do not hesitate to ring the bell for the nurses if you need anything even if it seems like a small matter to you Our team will be happy to help you 6

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Deep Infiltrated Endometriosis Patient Information Booklet Planning Your Discharge You will be discharged from Beacon Hospital when your Consultant decides you are clinically ready to leave hospital Discharge checklist What wound care is needed Prescriptions for any medications you require Letter for your GP What follow up care is required If there are problems after your discharge who do you contact in Beacon Hospital When can you return to work and normal activities Do you need a medical certificate for your employer 7

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Deep Infiltrated Endometriosis Patient Information Booklet Post Op Pain Management You are likely to experience pain from the surgery and the gas used during the laparoscopy This should get easier after about 2 3 days You will be given pain relief either through IV or tablets Please talk to the sta if you need additional pain relief Heat packs can help with the pain from the gas in your shoulders and in your abdomen The nurses can supply these for you Catheter Please check with your Consultant when you can commence fluids after surgery You are likely going to be fitted with a catheter during your surgery Once you are able to move after surgery 12 36 hrs the nurses will decide with you when the catheter is removed You should drink plenty of clear fluids 2 litres or 5 pints a day of water tea broth to ensure you are su ciently hydrated and producing good clean urine volumes If you still experience pain after the first two times of urination please talk to your nurse How Can I Support A Fast Recovery A Physiotherapist will visit you the day after your surgery It is important to mobilise as early as possible post surgery This will help facilitate a speedier recovery and assist with your chest care and bowel function Even if you cannot walk far sitting up and moving your feet legs while lying down all helps to get your circulation going Deep breathing exercises will help to ensure you do not develop fluids in your lungs and help with the pain from the gas used during the laparoscopy Follow the physiotherapy exercises and carefully read any information provided by the Physiotherapist 8

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Deep Infiltrated Endometriosis Patient Information Booklet Food In hospital the medical sta will tell you when you are allowed to start drinking and eating again If you have had bowel surgery you will be prescribed a low fibre low residue diet A dietitian will visit you as soon as you start eating again and will give you more information If in doubt over what you are allowed to eat please check with the medical sta You may feel like eating more frequent and smaller meals at first If you are hungry between meals ask the sta for light foods such as yoghurts toast etc Once you are discharged we recommend you take a good quality probiotic supplement from your pharmacy or health food store Take this for one month to help your gastrointestinal bacteria recover from antibiotic medication received during your treatment Stitches and Dressings You will have between one and four small scars on di erent parts of your abdomen one scar will usually be in your umbilicus belly button Each scar will be between 0 5 cm and 1 cm long Your cuts will be closed by absorbable stitches and paper stitches Some dissolvable stitches may be present these will disappear by themselves Once the dressings have been removed keep the incisions moisturised with Vaseline or Bepanthen Rosehip oil will help heal scars only apply once incision is healed Potential Bowel Surgery Complications Bowel surgery is a major procedure which carries the risk of developing some complications These were explained to you previously by your Consultant in consultation Some complications can can occur in the immediate post operative period and some at a later stage 9

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Deep Infiltrated Endometriosis Patient Information Booklet Potential Immediate risks are related to Infections Chest infection urinary tract infection prevented by early postoperative mobilisation removal of urinary catheter as soon as possible breathing exercise If they do occur they are usually treated with antibiotics Surgical Site wound Infection You may suspect a wound infection if the surgical site is red if it has a discharge or if it is abnormally painful Intra Abdominal Infection Abscess Unlikely but if this does occur it is usually treated with antibiotics drainage of collection Anastomotic Leak When the anastomosis the area where the joining of the bowel is located doesn t heal properly This is a rare but serious complication which may require return to theatre and stoma formation A stoma is when a part of your bowel small or large intestine is brought to the surface of the abdominal wall and the bowel empties into a stoma bag Ileus and Bowel Obstruction Sometimes the bowel is slow to restart working after a big surgery and it takes more time for it to function If this occurs you will be kept fasting You will be given intravenous fluids drip and sometimes may require a nasogastric tube This usually resolves in a few days In the unlikely situation where it doesn t resolve you may require a return to theatre Blood Clots Deep Venous Thrombosis DVT With any type of surgery there is a risk of developing blood clots in your legs deep venous thrombosis These clots that may travel to your lungs and cause a pulmonary embolism As a precaution you will be asked to wear TED stockings compression stockings and you will be given a daily injection of blood thinner to help prevent the formation of this clots Early mobilisation is also essential to help avoid clots forming 10

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Deep Infiltrated Endometriosis Patient Information Booklet Atelectasis This occurs when an area of the lung doesn t inflate properly This can be prevented with early postoperative mobilisation and breathing exercise Bleeding Haematomas In the immediate post operative period blood tests will be performed daily to ensure that blood count is normal Your drain output will be closely monitored and if any signs of bleeding are recorded you will be given haemostatic treatment In some situations you might require a blood transfusion or return to theatre for bleeding control Potential Late Complications Damage to Nerves With extensive surgery performed in the deep area of your pelvis there is a risk of nerve damage which may a ect the function of your bladder or sexual function This complication can cause problems with control over your bladder or with passing urine or it can also cause vaginal dryness painful intercourse diminished libido This may resolve on its own within a few months post operative Incisional Hernias This is an abdominal wall disruption close to the incisional site which causes a bulging of the abdominal wall Changes in Bowel Habits Bowel resection surgery a ects each individual di erently due to the resection of the lower part of the large bowel rectum which has the role of storing stool Some women experience increased frequency or looseness increased urgency constipation or diarrhoea These symptoms will settle down within a couple of months but sometimes may take up to a year 11

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Deep Infiltrated Endometriosis Patient Information Booklet When should I contact Beacon Women s Centre for advice Your care will include follow up appointments to track your recovery Contact the clinic immediately if you experience complications such as Blood soaked dressings which can be a sign of excessive bleeding Infections which can cause a fever or yellowish discharge from the incision Pain that does not respond to medications Signs of blood clots such as abnormal swelling in your groin or lower leg Vomiting and not being able to keep fluids down Fever Chest pain or unusual shortness of breath Vaginal Surgery What can I expect in terms of bleeding discharge after vaginal surgery Some bleeding and discharge is normal after vaginal surgery and can last for several weeks It may get a bit worse 10 14 days after surgery when the stitches start to dissolve after this it will start to ease o Wear pantyliners or pads for comfort and change them frequently If you experience increased pain heavy bleeding or foul smelling discharge please contact the Women s Centre for advice 12

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Deep Infiltrated Endometriosis Patient Information Booklet Bowel Surgery No Colostomy Bag When can I expect my first bowel movement You can expect your first bowel movement within 2 4 days of the surgery even if you have not been eating any solid food Once you have had your first bowel movement your medical team will decide when you can start eating light foods What are my bowel movements going to be like At first they will be very loose watery and possibly frequent They will also smell di erent from your normal bowel movements This is to be expected This is due to the medications and fluids you have been given during and post op If you are worried at any stage please talk to the medical sta about it Your bowel will likely take several weeks to return to some more normal pattern and consistency of stool If you are going 24 48 hours without a bowel movement please start taking the prescribed stool softeners laxatives and contact the Women s Centre for further advice especially if it is more than 48 hours without a bowel movement How can I help ensure I have regular bowel movements A glass of lukewarm room temperature prune juice and a cup of boiled water cooled down to drinking temp first thing in the morning before breakfast are a great and natural way to encourage bowel movements Start introducing some fibrous foods fruit cooked vegetables like soups porridge 3 4 weeks after surgery which will help your bowel movements to become more frequent Never strain when emptying your bowel or bladder 13

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Deep Infiltrated Endometriosis Patient Information Booklet What should I eat after bowel surgery Once you are allowed to eat again you should follow a low fibre and light diet for about the first 4 6 weeks after surgery You will be seen by a dietitian in hospital who can give you more advice In general avoid processed fatty and sugary foods co ee and alcohol You should also avoid high fibre vegetables beans cabbage broccoli cauliflower and wholegrain breads pasta rice Examples of easily digested food is white flour rice products eggs soups chicken and fish fruits such as melon pear grapes tinned peaches and vegetables such as potato mashed potato carrots green beans cucumber tomato sauce and asparagus tips as well as soups After the first 3 4 weeks you can start re introducing more fibrous foods fruit larger variety of cooked vegetables porridge in small quantities and observe how your bowel behaves Try to drink at least 1 5 litres of fluids daily mostly water Minimise ca eine and alcohol and ensure adequate fibre intake when it is safe to do so for bowel operations How long does it take for the internal sutures to heal The internal sutures will take between 2 4 weeks to heal 14

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Deep Infiltrated Endometriosis Patient Information Booklet When is the highest likelihood of internal infection Internal infection is unlikely but can happen in the first four weeks after surgery If you are experiencing a fever chills or increased pain please contact the Women s Centre for advice What if I have urinary problems You can expect to feel some pressure when passing urine within the first few weeks after your operation This should not be painful However if you experience burning stinging or feel like you are not completely emptying your bladder please call the Women s Centre Your Consultant may have already started you on some medication to help prevent UTI s What To Expect At Home Wound Care Initially your cuts will be covered with a dressing You should be able to take these o about 48 hours after your operation leave the paper stitches steri strips for 7 days When showering or washing please do so only with water Do not use soaps or body washes Do not put any creams or lotions on your wounds as these may interfere with your stitches and the healing process Vaginal Bleeding You may get vaginal bleeding for 24 to 48 hours This should lessen over 4 5 weeks after surgery Please do not use any tampons as they can cause an infection sanitary pads are best If you notice a brown green discharge or an odour please contact the Women s Centre and speak with a nurse Please note if you are still menstruating your first period after your procedure may be more painful and heavier than usual This is normal as your body is still healing You can take your usual painkillers if needed 15

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Deep Infiltrated Endometriosis Patient Information Booklet Rest Rest is important for your recovery Take rest whenever your body feels fatigued or tired If you are feeling a heaviness dragging in your abdomen or vagina this is a sign that you may have overdone things and need more rest Walking Walking is a very valuable exercise Try to walk for at least 20 minutes once a day Build up gradient speed and distance gradually and always ensure to rest afterwards When 20 minutes becomes easy add on an additional 5 10min every week 16

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Deep Infiltrated Endometriosis Patient Information Booklet Driving You should not drive for six weeks after a Laparoscopy However each insurance company will have its own conditions for when you are insured to start driving again You can check your policy provider Before you drive you should be Free from the sedative e ects of any painkillers Able to make an emergency stop with no pain Able to do a three point turn without causing yourself any discomfort Able to wear the seatbelt comfortably 17

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Deep Infiltrated Endometriosis Patient Information Booklet Returning to Work You can expect to feel able to go back to work within 4 6 weeks sometimes you might need more time depending on your specific surgery Your Consultant will give you a sick cert for work depending on your surgery If you are still not ready to go back to work after the date on your sick cert please see your GP for a further cert Sports Gardening You should expect not to return to high impact exercise sports for at least 6 12 weeks or as guided by your Consultant and Physiotherapist Gardening should be avoided for 6 weeks House Work For the first 6 weeks avoid any heavy lifting more than 3kgs or heavy housework eg changing bed sheets coking large meals using oven hoovering mopping emptying dishwasher washing machine You may be able to do light housework such as making drinks light meals dusting washing drying dishes 18

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Deep Infiltrated Endometriosis Patient Information Booklet Sexual Activity You should refrain from sexual intercourse for about six weeks or as advised by your Consultant Once you have been seen at your post op appointment and your Consultant is happy with your healing they will inform you When you feel ready if your vagina feels dry try using a lubricant You can buy this from your local pharmacy However if you have any pain vaginal bleeding or discharge please do not resume sexual intercourse until these symptoms have subsided or call the Women s Centre with any concerns Travel Due to the complexity of your surgery it would be advised that you do not travel abroad within the first six weeks after your operation Formation Of Blood Clots How To Minimise The Risk There is a small risk of blood clots forming in the veins of your legs and pelvis deep vein thrombosis after any operation These clots can travel to the lungs pulmonary embolism which could be serious You can reduce the risk of clots by Wearing Ted compression Stockings for 2 weeks after your surgery or as long as indicated by your Consultant Being as mobile as possible as early as you can after your operation Doing exercises when you are resting For example pump each foot up and down briskly for 30 seconds and move your ankle in circular motions try to do this every hour when resting Bend and straighten your legs one leg at a time three times for each leg every hour when resting 19

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Post Op Recovery Timeline Recovery How might I feel Days What is safe to do 1 2 You will still be in hospital Rest You will still have pain or Only eat and drink if discomfort in your abdomen your Consultant has Mobilising may increase the approved this discomfort Some bleeding or spotting on your pad is normal Can I return to work NO 3 7 You should be discharged by now Wash and dress yourself NO Pain and discomfort to your abdomen should be under control with analgesia You may still be tired Get out of bed and mobilise Increase your mobility to very short walks You should expect your first bowel motion Rest relax if needed in the afternoon 1 2 weeks 2 4 weeks 4 6 weeks Mobilising should be easier and pain settling You still may be bleeding but should be settling Energy levels are returning You should have very little or no tenderness or pain to abdomen You should feel stronger and have energy levels back to normal Pain should be manageable Your bowels should be returning to normal pattern or nearly there Tired at times is still normal Increase exercise NO slowly Only lift light loads No household cleaning allowed You can start to return NO to normal exercise regime listen to your body and build yourself back up Slow at first All daily activities returned Heavy lifting still not allowed No sexual activity until you see your Consultant Driving not allowed unless indicated by your Consultant Your Consultant will inform you when you can return to work 20

Deep Infiltrated Endometriosis

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