Post-op: bowel activity

When bowels are handled and disturbed, as happens during a hysterectomy or any other abdominal surgery, they shut down activity for a period of time. This is why women are often surprised to find that they are limited to only liquids for the first day or so after their hyst: this gives the bowels a rest and doesn't overwhelm them before they are ready to resume activity. Eating too soon will only cause the undigestible food to back up, producing vomiting that is not a real appealing prospect for anyone who has just had abdominal surgery--not a pleasant thing to contemplate.

How do we know that our bowels are returning to function? Our caregivers can hear the sounds of sloshing when they listen with a stethescope, and before long, we can feel or hear the passage of gas. This is such an important recovery milestone that it is one of the criteria for discharge: we have to actually pass gas to demonstrate that our bowels are capable of taking up their digestive functions again.

For many women, this signals the most frustrating and uncomfortable part of recovery, however: dealing with gas and constipation. Narcotic drugs, low physical activity levels, a low-fiber diet, not drinking enough, and, for those who are users, lack of caffeine all contribute to impaired bowel motility and enhance these gas and constipation effects.

But those causes also provide us with a good set of things we can do to limit these unpleasant symptoms of our bowels recovering. 

Psychological Aspects of Pelvic Surgery

One of the things that is the most daunting about a hysterectomy is that for many of us, it represents the first major surgical experience of our lives. We don't know what to expect, and when we are facing a surgery that can have so many profound effects on our lives, our health and even our own self-image, that can all add up to a terrifying prospect.

While we used to be able to turn to our doctors for assurances of what we would be facing and how it would affect us, the truth is that the current model of medical practice often speaks more to the needs of insurance companies and malpractice lawyers than patients. We may see test results and permit forms, scheduling clerks and bland, lowest-common-denominator generic informational pamphlets, but we may hardly have a chance to meet the person who will hold our life and wellbeing in their hands for a matter of hours.

But how do we manage to gain the information we need if not from our surgeons? Most of us don't even begin to know the kinds of questions we should ask because the whole situation is so distant from our normal lives. I hope that as you've read this website you've gained a clearer impression of what to expect, so that you can begin to "try on" how surgery might fit in your life and speculate on what to expect, determine what specific things you need to ask about.

I'd like to add to this by pointing to a continuing education module for doctors that has recently been posted on medscape (free registration will be required to access it): Psychological Aspects of Pelvic Surgery. As the article notes:

This article briefly considers the gynecologic surgeon's preoperative responsibilities, special needs of various patient populations, and care during and after hospitalization. The aim is to encourage gynecologists to recognize that although a gynecologic operation may be an ordinary procedure for the surgeon, it is a unique experience for the patient. Her sense of well-being and health may be threatened; she may lose control of her body for some period of time; and she may perceive the planned procedure as temporarily or permanently affecting her sexual identity. As once complicated procedures become routine, the gynecologic surgeon risks losing perspective about the impact of surgery on the life of the individual woman.

Why would you want to read an article that tells your surgeon how to meet your preop needs? Because this helps you know what your doctor could tell you, and with that information on what constitutes good care, you are better prepared to directly ask for what you need. Now you don't need to wonder if you are "being a bother" by "wasting" his precious time with questions: it's his job to be available and answering questions is exactly the opposite of bother. Now you don't need to feel that you are especially clueless for not knowing all these things, since according to this article, all women in this position need this kind of care from their surgeons. If we know what he should be doing for us, we're better prepared to make sure we get it. It's as simple as that.

FDA warning on naproxen, ibuprofen, other NSAIDs

In case you haven't seen it elsewhere, the US Food and Drug Administration has just issued a warning that naproxen may be implicated in the same sort of heart problems as have just caused them to pull Vioxx and Celebrex. Since many women have used this for postop pain control after a hyst, thanks to its 12-hour duration of action, it's something that we should all be aware of. That doesn't mean you can't use it, but you should definitely discuss the matter with your doctor before doing so. I don't know if this will ultimately include other non-steroidal anti-inflammatories or even aspirin, so keep an eye on the news. This link may not be good for long, but you can read more on the story here.

Update

The above link, originally published in 12/04, is indeed dead now. But the FDA has finally and officially strengthened the warnings on naproxen, ibuprofen and a whole host of other non-steroidal anti-inflammatory drugs (NSAIDs). You can read the story in greater detail here, with all of the new precautions.

The main import for us is the addition of the cardiovascular risk warning, especially that of heightened clot risk. Since our surgery makes us more susceptible to clots (any abdominal surgery does; it's not specific to a hyst) and initiation of hrt can also raise our clot risk, these things all coming together do pose an interesting quandary in pain management and our ability to discontinue narcotics (which contribute to the dreaded postop constipation) as soon as possible. There are no firm answers here, but certainly a need to discuss this with your surgeon preoperatively, when you are still (relatively) lucid—not when you are at home clutching your generic discharge instruction sheet that was actually composed four years ago and never updated, and having second thoughts about what was really said in the uproar of checking out of the hospital.

Another update

As of 9/06, the latest thinking seems to be that naproxen may provide a lesser risk than some of the more high-powered NSAIDs. Still, because this is an issue that is still in flux and so many individual risk factors may come into play, it looks like the best policy remains "ask first."