1. Nursing Instruction
  2. Overview
  3. Women's Health
【Major points】
  1. The day before surgery, eating or drinking is prohibited after midnight (including food and water). Special medications such as antihypertensive drugs should be discussed with the doctor regarding whether they should be discontinued.
  2. After the surgery, adopt a gradual diet approach, starting with a small amount of lukewarm water. If there is no vomiting, you can then consume liquid or soft foods.
  3. After a full seven days post-surgery, you can resume normal activities and household chores. Within the first three months after the surgery, try to avoid lifting heavy objects as much as possible.
  4. After the surgery, it is advisable to supplement with vegetables and fruits as appropriate. We recommend a daily water intake of 2500-3000ml. When having a bowel movement, avoid excessive straining. 
What is pelvic reconstruction surgery?
Pelvic reconstruction surgery can adjust pelvic floor muscles and ligaments through the surgical process.
 
Why is this surgery needed?
Women with loose pelvic floor muscles and ligaments often experience clinical symptoms such as uterine prolapse, bladder and rectal bulging, urinary incontinence, frequent urination, sexual discomfort, lower abdominal sagging sensation, and involuntary urine leakage during coughing, laughter, and sneezing. These discomfort symptoms caused by the prolapse of reproductive and urinary system organs can be improved through pelvic floor reconstruction surgery.
 
Preoperative Preparation:
  1. The patient shall complete examinations ordered by the doctor, including blood drawn, chest X-ray, and electrocardiogram.
  2. Before the surgery, the doctor will explain the conditions and operation-related matters to the patient and the family members. Consent forms for operation, anesthesia, blood transfusion, and the various self-pay items would be filled out.
  3. Before the surgery, it is necessary to shave the hair around operation area. The patient would take laxatives, receive an enema, remove nail polish (including phototherapy nails), and receive nursing instructions regarding operations.
  4. It is forbidden for the patient to intake food and water after midnight the day before the surgery. However, the patient should ask the doctor whether to stop special medicines, such as antihypertensive drugs.
Prepare on the day of surgery:
  1. The patient would be put on surgical gown. All movable dentures, watches, jewelry, glasses, and other metallic objects shall be removed from the patient.
  2. The patient shall urinate before surgery.
Post-operative care:
  1. After returning to the ward, the patient can start drinking and eating according to the doctor's order. The patient could intake some warm water first. If no vomiting occurs, the patient can eat a liquid or soft diet.
  2. After the surgery, gauze is inserted into the vagina to put pressure to stop the bleeding. The nursing staff will remove the gauze the next day after operation, following the doctor's order.
  3. After the operation, the urinary catheter will be placed around 2 to 3 days. After the catheter is removed, if urination is smooth and there are no discomforts, you may be discharged based on the doctor's instructions after measuring the residual urine using non-invasive bladder residual urine measurement or a one-time catheterized measurement.
  4. After the operation, there will be some soreness feeling around the inner thigh due to the surgical wound. The doctor will prescribe painkillers as needed. This soreness will be relieved about 1 to 2 weeks later.
 Home care after discharge:
  1. Frequent urination will occur for about 2 to 3 weeks after the operation. It will improve after the patient takes medicine. If the patient finds it is challenging to urinate smoothly, with frequent urination, lower abdominal pain, and burning sensation, she should return to the Obstetrics and Gynecology Clinic to see the doctor.
  2. There will be a small amount of vaginal bleeding within 2 weeks after the operation, which will gradually decrease. The patient should continue to observe the bleeding and return to see the doctor for any abnormal condition, such as heavy vaginal bleeding.
  3. The patient can start taking a shower immediately after returning home, and she shall follow the doctor's instructions to perform a sitz bath 4 times a day. (Further reading: Warm water sitz bath)
  4. The patient can resume normal activities and do housework 7 days after the operation. The patient should avoid lifting heavy objects within 3 months after the operation, with no more than 3 kg by one hand and no more than 5 kg by both hands.
  5. When returning to the hospital for follow-up visits, the patient should discuss the time for recovery of sexual life with the doctor.
  6. After surgery, it is important to supplement with vegetables and fruits appropriately. It is recommended to drink 2500-3000ml of water daily. When having a bowel movement, please try to avoid excessive straining. If you experience constipation issues, please inform your doctor proactively, you can take stool softeners if necessary.
  7. The patient should follow the doctor's instructions to return to the Obstetrics and Gynecology Clinic regularly for follow-up visits.
References
  1. Radwan, R. W., Tang, A. M., Harries, R. L., Davies, E. G., Drew, P., & Evans, M. D. (2021). Vertical rectus abdominis flap (VRAM) for perineal reconstruction following pelvic surgery: A systematic review. Journal of Plastic, Reconstructive & Aesthetic Surgery, 74(3), 523-529. https://doi.org/10.1016/j.bjps.2020.10.100
  2. Tang, Y. Y. & Lin, L. J. (2019). Organic Diseases. In R. Z. Feng, Y. Z. Ye, M, F. Lu, Y. Y. Tang, A. M. Qi, L. J. Lin, H. L. Li, W. L. Pan, S. Z. Chen, S. F. Tian, F. W. Chang, X. L. Zhao, S. X. Ren, & B. F. Chang (Eds.), Practical Gynecological Nursing (6th ed., pp. 177-198). Farseeing.
  3. Witte, D. Y. S., van Ramshorst, G. H., Lapid, O., Bouman, M. B., & Tuynman, J. B. (2021). Flap reconstruction of perineal defects after pelvic exenteration: A systematic description of four choices of surgical reconstruction methods. Plastic and Reconstructive Surgery, 147(6), 1420-1435. https://doi.org/10.1097/PRS.0000000000007976
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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