Join Date: Jul 2011
An overly long list of laparotomy recovery advice
I was lurking around these boards a bit prior to having a rather large laparotomy for what they thought was a 22cm x 32cm ovarian mass (my first surgery, and I was terrified). Due to the size of the cyst, and the need to get it out in one piece, the incision was pretty large (it runs vertically from my public bone to a few inches above my bellybutton). I picked up some advice from various posts here that I was very grateful for, and wanted to add a few more things I learned along the way.
-Pay attention to what you eat. The better shape your body is in, the faster it can heal. It needs vitamins and minerals to do that, so make sure you get plenty. Eat lightly for a few days beforehand.
-Make sure you have things arranged so that you can spend the first week doing absolutely nothing except resting...no housework, no cooking, no errands.
-Make sure you have a few loose, soft comfy dresses. You won't be wearing anything with a waistband for a while, and you likely won't be feeling like going shopping either. That said, you can get bloody sick of walking around in a housecoat, so some actual clothing you'll still be comfy in is a good idea.
-A squishy teddy bear will do wonders, especially if you're scared of hospitals, or of the pain. Trust me on this one.
-Ask the anesthesiologist for anti-nausea drugs along with the anesthesia, and if you have problems with nausea generally, talk to them about it. The drugs work great on most people (I had no nausea at all), and they can give you extra/combinations if nausea is likely to be a problem for you.
-Ask for pain medication that you can control after, if you're opting to use an opiate. Fentanyl is shorter-acting, and causes the least nausea. Morphine lasts longer, but can cause nausea in more people. If you want to keep the amount of drugs you use to a minimum, you can ask them to set your button to a very low dose (and set the frequency with which you can push it higher, if you wish). That way you can take the pain medication you need, without getting extra, and keep side effects to a minimum. If you don't want to have an opiate an epidural may also be an option.
AFTER YOU WAKE UP:
-Make sure you have an extra pillow on hand, or a large stuffed animal, for when you cough. Coughing with staples sucks! If you have a vertical incision and you think you're going to cough sit up and lean forward as much as possible (if you can't sit up, try to bring your knees up), and push the pillow against the incision. If your incision is horizontal, just the pillow should do. It will help, though coughing will still suck. You do need to cough, though, to get the anesthesia out of your lungs, so don't fight it. Besides, even if you do fight it, you won't win, trust me lol. You'll likely just end up having a coughing fit, which will be worse.
-Eat LIGHTLY once you're allowed to eat. I'm a steak-lover normally, but I stuck to vegetarian for 2 weeks after surgery, and I'm glad I did, as I avoided all the bowel problems I was warned of. Anesthesia stops the peristalsis in your bowels, basically freezing your digestive system for a few days (or longer, if things go wrong). Until it "wakes up" everything you eat is basically just sitting there, so don't eat anything that's going to feel like a lump of lead in your belly. An incision in your abdomen also makes it hard to push when you go to the bathroom, so eat lots of fruits and veggies, some whole grains, and nothing that's going to be binding, like meat or cheese. If you're going to eat the hospital food, consider ordering a special diet...vegetarian is probably the way to go. Fruit, yogurt, veggies and some wholegrain crackers was pretty much it for me until everything kicked back in, and that worked nicely for me.
-Drink a lot of water!
-Go easy on the opiates! Opiates slow the peristalsis in your bowels, which can make them take longer to "wake up". They can also prolong the amount of time the pain is going to really bother you, because once you stop them you're going to have to deal with the pain all over again. I did an experiment, and stopped the opiates (Fentanyl in my case) 5 hours after surgery. I had one dose of an OTC painkiller 2 hours after, and absolutely nothing after that. I had bad (but not intolerable) pain the second day, and found it got better steadily after that. I'm not recommending the no painkillers route, unless you really dislike the sensation like me (in which case relax, you can get by without the opiates), but try not to take more than you need to deal with the pain, especially after the first day. You seem to get used to the pain faster without the painkillers, so while the initial day will be worse, after a few days you'll be able to adapt to it to the point where it doesn't bother you 90% of the time. This is where a lower dose per push comes in handy. You can try one push, and if that isn't enough you can always add a second push in a few minutes. Also, keep in mind your sensitivity to opiates may vary. For me 5 mg of Fentanyl was enough to stop about 80% of the pain, and 20 mg (what they initially had mine set to) got me so high I had no idea what was going on, not to mention give me brutal hot flashes. The higher dose didn't seem to add anything to the amount of pain control, either.
-Heating pads help a lot. Even the hot blankets they have at the hospital will help, especially when they're still very hot. Aside from helping with the incision, they seem to be the ONLY thing that helps with the gas pains.
-Get up and walk! The more you walk, the better everything goes. You'll get better faster, feel better faster, have less risk of complications like clots, and your bowels will "wake up" faster. Even the gas pains from the anesthesia will pass faster. If it hurts too badly, try pushing a pillow against your belly while you walk, for me this helped a lot. Also, the first minute or two, as your body adjusts to being upright, are the worst. It does get easier after that.
-Peppermint tea will help wake your bowels back up quite effectively.
-If you can't fart once your bowels wake up and the gas pains start, keep in mind that your muscles are all likely clenched from the pain and the trauma of surgery. Massage your lower back gently, walk around, and try to relax your muscles as much as possible, rather than push. If you can relax your muscles it will come out on its own. Heat packs on your lower back and abdomen will help a lot here, both with the pain and in relaxing the muscles.
-KEEP GERMS OUT OF THE INCISION! Make sure anyone touching the incision, or near it, is wearing gloves. Insist on it, even if you feel silly doing so. This includes nurses and doctors. An antibiotic resistant hospital infection is the worst thing that can happen at this point, so be active in making sure it doesn't. Better a little paranoid than sicker, right? Which leads to the next point:
-Pay attention to what is being done to you, ask questions, and look out for your own health. Ask what medication you're being given every time, especially if you have any allergies. If something doesn't feel right, ask. If your concerns are ignored, ask someone else. While a lot of the people working in hospitals are great, some aren't. And even with the best doctors and nurses, they have a lot of patients, and not that much time. Look out for your own care. You also know your body better than anyone: if something doesn't feel right, it probably isn't.
-Don't worry if your belly looks deformed, or your incision looks crooked. It will be mostly due to the swelling, and to the staples. It will look straighter, and far better, once the staples come out, and even better once the swelling goes down. Promise. Really, it will.
-Ensure your wound is closed before your staples are removed. A small section of mine wasn't, and of course reopened the second they removed my staples. I knew it wasn't healed yet, it felt different and more painful the rest of my incision, I did tell them, but I let them convince me otherwise and wow, did I pay the price. Going home with 3 inches of open incision, fat exposed = very bad idea. An open incision hurts like hell! Its also an invitation to infection (which I did get...after they removed my staples without cleaning the area, or gloves. This is where sticking up for your own health is important). Make sure the area is clean first, because when they pull the staples out there is going to be a whole bunch of little open holes. Once your staples are out you shouldn't feel more pain than before, beyond some stinging where the ends of the staples were. If part of your incision hurts badly and doesn't appear closed after the staples come out ask for steristrips. They're basically stick-on stiches that will fall off in a week or so. They'll keep the wound closed in the meantime, which will help it heal properly (and keep you from getting a wider scar). You're better off getting a doctor or nurse to put them on, as its difficult to hold the wound fully closed and line the edges up nicely by yourself.
-They aren't kidding when they say no lifting, you can give yourself a hernia very easily.
-Stairs aren't nearly as hard as they look. That said, use the railing. Someone standing behind you with their hands on your back going up, or in front of you with your hands on their shoulders going down, might be a good idea the first few times.
-Keep walking, the more the better. You'll be tired a lot for a while, probably for longer than you think, but keep moving, it does help.
-A walking stick or cane is a handy thing for getting up and sitting down at first, especially from the bed.
-Sitting on a pillow will make it easier to get into/out of cars. Bring another to put between your belly and the seatbelt.
-Those log-shaped pillows make a nice wall to keep your signifigant other from rolling onto you/bashing your incision in their sleep. Sleeping with a pillow resting over your belly isn't a bad idea either.
-If someone is helping you stand, have them let you use their arm to pull yourself up using you own strength as much as possible, not pull you up. Being yanked up by someone can hurt, and make it hard to keep your balance.
-Pinch your nose to keep from sneezing, it will usually work. If it doesn't, you'll find out why I said to pinch it...ouch!
-The weird bloating in your belly will go away. It won't, however, go away quickly.
-Rosehip oil will help the scar as much as anything will. DON'T put scar oil, vitamin E, or any other oil or cream on the incision before its fully closed. It will make the scarring worse, and could give you an infection.
-The numbness around the incision will go away eventually. Its been 5 weeks for me, and the feeling has already come back totally in the top half of my scar. The bottom is still numb, but apparently it can take up to a year.
-Orgasm before the no-sex period is up can be painful. I had no incisions on my uterus, so this may not be true if your surgery effected that area, but you can masturbate (without penetration) or get oral sex before the no-sex period is up. Keep in mind, however, that your abdomenal muscles contract when you orgasm, often quite strongly. I found that a month after surgery, I had a little bit of discomfort but nothing major. My experiment 2 weeks after surgery, however, was one of the stupider things I've done.
-I got the go-ahead this week for sex, once I felt up to it. I was a bit worried it would hurt, but pleasantly surprised to find I had only a tiny bit of discomfort, and then only in certain positions. But do be careful once you decide you're ready (and your doc agrees)...gently is one thing, but anything that shakes your insides around is a whole different story.
-Drink a lot of water, especially if you're tired/a bit dizzy. Dehydration can cause low blood pressure, and if you've lost a lot of blood its extra important to drink LOTS.
-Once you're allowed alcohol, be careful. I had one glass of wine, and was hammered. I'm not a big drinker to begin with, but the blood loss and trauma can really whack your system.
-Its normal not to be able to concentrate for a week or two after surgery, you haven't developed ADD overnight, and you will go back to normal.
-Massaging muscles connected to where it hurts can help, if you can't massage the area directly. Your back (especially lower back) and thighs (especially the inner thigh) being massaged can help a lot with pain in your abdomen. I found that massaging my hands and feet also helps with the pain in general.