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A Case Study: Post-op Gynae Complications

29 December, 2012

The best thing about writing a blog is the ability to reach women all around the world and have a chat about their bladders, bowels or prolapse. I also get many email enquiries about problems following their gynae repair surgery. Recently a lovely lady – we’ll call her Mrs L wrote asking a question in an email, when purchasing my first book called Pelvic Floor Recovery: Physiotherapy for Gynaecological Repair Surgery. Initially she said she reported a few issues following her hysterectomy. But little by little her story came out and my response to her was a rather vulgar :”Wow you have been through hell!”

Mrs L in fact had the full works with her hysterectomy – a cystocoele, rectocoele, enterocoele repair and bladder sling with mesh for stress incontinence. Very major repair surgery indeed and unfortunately she had a difficult recovery – which can and does happen, which is exactly why I wrote my book. The book assists women with a plan of attack before and after their surgery to enable a speedy and safe recovery to enhance the chances that their surgery will last as long as possible. I find that patients often have an attitude that doing all the conservative measures to manage incontinence and prolapse is a bit of a pain, a bother…they don’t have time to do all that stuff! They just want to get on and have the surgery. And don’t get me wrong, if patients have exhausted the conservative measures and are still leaking, or their prolapse is too significant and definitely needs repair, then of course the surgery is important and necessary. But the thing is once you have the surgery you must keep going with all the conservative strategies to ensure the surgery lasts forever!!

The point of this blog is to point out that complications can happen and to caution women about rushing in with their repair without being suitably prepared. Here is Mrs L’s story.

The day following my surgery when I began walking around, I experienced a lot of pain in my left leg. This pain has not gone away and it is now 2 months post-operative. The pain is not as severe as it was but it often times is debilitating if I am on my feet for long periods of time especially. An ultrasound was performed after a few days which was negative for clots and then an MRI which showed fluid in two spots (left and right side) behind the rectum. The left side showed a larger amount. They attempted to aspirate the fluid with CT guidance only to find no fluid but scar tissue. I also had not had a bowel movement since the day before I was released from the hospital. Many attempts to sort the bowels (a mineral oil enema and pills that they use to clean people out for colonoscopies-twice……), with no results and I then began to throw up. I was then told to go to the ER.

A CT scan and my growing abdomen showed that my GI tract had stopped working. It was basically in a paralysed state-it had shut down. There was so much pain. They then admitted me to the hospital and with several enemas later things finally moved. I seriously wanted to die. The pain was intense. The emotional havoc was almost unbearable. I was released on a liquid diet for the next 2 weeks. I feel this whole episode set me back a bit in my recovery as I went home with a lot of pain in my rear end. I am sure all the enemas and bowel movements aggravated the repairs.

While the pain is not near where it was initially, it is definitely still present. It seems to be the worse when I am on my feet a lot but also when I put any weight on my leg or bending over. It occasionally goes kind of numb and has that tired leg feeling most of the time. I feel a lot of pain right in the middle of my left butt cheek. I am only 47 and have had four children that range from 22 to 2. I have pretty much always been active and was in the best condition of my life in my 30s and early 40s. I am not ‘a sit around and whine’ kind of person. I WANT and NEED to be active and usefulwhy doesn’t ANYONE ever tell us or warn us about what problems we could have?

A harrowing read I am sure you will agree. What Mrs L suffered is called an ileus-  a less common post-op complication but one of the most important things to learn prior to surgery is to learn the correct way to defaecate, to take the correct product (Osmolax or Movicol) to produce a soft, ’easy-to-pass’ stool regularly and for a number of weeks post-op and importantly never strain!!

Other more common complications include: urinary retention, bladder urgency and urge incontinence, prolapse recurrence, pain with intercourse, ongoing buttock pain (like Mrs L had). But I also see many women whose lives are transformed by their surgery and due to good preparation and ongoing vigilance with their conservative strategies – regular pelvic floor exercises, bracing with increased intra-abdominal pressure, good defaecation habits and ‘pelvic floor safe exercising’- they are happy and fulfilled!

I am waiting to hear from Mrs L to see how her progress is going and hopefully her 2013 will herald a turnaround in her symptoms.

A happy and healthy New Year to all who read this!

  1. Neroli permalink

    Feel for L . Look forward to hearing good reports moving forward for her.
    I too am recovering from a total pelvic floor reconstruction I am day 5 now and at home pottering around . My damage occurred with my first born who was only 6.2lbs, it was total mis management in the delivery room by the obstetrician who said nothing about what she had done to me . I have been living this way for 11yrs due to our desire for more children. Children for us has been very complicated and IVF was involved hence the long time before my repair was performed. I am glad to say we have 3 beautiful children ages 11 and 5. Yes I have twins, which would have only added a bit more to my already damaged pelvic floor. I had a C section with the twins and only wish I had ordered the same for my first. The recovery from the C section was a breeze compared to the 12-18 months after the vaginal delivery and the ongoing complications of it that I will have for life. I too was a very fit athletic type person running, playing hockey, skiing, you name it I was in it. That all stopped after my first born at age 36yrs. I am currently a few months of 37yrs .
    My repair was also delayed post twins, as I was in a bad car accident(young buck speeding) when the twins were 9weeks old, due to recovering from this event. I had a 1st rib resection performed last year to try and fix nerve damage down my right arm . A condition called thoracic outlet syndrome. I am no stranger to pain and know that it is temporary and things will always get better. I am very lucky to still be alive and in one piece and thank God that I am still here to enjoy life .
    I am looking forward to this repair being successful and returning to an active life. Not sure how active at this stage. My Dr has told me I can run again but am feeling a little bit devastated as on reading things on this web site by Sue, I am not convinced this is the case? I don’t want to have to go through this painful surgery again if I can help it.
    I suppose I am a bit of a C section advocate specially if people are very sporty as it is a huge risk, I also understand that there are risks with C section as I am also a registered nurse but for me personally they are fair less than a vaginal birth being mis-managed and someone having issues for life

  2. What a super blog Sue, as you say it is right that women are prepared for their surgery and how best to convalesce. Surgery as we all know if MAJOR SURGERY but it is vital that a woman arms herself with your book and vital post-surgery information so she can plan and be prepared – whether things go well or not well at all. I am sure this blog will reassure a lot of women reading it.

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