Physiotherapy Advice following Gynaecological Surgery

Transcription

1 Physiotherapy Advice following Gynaecological Surgery Information for patients Physiotherapy Department Macclesfield District General Hospital Phone no: Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 1

2 Introduction This leaflet is designed to teach you how to control your pelvic floor muscles and your bladder, so that you will be dry and comfortable. Following the exercises will also help your general recovery following your operation. Deep breathing This helps to clear your chest from the effects of the anaesthetic. You should begin as soon as possible after the operation. Sit up in bed, leaning against your pillows, or sit on a chair with your feet on the floor. Place your hands on your lower ribs. Breathe deeply in through your feeling your ribs push outwards. Hold your breath for a second and breathe out through your mouth. nose, then Repeat this 4 times every hour. Mucus may have gathered in your and it is important to get rid of it. lungs, If you feel you need to clear your chest, do 4 deep breaths and then clasp a soft towel over your incision, bend your knees, lean forwards and breathe out with a sharp huff - rather like steaming up a mirror. Do this two or three times. It may be uncomfortable, but will not burst your stitches and it will help to bring any mucus up into your throat to then cough up. If you have had a vaginal hysterectomy, or a repair operation, put your hand over your sanitary pad while coughing. Try to sit out in the chair on the first day after your operation. Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 2

3 Circulation Bend and stretch your feet at the ankle 20 times Bend and straighten each knee 5 times Practise hourly to maintain a healthy circulation. Back care When sitting up in bed or in a chair, make sure that your back is fully supported with a rolled up towel or pillow. As soon as possible, lie flat to sleep. Alternatively, lie on your side with a pillow tucked under your tummy and one supporting your upper leg. Pelvic tilting will ease backache and help to tone your stomach muscles and relieve pain associated with wind. Lie on your back with your knees bent up. Pull your tummy in and press the back of your waist firmly onto the bed. Hold this position for two to three seconds and relax. Repeat several times. Try to walk tall, supporting your incision with your hands. Abdominal Exercises Poor abdominal muscles can lead to back pain and strain on the pelvic floor. The most important muscle to work is transversus abdominus. This acts like a corset and it attaches at the front of the abdomen and at the back of the spine. It helps to stabilise the spine and pelvis, flatten your tummy and draw in your waistline. Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 3

4 You can start this exercise as soon as you feel comfortable to do so after your operation. Lie on your back as shown in the diagram with a small towel rolled under your waist to ensure a gentle curve in your spine. Breathe in, and as you breathe out, gently pull your lower tummy muscles inwards towards your spine. Do not pull in above your tummy button. Continue holding the muscles and breathing for a count of 10 seconds. As you become able to do this exercise, try doing it as you go about your daily activities. Getting in and out of bed To get out of bed, bend your knees and roll onto your side. Push up to the sitting position, using your hands, and ease your legs over the side of the bed. Reverse the process to get back into bed. Pelvic floor exercises Start these exercises after your catheter has been removed. The pelvic floor muscles form a sling between the pubic bone at the front and the tail bone at the back. They fan out on either side to support the pelvic organs and are pierced by the urethra (urinary passage), the vagina and the anus. These muscles are strong and elastic, and by their reflex action they prevent loss of urine during sudden movements such as coughing, sneezing, laughing, running and lifting. They also safeguard against prolapse of the uterus and vaginal walls. Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 4

5 Pelvic floor exercises are very important to keep these muscles toned up. Repetitive pelvic floor contractions help to reduce discomfort and swelling and increase the local blood supply to help heal any stitches you may have. You should practice these regularly especially if you have given birth. After surgery it is important to strengthen these muscles and provide added support. The basic pelvic floor exercise Make sure you are sitting or lying in a comfortable position. Now, draw up into your back passage as if stopping wind. At the same time, draw up at the front as if stopping the flow of urine. The movement is one of lift and squeeze. This is called a pelvic floor contraction. The pelvic floor exercise programme Now that you are able to do the basic pelvic floor exercise, you can follow this programme to gradually tone up your muscles: Lying down is the easiest position to start with as you are not pulling the muscles up against gravity. You can progress to sitting and standing over time. - Tighten your pelvic floor as strongly as you are able and hold for as many seconds as you can (up to a maximum of 10 seconds). This will be a relatively gentle pelvic floor contraction to begin with - you will be able to lift it more strongly with practice and as your stitches heal - Release this contraction and rest for 4 seconds - Now repeat the pelvic floor contraction as many times as you can (up to a maximum of 10 repetitions) - remembering to rest for 4 seconds between each lift Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 5

6 - Aim to do at least 4 sets of exercises each day - Build up gradually, increasing how many seconds you can hold for (up to a maximum of 10 seconds) and how many repetitions you can do (up to a maximum of 10 repetitions), so that eventually you can do 10 repetitions with a 10 second hold, 4 times a day. Try not to pull in your stomach excessively, squeeze your legs together, or tighten your buttocks. Do not hold your breath. Remember to start gently and stop if it hurts. This programme is designed to build up the strength and endurance of the pelvic floor muscles, so that they will be able to work harder and longer. Once you feel confident performing these strong, sustained contractions, you can add some quick contractions. Squeeze and lift your pelvic floor and then let go. Repeat this up to a maximum of 10 times. Quick contractions will help your muscles react quickly when you laugh, cough, sneeze, exercise or lift. The pressure generated by a cough, sneeze or lift is huge and can cause the muscles and ligaments to give way, allowing urine to escape or a prolapse to be felt. Making a conscious effort to pull up your pelvic floor before you cough, sneeze, laugh, exercise or lift can also help to protect these muscles, keep you dry and minimise the sensation of a prolapse. NB Do not practise stopping the flow of urine as this can cause bladder problems. Tips to help you Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 6

7 1 Get into the habit of doing your exercises at times in the day when you have a few minutes. For example, before getting up in the morning and before going to sleep at night. 2 If you are unsure that you are exercising the right muscle, put one or two fingers in the vagina and try the exercises to check. You should feel a gentle squeeze if you are exercising the pelvic floor. 3 Use the pelvic floor when you are afraid you might leak. Pull up the muscles before you sneeze or lift something heavy. Your control will gradually improve. 4 Drink normally, at least 6 to 8 cups every day. And don t get into the habit of going to the toilet just in case. Go only when you feel that your bladder is full. 5 Watch your weight - extra weight puts extra strain on your pelvic floor muscles. 6 Try to avoid being constipated - the extra strain needed puts more stress on your pelvic floor. 7 Try to stop or reduce smoking cigarettes - regular coughing puts a strain on the pelvic floor. 8 Once you have regained control of your bladder, don t forget your pelvic floor. Continue to do your pelvic floor exercises twice each day to ensure that the problem does not come back. You can do pelvic floor exercises wherever you are - nobody need know what you are doing! Try to practise these exercises 4 times each day until your outpatient appointment with the gynaecologist, and then once or twice each day for the rest of your life if you are experiencing no continence problems. If you have persistent leakage, your consultant may decide to refer you for physiotherapy. Getting back to normal activities Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 7

8 Rest During the first two weeks at home you will need plenty of rest, including a lie down in the afternoon. It is quite safe to go up and down stairs. Housework Someone will have to help you with housework for at least 6 weeks; 3 months for heavier jobs. Washing up, light dusting, preparing meals can be started 2 weeks after the operation. Heavier activities, such as shopping, vacuuming and ironing should be left for 4 to 6 weeks. Lifting Reduce lifting wherever possible for the first 4 to 6 weeks. Do not lift anything heavier than 3 to 4 kilograms (6 to 8 pounds - or the equivalent of 3 to 4 bags of sugar) during this time and less for the first 2 weeks. Do not lift anything heavy such as a vacuum cleaner for at least 3 months. Bending When bending to lift, position yourself close to the object. Place your feet apart in a walking position. Bend your knees to keep your back straight. Pull in your tummy and draw up your pelvic floor muscles. Hold the object close to your body and lift by straightening your knees. General exercise Walking is good exercise. You should aim to have a daily walk from about 2 weeks after your operation. Start with 5 to 10 minute walks, and gradually increase the distance and pace of your walks. Swimming is also good exercise. You may begin around 4 to 6 weeks after the operation, provided there is no blood loss and your wound is well healed. This is to avoid any risk of infection. More active sports, such as tennis and aerobics should be delayed for 2 to 3 months. Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 8

9 Driving Driving may be resumed around 4 to 6 weeks after your operation, if you can stamp your foot hard. If this is within 6 weeks, you are advised to check your insurance policy. Sex Sexual intercourse can be resumed 4 to 6 weeks after your operation, depending on how you feel. A lubricant such as KY jelly may be useful at first. Work Return to work may be anything from 6 weeks to 3 months after your operation. It will depend on whether you have a sedentary job, or one which involves lifting or standing for long periods. Do you have any questions? This leaflet is designed to teach you how to control your bladder, so that you will be dry and comfortable. If you have a problem doing the exercises, or if you don t understand any part of this leaflet, ask your doctor, nurse, continence advisor or physiotherapist for help. Please use this space to write down any questions you may have. The information in this leaflet has been compiled by Fiona Harrison and Emma Bowling, Senior Physiotherapists in Women s Health, Macclesfield District General Hospital telephone Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 9

10 Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: Phone: Textphone: Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation, contact Communications and Engagement on East Cheshire NHS Trust operates a smoke-free policy (including e-cigarettes) For advice on stopping smoking please contact the KICKSTART Stop Smoking service on East Cheshire NHS Trust does not tolerate any form of discrimination, harassment, bullying or abuse and is committed to ensuring that patients, staff and the public are treated fairly, with dignity and respect. If you have any comments about how we can improve our services please inform a member of staff in the department or complete a comment card available throughout the hospital. Macclesfield District General Hospital, Victoria Rd, Macclesfield SK10 3BL Leaflet Ref:10360 Pub: 01/17 Revised 01/19 Review: 31/12/2019 Page 10