Personal Care:

During surgery your cervix was dilated to allow for instruments to be used inside the uterus. To prevent bacteria from entering this area, do not use anything vaginally for two weeks – no tampons, no douching, no intercourse. Also, it is best to avoid soaking in a tub or swimming as bacteria in the water can enter the uterus in this way.

Bleeding:

You will likely have a small amount of bleeding after your procedure. It should not be heavier than a light menstrual period and will probably resolve spontaneously within a few days.

Activity:

You may resume your normal daily activities. You may find that you tire more easily as a result of surgery and anesthesia. It is best to avoid strenuous activity or sports for about a week after surgery, although there are no specific restrictions on activity. The speed with which patients “bounce back” after surgery varies widely and is largely dependent on the individual.

Pain:

Mild pelvic or abdominal cramping may occur after surgery. Regular paracetamol and non-steroidal anti-inflammatory was such as ibuprofen may be used to manage discomfort.

Your post-operative follow up is important for receiving results and discussing any further plans for management.

For a large loop excision (cut) of the transformation zone (LLETZ), a small piece of the cervix, previously identified as abnormal by colposcopy, is removed and the site is burnt with an electrical instrument.

Risks and complications of LLETZ

There are potential risks and complications with this procedure. They include but are not limited to the following.

Common risks and complications include:

• infections of the cervix can occur, and occasionally infection may be introduced into the uterus, fallopian tubes or other pelvic organs. This may require treatment with antibiotics and further treatment

• increased risk of wound infection, chest infection, heart and lung complications, and blood clot in the leg or lungs for people who are obese and/or smoke

• bleeding could occur from the cervix and may require a blood transfusion, a return to the operating room or other measures, such as vaginal packing, to control the bleeding

• bleeding is more common if you have been taking blood thinning medications or complementary/alternative medicines, such as fish oil and turmeric.

Uncommon risks and complications include:

• damage and narrowing of the cervix could occur which can cause painful periods and difficulty in labour

• complete closure of the cervical canal, which can cause difficulty in having a period, pelvic pain, infertility and difficulty obtaining a pap smear. The cervical canal might require dilatation under anaesthetic and on some occasions it may require having a hysterectomy (removal of uterus)

• the cervix may be weakened which can lead to early pregnancy loss and the occasional need to strengthen the cervix

during a pregnancy by the insertion of a special stitch (cervical cerclage). The risk of preterm labour is also increased.

Women who have had a prior LLETZ procedure may have to have their cervix length measured regularly by ultrasound during pregnancy to ensure it is not shortening or opening too early

• failure of the procedure, incomplete excision or recurrence of disease

• blood clot in the leg causing pain and swelling. In rare cases, part of the clot may break off and go to the lungs

Post-Operative Care Instructions

Some period like cramps may be expected. Use over the counter pain relief such as Paracetamol or Ibuprofen as required

You may have some vaginal bleeding for a few days after the operation. Use sanitary towels only. Do not use tampons or menstrual cups for four weeks, as they can increase the risk of infection. At around 10 days after the operation, you may have some further bleeding, which can last for up to four weeks. This is a normal part of the healing process.

You may also have some vaginal discharge. This can be brown in colour to begin with, and may continue as watery, yellowish discharge for another two or three weeks. This is normal.

Avoid sex for 4 weeks following the procedure

If your discharge becomes thick, green in colour or offensive smelling, contact your GP or Surgeon.

Follow Up

In women who have been treated for a high-grade squamous lesion (HSIL (CIN2/3)) the risk of recurrence and invasive cervical cancer remains elevated for 10–25 years. In Australia, the combination of liquid based cytology (papsmear) and testing for oncogenic HPV types (co-test) is used as a Test of Cure following treatment of HSIL (CIN2/3)

Therefore, it would be recommended that you have a co-test performed at 12 months after treatment, and annually

thereafter, until you receive a negative co-test on two consecutive occasions. At this point, you can return to five yearly

screening.

In the past, a post-treatment colposcopic assessment at 4–6 months has been the usual practice. This practice is not

evidence-based, but may provide reassurance. If you would like a 4 -6 month review it will examine the vagina and cervix but will not involve HPV testing.

Subsequent post-treatment Test of Cure surveillance can be performed by the your GP or health professional, who should follow the national recommendations for management.

Medications

It is normal to have some pain (including cramps) post-surgery. Taking regular analgesia such as paracetamol, every four to six hours will help to keep your pain under control.

To help with cramps and pain, non-steroidal anti-inflammatory medications such as ibuprofen or diclofenac may be useful.

If you require stronger analgesia, regular bowel care including, if necessary, the use of laxatives to prevent constipation is important.

As your body heals, this discomfort should decrease and you can gradually reduce the amount of pain medication you are taking. Remember, some discomfort is normal, but pain is a signal to slow down and rest.

Abdominal wounds / pain

Shower as usual. Avoid baths for the first 2 weeks

A light pink discharge or bleeding is not uncommon for 4 – 6 weeks. If you notice heavier bleeding around day 10 – 14 this can sometimes occur. Any concerns, please contact your doctor.

Pain should get better each day. If not, seek medical advice.

Activity

Rest is important, take short naps but do not spend all day in bed.

Continue to wear your compression stockings when resting, also if driving for over an hour or flying.

Walking is the best exercise to start once you get home – progress at your own pace by starting with small distances and slowly build up.

You should be able to resume your regular activities once you feel comfortable.

Depending on your type of work, you can return to work about four to six weeks. Check with your doctor if you have any queries.

Avoid heavy lifting, over three kilograms of weight from the floor, for the first four week and no more than five kilograms of weight for the next four weeks. This will minimise stress on your healing wounds, both internal and external. If you cannot easily lift an object with one hand, ask for help.

Avoid driving until full mobility returns and strong analgesia is no longer required (approximately four weeks).

The first time you drive, you should be accompanied. However, for medico-legal reasons, it is important to check with your insurance company prior to recommencing driving.

Pushing yourself too fast after surgery will only cause setbacks in your recovery. Discomfort should decrease a little each day. Increases in energy and activity are signs that recovery is going well.

Vaginal discharge

You may experience slight pink or old brown discharge on your sanitary pad or liner for the next three weeks. This may sometimes slightly increase around day 10 – 14 before it then settles again.

Do not use tampons or douche as this may cause infection.

You may notice some vaginal spotting about four to six weeks after surgery (thought to be due to suture reabsorption). If this is less than a period, continue with normal activities, otherwise seek advice.

If your bleeding continues or changes in any way that worries you, please contact your doctor

Sexual activity

Penetrative sex (vaginal intercourse) is not recommended until internal healing has happening (approximately six weeks). You may need to use a water-based lubricant when recommencing sexual activity.

Diet

Avoid constipation by:

Drinking extra fluids, especially water. This also helps to prevent urinary infections.

Adding fibre to your diet, e.g. wholemeal bread, fruit and vegetables.

Drinking a glass of pear or prune juice twice a day.

Exercising gently and moving around more.

If wind is a problem, you may find trying peppermint or chamomile tea useful.

Using laxatives as necessary, e.g. Coloxyl®

When to seek advice

If you experience any of the following symptoms that are not relieved by your usual medications or practices you should seek your local doctor’s advice, or contact your surgeon.

• Sudden shivers or chills, hot flushes or sweating, fever and feeling generally unwell.

• Unusual shortness of breath or chest pain or pain when breathing.

• Severe abdominal pain or cramping lasting longer than 48 hours, with worsening pain.

• Heavy or prolonged vaginal bleeding, or large clots (especially if bright red).

• Offensive smelling or unusual coloured vaginal discharge.

• Wound becomes painful, swollen and red and/or has discharge.

• Vomiting develops more than 24 hours after the operation.

• Burning, stinging, excessive frequency or difficulty in passing urine.

• Tenderness and/or swelling or a hot sore area in the calf muscles.

Follow up appointments:

It is important that you have an appointment four to six weeks after your operation. If you are not already aware of your appointment date and time, or you need to change this, please contact the rooms 8161 4381

What can I expect after a vaginal hysterectomy or Prolapse repair?

In most instances, you will be admitted to hospital on the day of your operation.

You may be able to go home within 24 hours or, depending on your circumstances, you may need to stay in hospital for two to three days.

After-effects of general anaesthesia

During the first 24 hours you may feel more sleepy than usual and your judgement may be impaired. You are likely to be in hospital during the first 24 hours but, if not, you should have an adult with you during this time and you should not drive or make any important decisions.

Catheter

You may have a catheter (tube) in your bladder to allow drainage of your urine. This is usually for up to 24 hours after your operation until you are easily able to walk to the toilet to empty your bladder. If you have problems passing urine, you may need to have a catheter for a few days.

Scars

A vaginal hysterectomy or prolapse repair is carried out through your vagina so your scar will be out of sight. However, if you have keyhole (laparoscopy) surgery as part of your operation, you will have between two and four small scars on different parts of your abdomen. Each scar will be between 0.5cm and 1cm long.

Stitches and dressings

The stitches in your vagina will not need to be removed, as they are dissolvable. You may notice a stitch, or part of a stitch, coming away after a few days or maybe after a few weeks. This is normal and nothing to worry about.

Packs

You may have a pack (a length of gauze like a large tampon) in your vagina after the operation to reduce the risk of bleeding. A nurse will remove this after your operation while you are still in hospital. Check with your nurse that this has been done before you go home.

Vaginal bleeding

You can expect to have some vaginal bleeding for one to two weeks after your operation. This is like a light period and is red or brown in colour. Some women have little or no bleeding initially, and then have a sudden gush of old blood or fluid about 10 days later. This usually stops quickly. You should use sanitary towels rather than tampons as using tampons could increase the risk of infection.

Pain and discomfort

You can expect pain and discomfort in your lower abdomen for at least the first few days after your operation. When leaving hospital, you should be provided with painkillers for the pain you are experiencing. Sometimes painkillers that contain opiate medications can make you sleepy, slightly sick and constipated. If you do need to take these medications, try to eat extra fruit and fibre to reduce the chances of becoming constipated.

Following your operation your bowel may temporarily slow down, causing air or ‘wind’ to be trapped. This can cause some pain or discomfort until it is passed. Getting out of bed and walking around will help. Peppermint water may also ease your discomfort. Once your bowels start to move, the trapped wind will ease

Activity

Rest is important, take short naps but do not spend all day in bed.

Walking is the best exercise to start once you get home – progress at your own pace.

You should be able to resume your regular activities once you feel comfortable.

Increases in energy and activity are signs that recovery is going well.

Avoid heavy lifting, over three kilograms of weight from the floor, for the first two weeks.

Avoid driving until full mobility returns and strong analgesia is no longer required. The first time you drive, you should be accompanied. However, for medico-legal reasons, it is important to check with your insurance company prior to recommencing driving.

When to seek advice

If you experience any of the following symptoms that are not relieved by your usual medications or practices you should seek your local doctor’s advice, or contact your surgeon.

• Sudden shivers or chills, hot flushes or sweating, fever and feeling generally unwell.

• Unusual shortness of breath or chest pain or pain when breathing.

• Severe abdominal pain or cramping lasting longer than 48 hours, with worsening pain.

• Heavy or prolonged vaginal bleeding, or large clots (especially if bright red).

• Offensive smelling or unusual coloured vaginal discharge.

• Wound becomes painful, swollen and red and/or has discharge.

• Vomiting develops more than 24 hours after the operation.

• Burning, stinging, excessive frequency or difficulty in passing urine.

• Tenderness and/or swelling or a hot sore area in the calf muscles.

Follow up appointments:

It is important that you have an appointment four to six weeks after your operation.

Medications

It is normal to have some pain (including cramps) post-surgery.

Paracetamol 2 tablets every four to six hours will help to keep your pain under control. (No more than 8 tabs per day)

A non-steroidal anti-inflammatory medications such as ibuprofen or diclofenac may be useful.

If you require stronger analgesia, regular bowel care including, to prevent constipation is important.

As your body heals, this discomfort should decrease and you can gradually reduce the amount of pain medication you are taking. Remember, some discomfort is normal, but pain is a signal to slow down and rest.

Abdominal wounds

Keep your wound dry and clean. No special creams or ointments are needed. Your incisions are closed with a suture underneath the skin, which will dissolve on its own. It is then covered with a surgical-glue. This protects the incision and will stay in place for two weeks or longer.

Shower as usual. Avoid baths for the first 2 weeks

Activity

Rest is important, take short naps but do not spend all day in bed.

Walking is the best exercise to start once you get home – progress at your own pace.

You should be able to resume your regular activities once you feel comfortable.

Increases in energy and activity are signs that recovery is going well.

Avoid heavy lifting, over five kilograms of weight from the floor, for the first two weeks.

Avoid driving until full mobility returns and strong analgesia is no longer required.

The first time you drive, you should be accompanied. However, for medico-legal reasons, it is important to check with your insurance company prior to recommencing driving.

Vaginal discharge

You may experience slight pink or old brown discharge on your sanitary pad or liner for the next three weeks. This may sometimes slightly increase around day 10 – 14 before it then settles again.

Do not use tampons or douche as this may cause infection.

Diet

Avoid constipation by:

Drinking extra fluids, especially water. This also helps to prevent urinary infections.

Adding fibre to your diet, e.g. wholemeal bread, fruit and vegetables.

Exercising gently and moving around more.

If wind is a problem, you may find trying peppermint or chamomile tea useful.

Using laxatives as necessary, e.g. Coloxyl®

When to seek advice

If you experience any of the following symptoms that are not relieved by your usual medications or practices you should seek your local doctor’s advice, or contact your surgeon.

• Sudden shivers or chills, hot flushes or sweating, fever and feeling generally unwell.

• Tenderness and/or swelling or a hot sore area in the calf muscles, Unusual shortness of breath or chest pain when breathing

• Severe abdominal pain or cramping lasting longer than 48 hours, with worsening pain or associated vomiting.

• Heavy or prolonged vaginal bleeding, or large clots (especially if bright red).

• Offensive smelling or unusual coloured vaginal discharge.

• Wound becomes painful, swollen and red and/or has discharge.

• Burning, stinging, excessive frequency or difficulty in passing urine.

Follow up appointments:

It is important that you have an appointment four to six weeks after your operation.