Bowel prep before hysterectomy

Preparing for a Hysterectomy Surgery

You’ve discussed the benefits and risks of having a hysterectomy with your doctor. You’ve considered and tried alternative treatments, if any. And you’ve finally decided that a hysterectomy is the best way to proceed based on your personal and medical reasons for having the procedure.

Now, it’s time to get ready for your hysterectomy. “It’s helpful to be mentally and physically prepared,” says Hye-Chun Hur, MD, the director of minimally invasive gynecological surgery at Beth Israel Deaconess Medical Center and an assistant professor of obstetrics and gynecology at Harvard Medical School in Boston. Taking these steps — and others your doctor may have recommended — can help ease worries and speed recovery.

A Month (or More) Before a Hysterectomy Surgery

  • Gather information. Learn as much as you can about having a hysterectomy. Make sure you understand how the procedure will go, as well as what is involved in the recovery process. “You need to be comfortable with what to expect,” says Sarah L. Cohen, MD, MPH, director of research at the division of minimally invasive gynecologic surgery at Brigham and Women’s Hospital.
  • Lose weight, if you’re overweight. Being overweight can increase the risks associated with surgery and anesthesia, and severe obesity can increase surgery time and blood loss. If you’re overweight, talk to your doctor about the best way to go about losing weight before your surgery.
  • Stop smoking. “Stopping or cutting down on smoking as much as possible can help with general anesthesia and recovery from surgery,” Dr. Cohen says. Smokers may have problems breathing during surgery, and they tend to heal more slowly afterward.
  • Discuss your medication with your doctor. Talk to your doctor about whether you need to change your usual medication routine before having a hysterectomy. You should also let your doctor know about any over-the-counter medications, such as aspirin, or dietary supplements you’re taking. Some supplements can help prepare you for a hysterectomy. For example, taking a daily multivitamin can help improve general health, and vitamin C can help promote healing. Talk to your doctor about recommended supplements you might take before your hysterectomy surgery.
  • Make sure other medical conditions are well-controlled. If you have diabetes, high blood pressure, sleep apnea, or other medical conditions, check with your doctor to make sure they’re under control before you have a hysterectomy. When other pre-existing conditions are managed, Cohen says, surgery is likely to be safer and recovery faster.
  • Plan to take time off work to fully recover. Fill out any necessary paperwork for medical leave before your hysterectomy. Depending on the type of surgical procedure performed, recovery time may take two to six weeks. During that time, you may not be able to drive or lift heavy objects, so also arrange for someone to help you on a day-to-day basis.

A Week Before a Hysterectomy Surgery

  • Drink lots of liquids. Being well-hydrated can help prevent constipation, a common side effect of surgery that can cause particular discomfort after a hysterectomy.
  • Get your post-op prescriptions filled. “Ask if your doctor can write your post-op prescriptions ahead of time, and have them filled,” Cohen says. It will save you from having to make an uncomfortable stop on the way home from the hospital.
  • Don’t worry about your menstrual cycle. Being on your period will not delay or affect your surgery.
  • Plan ahead for an easier recovery at home. Shop for and prepare easy-to-make meals for the weeks following surgery. “Also think about your home’s layout,” Cohen says. “Limit the need to climb stairs during recovery, and move things around for easier access.”
  • Make arrangements for someone to drive you home after the procedure. You will not be allowed to drive after undergoing anesthesia and will be required to have someone drive you home after the procedure. Your doctor will likely recommend that you don’t drive for up to two weeks after the surgery.

A Day Before a Hysterectomy Surgery

  • Eat light. Limiting heavy foods and avoiding big meals can help you feel better before and after the procedure. “Eating healthy is always important, but even more so when you plan to have surgery,” Dr. Hur says.
  • Gather your medical information. This may include your medical records, a list of any drugs or supplements you’re taking, any imaging results, such as X-rays, and allergy information. You’ll be required to provide this medical information at your pre-op appointment.
  • Follow your doctor’s instructions for eating, drinking, and bowel preparation. In most cases, you won’t be able to have any solid foods or liquids after midnight the night before surgery. Prior to any abdominal surgery, your doctor may also prescribe a bowel cleansing oral solution. However, if you have certain conditions, such as a perforated bowel, a bowel obstruction, or severe constipation, this step may not apply for you. It’s important to follow your doctor’s instructions when it comes to this and other kinds of preparation before surgery.
  • Relax the night before your procedure. The anticipation of surgery is stressful for some women. When you’re stressed, your body releases stress hormones, which can weaken the immune system and disrupt the body’s ability to manage pain and infection. For this reason, it’s important to relax the night before surgery — and even earlier. Make sure you get plenty of rest, and if you’re very anxious, try deep breathing and positive visualization (picture the surgery going well, and think about how much better you’ll feel afterward).

The Day of a Hysterectomy Surgery

  • Skip breakfast. Don’t eat or drink anything unless you have been specifically told by the anesthesiologist that it’s OK to do so. Even if you brush your teeth, do not swallow the water.
  • Don’t wear jewelry to the hospital. “You should remove all jewelry in preparation for surgery,” Hur says. “If you can’t, it doesn’t mean you have to cut it off, such as with a wedding ring that hasn’t been taken off for many years.” Talk to your doctor about what’s appropriate.
  • Reschedule the procedure if you’re sick. Any illness that affects your respiratory system, like pneumonia or the flu, may be a reason to delay the procedure. Minor problems like having the sniffles shouldn’t be a problem, but tell your doctor if you’re not feeling well on the day of surgery.

Preparing for Surgery

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Treatment

The steps you will take while preparing for any type of surgery are typically the same. Below, a number of practical issues are discussed, as well as information on surgeries that are common for women, primarily those related to your reproductive system.

What to bring to the hospital

  • Ask the hospital for a list of the items they provide, such as toiletries (toothbrush, toothpaste, shampoo, etc.). If you prefer certain brands of toiletries, bring your own. Leave cash and jewelry at home (remove your rings). Bring an inexpensive watch, clock or clock/radio to help keep you oriented after surgery.

  • Favorite magazines, books, crossword puzzles, etc., to spend relaxed time while your body resumes normal functioning. Bring eyeglasses, if required.

  • Flowers, family photos, cards, etc., to make your room warmer and more cheerful.

  • Music, audio books, and humorous or inspiring tapes or CDs because reading after surgery may at first be tiring or difficult with certain medications.

  • Spiritual or religious art, medallions, beads, etc.

  • Favorite foods and snacks, if allowed.

  • List of phone numbers you might need.

  • Notepad and pencil to have by your bed to jot down questions for your doctors or nurses.

  • Your own pillow, quilt and pajamas, although these are optional.

  • Something nice to smell, like mild fragrances to counteract the hospital atmosphere, can be very uplifting—for example, lavender, which is often used for relaxation, and Melissa, the “gladdening” herb, which has a fresh lemony scent. Putting a few drops of a high-quality essential oil on a cotton ball inside a small paper cup can be very pleasant when placed by your bedside, without bothering a roommate.

  • Consider bringing a pair of earplugs or eye-mask to promote restful sleep.

The Presurgical Visit

The presurgical visit is generally scheduled the day before surgery. An anesthesiologist will examine you and review your medical history to determine what type of anesthesia is safe for you. You will be examined and questions will be asked about your health. Blood and urine samples will be taken. You may undergo an electrocardiogram, or EKG, which provides an electrical recording of the heart. If you have had a blood or urine test or EKG in the past 30 days, let your physician know—this may eliminate the need for these tests during the presurgical visit.

Preoperative Preparation

Just before surgery, preoperative preparation—or preop prep—takes place. The steps vary, but this is what you can expect:

  • An identity bracelet will be placed around your wrist.

  • A health care professional will review your medical history and will perform a brief physical exam.

  • The area of your body undergoing the operation will be cleaned and may be shaved.

  • You may be given a laxative or an enema to empty your bowels. You may be asked to douche or to empty your bladder.

  • You’ll be asked to remove any dentures, hearing aids, contact lenses or eyeglasses, nail polish, wigs, hairpins, combs and jewelry.

  • You’ll be asked to remove all your clothes and will be given a hospital gown and perhaps a cap.

  • You may be given medication to help you relax. You may also be given other medications that your doctor has ordered.

  • A needle may be placed into a vein in your arm or wrist. This needle is attached to a tube that will supply your body with fluids, medication or blood during and after the surgery. This is called an intravenous (IV) line.

  • A tube called a catheter may be placed in your bladder to drain urine. This is often done after you have been given anesthesia. This way it is not felt.

Common Surgical Procedures

There are several reasons why gynecologic surgery may be recommended. Examples include symptoms caused by abnormal uterine bleeding, fibroids, pelvic pain from endometriosis (a disorder that occurs when some of the tissue that forms the lining of the uterus grows in other parts of the body) or other conditions, and uterine prolapse (when the uterus is no longer supported by muscles and ligaments, and drops into the vagina). All are common reasons why women seek surgical treatment from their health care professionals.

If you have one of these conditions, here are some of the procedures your health care professional may recommend:

  • Laparoscopy and hysteroscopy. These minimally invasive techniques are used to diagnose and treat many conditions. The laparoscope is inserted through a small incision just below the navel so the surgeon can view and treat conditions in the pelvis. Sometimes other small incisions may be needed. General anesthesia is often used during laparoscopy. The hysteroscope is inserted through the vagina and cervix, giving the surgeon access to the uterus.
    Both procedures are performed with long, thin telescope-like instruments equipped with a light and camera so the surgeon can view the area being treated on a video monitor. Complications are not common but may include bleeding, injury to other organs or reactions to the anesthesia. You may also feel bloated and gassy the next day because often the abdomen has to be inflated with gas to make it easier to more easily maneuver the tools. In the hands of a skilled surgeon, minimally invasive surgeries offer several advantages to abdominal surgery: smaller incisions, less pain, smaller risk of bleeding, shorter recovery and less visible scars.
    Laparoscopy may be used for diagnosing endometriosis, pelvic pain and infertility. It can also be used for surgery on the fallopian tubes and to treat adhesions (painful scar tissue that may develop internally as a result of prior surgery).
    Hysteroscopy can be done in a health care professional’s office or operating room under local, regional or general anesthesia depending on whether other procedures, including laparoscopy, are done at the same time. Hysteroscopy may be used, among other reasons, to identify causes of abnormal bleeding or repeated miscarriages, to take a biopsy or to diagnose infertility.

  • Myolysis. This laparoscopic procedure uses an electric current or laser to destroy fibroids and shrink the blood vessels that feed them. A similar procedure called cryomyolysis freezes fibroids with liquid nitrogen. Safety, effectiveness and risk of fibroid recurrence with these procedures are yet to be determined.

  • Myomectomy. This surgical alternative to hysterectomy treats fibroids by cutting the growths out of the uterus and removing them through an incision in the abdomen. The surgery may also be done through the vagina with the use of a hysteroscope, or laparoscopically through a small incision in the lower abdomen. General anesthesia is usually used. The benefit of a myomectomy is that fertility is preserved because the uterus and cervix are left intact.
    This procedure is frequently more complicated than hysterectomy, and the risks of a myomectomy should not be underplayed. Myomectomy takes as long and often longer than a hysterectomy, and it may involve greater blood loss and a greater need for transfusion than hysterectomy.
    Myomectomy may also involve a more difficult postoperative course than hysterectomy, and there is the risk of damage to ureters and other structures, as with hysterectomy. Scarring of the uterus following myomectomy may also affect fertility. And the procedure doesn’t prevent further fibroids from growing. In fact, they often grow back and may require more surgery.

  • D&C. This common surgical procedure, also known as dilatation and curettage, involves scraping the internal lining of the uterus to diagnose and treat abnormal uterine bleeding. It can also be performed to determine the cause of severe menstrual pain or gain information about why you are unable to get pregnant. This elective procedure is also commonly performed after a miscarriage to empty the uterus of remaining tissue associated with the pregnancy. D&C is sometimes done to remedy a condition called endometrial hyperplasia, in which the uterine lining has become too thick. Occasionally, a woman may experience bleeding after menopause; if vaginal bleeding occurs after a cessation of at least six months, then a D&C may be recommended.
    The procedure can be done on an inpatient or outpatient basis and involves dilating the cervix and inserting a thin, spoon-shaped instrument (a curette) to remove a sample of the internal lining of the uterus for testing or to remove the portion of the lining that is causing excessive bleeding. Following the D&C, you will be given oral medication for any postoperative pain, such as severe cramps. Most pain disappears within 24 hours. You may also be given an antibiotic to prevent infection.

  • Endometrial ablation. Endometrial ablation involves using heat, electricity, laser, freezing or other methods to destroy the lining of the uterus. These procedures are recommended only for women who have completed their families because they affect fertility. However, following treatment, you must use contraception. Although endometrial ablation destroys the uterine lining, there is a small chance that pregnancy could occur, which could be dangerous to both mother and fetus. Overall, endometrial ablation procedures have a good success rate at reducing heavy bleeding, and some women stop having menstrual periods altogether.
    Some endometrial ablation procedures are performed with the help of a hysteroscope or a resectoscope, a device similar to a hysteroscope that has a built-in wire to deliver electrical current to remove endometrial tissue. And some endometrial ablation procedures use ultrasound to guide the instrument into the uterus.
    Depending on the type of endometrial ablation performed, it may be done as an outpatient surgery or as part of a hospital stay, and it may be performed under local or general anesthesia. The length of surgery and recovery time will vary depending on the type of ablation used.

  • Hysterectomy. This common procedure removes the uterus and possibly other parts of the reproductive tract, such as the cervix, fallopian tubes and ovaries. If your ovaries are removed during the surgery, the procedure is called a bilateral salpingo-oophorectomy. A hysterectomy may be performed through the abdomen (abdominal hysterectomy), through the vagina (vaginal hysterectomy) or through the vagina with assistance from viewing instruments placed in the abdominal cavity (laparoscopically assisted vaginal hysterectomy ). The most common complications are infection, injury to the bladder or bowel and bleeding.
    The setting and type of anesthesia used for hysterectomy can depend on the type of hysterectomy that is recommended. Typically there is a one- to two-day stay in the hospital and a two- to six-week recovery period. Side effects from hysterectomy include: difficulty emptying the bladder or bowels, urinary tract infections, abdominal pain and fatigue.

How Anesthesia Works

One of the most common fears people have about any type of surgery concerns anesthesia. Anesthesia refers to the drugs and gases used during an operation to relieve pain. These drugs work by artificially putting you to sleep and by blocking messages to the brain. As a result, all or part of the body becomes insensitive to pain and feeling for as long a time as needed.

Anesthesia can be given by either an anesthesiologist (a doctor who specializes in anesthesia) or by a nurse anesthetist working under the supervision of a physician. For minor surgeries done in a health care provider’s office, local anesthesia can also be given by the health care professional performing the procedure.

During surgery requiring anesthesia, the anesthesiologist adjusts the level of the drugs to heighten or lessen their effect. He or she also continually monitors a patient’s breathing, heart rate, blood pressure, temperature and other vital signs, and performs blood transfusions, if necessary.

Before any operation, you should ask who will be administering and monitoring the anesthesia. Because it is difficult for a surgeon to operate and monitor a person’s anesthetic at the same time, it is best if another person monitors the anesthetic. Minor procedures must be carefully monitored as well, because even sedatives can depress breathing.

The type of anesthesia used during surgery depends on a woman’s age and physical condition; on the nature and length of the procedure; and on any personal history or family history of adverse reactions to drugs. Some operations can be done with more than one type of anesthesia. In some cases, a health care professional may steer you toward one type of anesthesia based on your medical history and the type of surgery.

The four types are: conscious sedation, local anesthesia, regional anesthesia and general anesthesia. Their effects range from a short-lived numbness to temporary paralysis or unconsciousness, depending on the blend of products used and how they are administered.

  • Conscious sedation puts you to sleep using sleeping pills, but not deeply enough to cause unconsciousness. It is often used in office-based gynecological procedures, such as new methods of sterilization, and may be used during colonoscopies.

  • Local anesthesia is injected directly into a tissue to numb it. It is used for minor surgeries and may be coupled with a mild sedative. There are few, if any, side effects.

  • Regional anesthesia blocks sensation in a region of the body, such as from the waist down. The two main types are spinal and epidural. Both are injected near the spinal cord. An epidural is administered through a thin plastic tube or catheter and can be given continuously during surgery. After surgery the catheter can be left in to provide postoperative pain relief. Spinal anesthesia acts faster and produces more numbness than an epidural, but it cannot be given continuously. Spinal anesthesia is often associated with headaches as it wears off.

  • General anesthesia includes a group of agents that block pain, relax the muscles and produce unconsciousness. It can also shut down memory function. Typically, general anesthesia agents are given via inhalation or intravenously. In some cases, the anesthesiologist may also give a pre-medication orally or through an injection anywhere from a few minutes to a few hours before the surgery to induce relaxation and drowsiness. Temporary side effects of general anesthesia may include nausea, vomiting, muscle pain or shivering.

Many gynecologic surgeries are performed using an epidural injection—the type of anesthesia commonly used during childbirth. Epidurals are becoming increasingly popular because they can keep a person comfortable without causing grogginess or affecting a person’s consciousness.

An epidural works by putting anesthetic drugs in the epidural space just outside the spinal cord, which affects the large nerves entering and leaving the spinal cord. These nerves are responsible for transmitting information to the spinal cord and brain about touch, temperature and pain. If too large a dose of the medications is given or if the needle is inadvertently placed inside the spinal sac, the anesthetic could affect nerves higher up in the chest that control breathing and heart rate. An epidural can also cause blood pressure to fall. The administration of an epidural requires a skilled anesthesiologist.

Some procedures demand a particular method of anesthesia, leaving you without a real choice. You may, however, be able to request that the smallest possible amount of a drug be administered, which may reduce side effects. Before receiving any anesthesia, you should discuss the options with your surgeon or anesthesiologist.

The anesthesiologist typically will discuss your surgical procedure and anesthesia-related issues before your scheduled surgery. Use this meeting to express any fears or concerns you have about anesthesia. You should also ask the following questions:

  • What types of anesthesia are appropriate for this type of surgery?

  • What effects can I expect after the operation?

For safer surgery, it’s important to share as much information as possible about yourself and your health history with the anesthesiologist including:

  • previous adverse reactions to anesthesia in yourself and in other family members

  • any allergies you have

  • if you smoke

  • which medications, including herbal supplements, you’ve recently taken

  • if you think you might be pregnant

Prevention

While there is not really a way to prevent necessary gynecologic surgery, you should carefully consider alternatives to elective surgery. The most common alternatives to hysterectomy as a treatment for fibroids, endometriosis and abnormal uterine bleeding, for example, are watchful waiting and hormonal therapies.

For example, birth control pills may be used successfully to treat abnormal bleeding or pain caused by endometriosis.

If you decide surgery is your best option, ask your surgeon:

  • Is there a minimally invasive approach to this type of surgery?

  • What are the risks and benefits associated with this choice?

  • How many times have you performed this procedure?

  • How long will I be hospitalized and approximately how long will it take for me to recover?

  • How can I prepare before and after the surgery?

  • Where can I learn more about the surgery?

Overview


Hysterectomy

Types of hysterectomy

There are various types of hysterectomy. The type you have depends on why you need the operation and how much of your womb and surrounding reproductive system can safely be left in place.

The main types of hysterectomy are:

  • total hysterectomy – the womb and cervix (neck of the womb) are removed; this is the most commonly performed operation
  • subtotal hysterectomy – the main body of the womb is removed, leaving the cervix in place
  • total hysterectomy with bilateral salpingo-oophorectomy – the womb, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy) are removed
  • radical hysterectomy – the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue

There are 3 ways to carry out a hysterectomy:

  • laparoscopic hysterectomy (keyhole surgery) – where the womb is removed through several small cuts in the tummy
  • vaginal hysterectomy – where the womb is removed through a cut in the top of the vagina
  • abdominal hysterectomy – where the womb is removed through a cut in the lower tummy

Find out how a hysterectomy is performed

To prep, or not? Evidence is against mechanical bowel preparation in gynecologic surgery

Think mechanical bowel preparation (MBP) is a must for gynecologic surgery?

Think again.

Although MBP has been around since the 1930s, a growing body of data suggest that, with rare exception, gynecologists can eliminate routine use of preoperative MBP from their practice.

In this article, we discuss the evidence surrounding MBP so that you can assess the benefits and risks it poses for your surgical patients.

Unproven assumptions are behind MBP

For most of the past century, MBP has been used in advance of abdominal surgery,

including gynecologic surgery. Clinicians made the rational assumption that, by decreasing the fecal load within the colon, they could lower the risk of certain surgical complications, especially during an era when antibiotics were not available to treat serious infectious morbidity. In modern times, the practice has continued when major abdominal surgery is planned. Why? Because surgeons believe it will reduce the risk of wound infection, anastomotic leakage, and bowel spillage in the event of injury, and that it will increase the ease of bowel manipulation.1

A growing body of literature challenges these assumptions and suggests that MBP is not associated with these benefits—and may even increase the incidence of some of these complications. Moreover, the induction of profuse, watery diarrhea to evacuate the colon before surgery has been associated with severe electrolyte imbalance, renal failure, and difficult intraoperative fluid management.

These risks make a thorough assessment of MBP’s effects imperative to guide optimal practice.

Key points for the use (or avoidance) of mechanical bowel preparation

  • Mechanical bowel prep has many side effects, ranging from mild (discomfort) to severe (renal failure).
  • The risks of surgical site infection and anastomotic leakage are not lower with MBP, compared with no preparation, in patients undergoing elective colon surgery.
  • MBP does not reduce the risk of intraoperative contamination of the surgical field.
  • In unplanned injuries to unprepared colon (e.g., in cases involving trauma), primary anastomosis is the recommended mode of repair rather than diverting colostomy.
  • MBP does not ease bowel manipulation in laparoscopy, compared with no preparation.
  • The only proven value of MBP is to improve visibility during intraoperative colonoscopy.
  • Gynecologists can eliminate the routine use of MBP from their surgical practice.

MBP defined

MBP is the chemical or physical process of eliminating fecal matter from the intestinal tract. There are a variety of methods, including ingestion of an oral preparation and enemas and suppositories. Historically, MBP included stimulant laxatives, such as senna extract and castor oil, and hyperosmotic solutions, such as mannitol and lactulose.

MBP is distinctly separate from antibiotic bowel preparation and preoperative prophylactic antibiotics, both of which fall beyond the scope of this article.

The most common forms of MBP prescribed today are balanced electrolyte solutions, including polyethylene glycol, and saline laxatives, such as magnesium citrate and sodium phosphate.2

Some investigators have attempted to determine which MBP formulations are most effective, based on visualization during colonoscopy, but a recent meta-analysis suggests that most formulations perform similarly.3

MBP carries established risks

The risks associated with MBP are clearly documented in the literature and range in intensity from mild to severe. Overall, patients report discomfort, with symptoms such as abdominal pain and distension, nausea and vomiting, weakness, and insomnia.4 High-volume preparations, such as polyethylene glycol, are unpalatable to patients and, therefore, less likely to be ingested completely, leaving the surgeon with a partially evacuated colon.

Dehydration and electrolyte disturbances may also complicate the use of MBP, particularly with saline laxatives. Although young patients can likely tolerate electrolyte shifts without severe sequelae, elderly patients who have comorbid heart and kidney disorders may become further deconditioned during the MBP process. Seizures and esophageal tears have been reported as a result of MBP.5 Sodium phosphate, in particular, is associated with renal failure, with 171 cases reported to the US Food and Drug Administration (FDA) from 2006 to 2007—leading to an issued warning not to employ this agent in preoperative MBP in the liquid formulation.6

In addition, in one study, investigators observed an increased time to the return of bowel function and a prolonged hospital stay among patients who underwent MBP.7

Purported benefits of MBP

Reducing the risk of surgical site infection

Surgical site infection (SSI)—whether intra-abdominal or in the superficial wound—is a serious complication that can lead to severe morbidity. As colorectal surgeons began performing more aggressive colon surgery in the 1930s, 40s, and 50s, they sought a way to reduce SSI. Mortality from colon surgery was 10% to 30%, with a rate of SSI of 80% to 90%, so surgeons began to seek a method to decrease the fecal bacterial load, presuming that doing so would also reduce the rates of infection and mortality and allow for primary repair of the colon. MBP appeared to address the problem.1

Pre-operative Bowel Prep

  1. Bowel preparation aids in visual inspection and diagnosis of any endometriosis present. If the bowel is full of stool, it gets in the way of seeing the entire pelvic area, and can, therefore, hamper the surgeon’s ability to carefully inspect all areas for the presence of disease.
  2. Bowel preparation is necessary for the complete removal of invasive bowel endometriosis. If endometriosis is growing on the bowel, it must be removed. Occasionally endometriosis penetrates through the bowel wall and, in the process of removal, a hole must be made in the bowel. If the patient has completed a bowel prep, the bowel can be safely repaired laparoscopically, with minimal risk of contaminating the pelvis. When endometriosis completely invades a large area of the bowel, the entire affected segment of the bowel must be removed and the two loose ends reconnected. Again, the bowel should be clean in order to perform this procedure safely. In the absence of a preoperative bowel prep, this procedure would need to be postponed until a later surgery with the required preoperative bowel preparation. Even if the bowel is not involved by disease, occasionally damage may occur to the bowel during complex surgery, such as when the bowel is fused to surrounding organs by dense scar tissue. In such situations, if the bowel is clean, any damage can be safely and uneventfully repaired during the surgery.

Bowel preparation is, therefore, an essential step in enabling the complete and safe removal of all areas of disease during one procedure. It is definitely worth the inconvenience of undergoing the prep in order to obtain the best outcomes from your surgery. If your surgeon does not order a prep prior to your endometriosis surgery, it may be worth asking why.

Gynecologic Services

Gynecologic Surgery — Preoperative & Postoperative Instructions and Precautions

Preoperative bowel preparation

Postoperative instructions for most gynecologic surgeries

Preparation for surgery

  • Make an appointment, usually with your primary care doctor, for a history and physical (H&P) examination. Regulations require that this exam take place within 30 days of your surgery, or your surgery will be delayed or canceled.
  • If you take medication daily, please check with your prescribing physician for instructions on whether to stop or continue to take them the day of surgery. Medication on the day of surgery can be taken with a sip of water that morning.
  • Do not take any aspirin or over-the-counter products that contain aspirin 1 week prior to surgery. You may take Tylenol only.
  • If your procedure requires a bowel prep, you may have solid food up until you start the prep. Once started, you may only have clear liquids up until 6 hours before your surgery. If you do not require a bowel prep, have nothing to eat after midnight; you may have clear liquids up until 6 hours before your procedure. See bowel preparation instructions.

Preoperative bowel preparation

Your surgery requires a bowel prep to cleanse your bowel of all solid material. Follow the instructions below. Proper bowel preparation will reduce the risk of injury to the bowel during surgery.

A few days prior to surgery

  • You will need to purchase 2 bottles of Magnesium Citrate (10 oz. each) and 2 Bisacodyl tablets (5 mg each tablet) from your local grocery store or pharmacy.

One day prior to surgery

  • Your bowel prep begins the day before your surgery. You can have solid foods the day before, but once you’ve started the bowel prep you can only have clear liquids.
  • We also recommend that if you do eat solid foods before your prep that you eat lightly. Examples: Toast, yogurt, soup.
  • OPTION 1 (noon & 4 p.m.) — If you will be home the day before your surgery, start bowel prep:
    • At noon — Drink one bottle of Magnesium Citrate. This can be swallowed alone or mixed with a clear liquid of your choice. Continue to drink at least 8 oz. of clear liquid each hour.
    • At 4 p.m. — Drink the second bottle of Magnesium Citrate (10 oz.) AND take 2 Bisacodyl tablets. Continue to drink at least 8 oz. of clear liquid each hour until retiring for sleep.
  • OPTION 2 (4 p.m. & 8 p.m.) — If you are unable to be home the day before your surgery, start bowel prep:
    • At 4 p.m. — Drink one bottle of Magnesium Citrate. This can be swallowed alone or mixed with a clear liquid of your choice. Continue to drink at least 8 oz. of clear liquid each hour.
    • At 8 p.m. — Drink the second bottle of Magnesium Citrate (10 oz.) AND take 2 Bisacodyl tablets. Continue to drink at least 8 oz. of clear liquids each hour until retiring for sleep.
    • We would like you to have at least 10 8-oz. glasses of clear liquid from the time you start the bowel prep until you go to sleep.
    • You may drink clear liquids up until 6 hours prior to your scheduled surgery time.
    • You will notice an increase in watery bowel movements throughout the day. If this does not occur by the completion of the second dose of Magnesium Citrate, you may take a Fleet Enema or Milk of Magnesia to completely clear your bowels.
    • Because you are drinking an increase in clear liquids during the bowel prep experience, you may notice that your urine is a light clear yellow color.
    • Note: The later you start your bowel prep, the later you’ll be awake with bowel movements.

Clear liquid diet

These items are allowed during your bowel prep up until 6 hours before surgery:

  • Water
  • Clear broths (chicken or beef)
  • Juices (apple or cider)
  • White grape juice
  • Clear soda
  • Tea (no milk, creamer, or honey)
  • Coffee (no milk or creamer)
  • Jell-O (without fruit/no red Jell-O)
  • Popsicles (without fruit/cream)
  • Italian ice (no red)
  • Clear Gatorade
  • Spices and seasonings such as salt, pepper, sugar, and sugar substitutes may be used.

These items are not allowed:

  • Milk
  • Cream
  • Milkshakes
  • Orange juice
  • Tomato juice
  • Creamy soup or any soup other than clear broth
  • Solid foods

Day of the procedure

  • Do not shave or mark your skin anywhere near your surgical site.
  • Do not wear makeup.
  • All jewelry, including body piercings, must be removed prior to surgery. Leave all jewelry at home.
  • Wear loose and comfortable clothing.
  • Please arrive on time. Every effort is made to ensure your surgery begins at the scheduled time; however, your surgery may be delayed as a result of a hospital emergency or because of commonly encountered variations in the length of certain procedures due to unanticipated findings.
  • All patients are required to have an escort home after surgery.

If you are going home the same day

  • If your surgery involves anesthesia or sedation, you must be accompanied by a responsible person when you leave the hospital. You cannot drive yourself home.
  • You should have an adult stay with you for 12-24 hours following your surgery.

Questions

  • If you have questions about your surgery, contact our office during office hours.
  • If you have other questions, contact the Abbott Northwestern surgical information line at 612-863-3138, Monday through Friday from noon to 6 p.m. A registered nurse will be available to answer your questions.
  • Visit Preparing for Your Surgery for more information about Abbott Northwestern and your surgery.

Postoperative instructions for most gynecologic surgeries

The recommendations that follow are intended as a general guide to your first weeks at home. However, the most important thing is to use good common sense in planning your activities. If it hurts, don’t do it; and don’t do anything to the point of exhaustion.

  • After minimally invasive procedures, laparoscopy, hysteroscopy, vaginal surgeries, and robotic procedures, you should be up and moving about freely soon after the surgery. Gradually increase your activities.
  • You are allowed to climb stairs, but try not to become too tired.
  • Avoid heavy lifting. Avoid strenuous exercise or sports for 2 weeks.
  • Do not drive until you can do so without discomfort and without using pain medicine. This can take from 3 to 7 days.
  • You may shower and wash your hair. Soapy water can run over the incisions. Do not soak the incisions in a tub immediately following surgery.
  • No intercourse, douching, or tampons for at least 2 weeks. Longer restrictions may apply to vaginal surgeries.
  • It can be normal to have a slight vaginal discharge, which may be bloody. Use sanitary pads not tampons.
  • If you experience bleeding heavier than a period, call the office.
  • You may eat and drink as tolerated. Go easy at first, with clear liquids, soup or broth, and crackers, before progressing to solids.
  • Increase fiber and fluids if you get constipated. If needed, a stool softener (Surfak, Colace, or a generic equivalent) maybe purchased and taken by mouth as directed. It is common for narcotic pain medicines to cause constipation. If no bowel movement has occurred for 2-3 days, you may use Miralax, Milk of Magnesia, or Senokot. Do not use Correctol or Ex-Lax.

Precautions

  • Contact the office if you experience fever of 100.4 or higher, chills, vomiting, pain unrelieved by using pain pills, vaginal bleeding heavier than a period, or foul-smelling discharge.
  • Contact the office if you experience any urinary frequency, urgency, or burning that doesn’t respond to increasing fluids, cranberry juice, and nonprescription bladder medicine such as AZO.
  • Contact the office if you have any chest pain, shortness of breath, pain in the calves or legs, or redness, drainage, or separation of the incisions.

Follow-up

  • If an appointment has not been scheduled for you, call the office and tell them the date of your surgery and which procedure you had, and they will schedule the follow-up visit. A pelvic examination is often done at that visit.

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