Caring for Yourself After Surgery

New Research on the Myths Regarding Instructions Doctors Give Following Surgery

A recent study from National Institutes of Health recommends that doctors change many of the current restrictions on activities following gynecologic surgery. After reviewing information from medical journals, medical textbooks in obstetrics, gynecology, and general surgery, the American College of Obstetricians and Gynecologists Practice Bulletins and Committee Opinions and clinical guidelines of Royal College of Obstetricians and Gynecologists of the United Kingdom, they found that the available studies do not support many of the recommendations currently provided by doctors. Resumption of usual activities after gynecologic surgery helps integrate women back into normal life and, although more study is needed, they suggested the following after abdominal surgery (restrictions are less after laparoscopic surgery):

Resumption of Normal Activity: Prolonged bed rest increases the risk of pneumonia and blood clots in the legs. A quick return to normal activity after gynecologic surgery should decrease the likelihood of these problems. For most women, normal activity includes walking, lifting, and climbing stairs. Many of the previous restrictions were intended to avoid straining the abdominal incision in a way that might cause it to open. But, as seen below, these fears are not justified.

Lifting: Patients have usually been instructed to not lift more than 10 pounds. However, normal events like forceful coughing (which we often encourage you to do) , or getting up from a lying down position (which you have to do to get out of bed every morning) place more stress on the incision than lifting. In fact, the force needed to tear open a surgical incision is much greater than the force generated by any kind of daily activity.

Poor nutrition, infection, obesity, anemia, and diabetes, as well as the type of suture material and the surgeon’s technique are more likely causes of the incision opening after surgery.

Climbing Stairs: Climbing stairs is a common and normal activity. There is no evidence that climbing stairs increases the risk of the incision opening.

Bathing and Swimming: Baths have usually not been permitted for 2 to 6 weeks after surgery in order to prevent wound infection. However, if the incision is closed and not already infected, there is no evidence that a tub bath is harmful once the bandage has been removed.

Driving a Car: The concerns have been that the physical activity associated with driving might cause the wound to open or that post-operative pain might cause you to hesitate to step on the brakes quickly in an emergency. However, there is no evidence that these things are true. It is a good idea to first try the pedals and hand controls in a stationery car. If this feels comfortable, then take the car for a short ride accompanied by another adult who could drive the car if you feel unable to continue driving.

More important is the possibility that narcotic pain medication may cause drowsiness or slow your reflexes while driving. Therefore, you should not drive until you no longer need narcotic pain medication.

Sex Following Hysterectomy: Sex can probably be initiated once you are comfortable and both partners are ready. If your cervix has been removed with the uterus (total hysterectomy), there is a small risk of infection around the sutures left in the vagina and a small risk of these sutures coming undone during intercourse. If you are menopausal, had prior pelvic radiation therapy, or have diabetes your risk is higher.

The cervix is a major source of normal lubrication, so if your cervix has been removed it is best to use vaginal lubricants during sex and try sexual positions with the woman on top so penetration can be controlled. This puts less pressure on the sutures at the top of the vagina.

If your cervix was left in place (supracervical hysterectomy) the risk of infection is even less and there are no sutures at the top of the vagina to worry about coming apart.

Returning to Work After Gynecologic Surgery: Advice on when to return to work varies greatly. In the United Kingdom, a survey found that doctors recommended returning to work anywhere from 1 to 10 weeks after surgery. It appears that a gradual return to work is better than an abrupt return to full-time work.

These new recommendations need to be fully tested by scientific study, but since this is unlikely to happen soon (or ever), it is best to discuss the new recommendations with your doctor.