Post-operative Advice and Exercise following Surgery

A Guide to Returning to Pre-Surgery Fitness

Contents
Pages After your Operation ........................................................ Breathing and circulation Moving Around & Getting Comfortable ............................ Pelvic Floor exercise .......................................................... Abdominal (Tummy) Exercises .......................................... Safe Lifting ...................................................................... Emotions .......................................................................... 1-2

3-4 5-6 7-8 9 9

After Leaving Hospital ...................................................... 10 - 12 General Tips Rest & Exercise Housework & Gardening Driving, & Sex) Returning to Work .......................................................... Further Information .......................................................... 12 13

From the day of your operation

Start these two simple exercises as soon as you wake up. Continue until you are fully up and around.

Breathing Exercises
Regular DEEP BREATHING exercises will help to:

keep your chest clear ease nausea (sickness) relax and calm you ease wind pains

Bend your knees up gently, feet on bed.

Take a slow, deep, comfortable breath in Allow your tummy to rise Hold for a moment, then sigh out Do 5 of these deep breaths Rest for a few normal breaths Then do 5 more deep breaths
Try to do these every hour during the day.

If you have the need to cough something up (secretions), the least painful and most effective way is to huff. Start with the deep breaths. Support firmly over your dressing or pad with both hands, and do a short, forced breath out through an open mouth as if steaming up a mirror (this is a huff). Finish with some deep breaths. It will help to hold yourself in the same way if you laugh or sneeze.

Circulation Exercises
These should help to maintain the circulation in your legs whilst you are not so active. Keep your legs and ankles uncrossed at all times

With your legs stretched out, briskly circle your feet and bend them up and down. You should feel your calf muscles acting as a pump. Do these often while you are awake.

Moving Around, and In & Out of, Bed

It is important to do these in a way, which does not strain you.

1.

1. Bend both knees up and press them together. Turn your head.

2.

2. Reach across with your top arm and roll onto your side (gently pulling your tummy in).

Then - To move up the bed

3a.
3a Prop up on your elbow and push up through your hands and feet.

or To get out of bed

3b.

3b Lower your feet off the bed and slowly push yourself up to sit on the side of the bed. Slowly straighten up.

Do the reverse to get into bed, sit as near to the pillows as possible.

Getting Comfortable in Bed

When lying on your side, try supporting your tummy and top leg with pillows.

Sitting up in bed, place your bottom as close to the back rest as possible. Use the pillows to keep your back straight and supported.

Sitting and Standing

Many people sit out of bed on the first day after their operation. Support your back in the chair with pillows or a small rolled towel, so you are sitting upright

When you first stand up or start walking around you may be tempted to stoop. Try to stand and walk as tall as you can. Relax your shoulders.

Exercising your Pelvic-Floor Muscles

Your pelvic floor muscles form a wide sling between the coccyx (tailbone) and pubic bone.
Spine (back bone)

Bowel Uterus (womb) Bladder Pubic Bone Urethra (front passage) Vagina (birth canal) Anus (back passage Perineum/Vulva Pelvic Floor Muscles
They are important for

 good bladder and bowel control  supporting the bladder, bowel & uterus  enjoyment of sex
Start to exercise them as soon as your catheter has been removed.
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How to exercise
Get into a comfortable position. Imagine that you are trying to stop yourself from passing wind and at the same time trying to stop your flow of water (urine). Tighten those muscles.
The feeling is one of squeeze and lift, closing and drawing-up the back and front passages.

REMEMBER:

Dont hold your breath, or pull in your tummy, or tighten your buttocks, or squeeze your legs together.

Now that you can do the basic pelvic floor exercise, you can use it to gradually tone up your muscles.
How many to do

Start with what you can do now How many seconds can you hold the squeeze for? (maximum of 10 seconds) How many times can you repeat this? (Up to a maximum of 10, resting for 4 seconds between squeezes). Squeeze and lift more firmly and let go quickly. How many of these quick squeezes can you do?

Now that you know what your starting block is try to do this starting block 4 to 6 times a day. (For example, a 5-second squeeze repeated 5 times, plus 5 quick squeezes). Remember also to squeeze your pelvic floor as you cough, sneeze, run or lift.
If you are having problems controlling your bladder or bowel (such as wetting, soiling or having to rush to the toilet) ask your Doctor for advice and/or to be referred for treatment.

Exercising your Abdominal (tummy) Muscles

These exercises are a useful part of your recovery. The first two can help to ease low backache, wind, and constipation. They can be started in the first few days after your operation. Do them 3 times a day.

1. Deep Abdominals
Lie on your back, knees bent, feet flat. Put one pillow under your head. Breathe in, gently letting your tummy rise.

As you breathe out, gently draw your tummy button towards your spine. Hold for a few seconds, then relax Rest for a few seconds Repeat 3-5 times to begin with

REMEMBER:

Keep your back still. Dont hold your breath. gently squeeze your pelvic floor too.

Aim to build up gradually - holding your tummy in for a maximum of 10 seconds, repeating it up to 10 times.

2. Pelvic Tilting
Lie in the same position as exercise 1. As you breath out and draw your tummy in, gently tilt your pelvis (pubic bone) and flatten the small of your back into the bed or floor.

Hold for a few seconds, then relax. Repeat 3-5 times and gradually build up to 10 times.

3. Knee Rolling
Lie in the same position as exercise 1.

Draw your tummy in. Slowly lower your knees a little to one side and then to the other side. Stop and relax in the middle. Keep breathing. Repeat 3-5 times and gradually build up to 10 times.

REMEMBER:

Exercise should not cause pain. Do not exercise if you feel unwell or are in pain (except wind). Start gently and progress at a speed which suits you.

Safe Lifting
Think before you lift. If in doubt, ask for help. Practice with the light things, and then you will be in a good habit for heavier ones.

Get close to the object, feet wide apart. Bend your knees, (or go down onto one knee). Take a firm hold around the object. Tighten your pelvic floor and tummy muscles, and slowly stand up. Use your legs to do the work and lead with your head.

Emotions
For the first few weeks you might feel a little down or tearful at times. This is quite common and will soon pass. But if you feel very down or upset, or if you are worried about your recovery, speak to your doctor or telephone the ward.

After leaving hospital

Before your discharge you will be invited to attend a group session to discuss guidelines for building up your everyday activities.

GENERAL TIPS:

Listen to your body Use your common sense Stop if it hurts Rest if you are tired Everything in moderation Build up your activities gradually

Rest and Exercise

When you go home, do not push yourself too hard too soon. At first you might feel weak and tired, and you may have difficulty concentrating. Your will need to build up your strength and energy again. This should happen gradually over the coming weeks, and will be different for everyone. Do not feel a failure if others seem to recover more quickly than you. Allow time to rest when you get home, it is part of your recovery. Avoid standing for a long time. Sit on a stool or chair whenever possible, to begin with. It is also important to make time for your pelvic floor and abdominal (tummy) exercises every day. Walking is also a very good exercise for you at this time. Start with a 5-10 minute stroll, and gradually increase the length and pace of your walk. Aim to do about a hours walk by 6 weeks, or two shorter walks if your prefer. If you had no problems going up or down stairs before your operation, you should not have any problems when you go home. Do not rush or carry too much.
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REMEMBER:

Do what you can comfortably do now and do not necessarily try to do more than you could before your operation.

After your 6 week check-up, you can start to swim again and gradually return to other low impact activities, such as cycling, gentle dancing or keep fit classes. Do not start competitive or contact sports, heavy gym work or high impact aerobics until at least three months after your operation. If you have had a repair or have continence problems, seek advice first.

Housework and Gardening

Start only with light chores, and do not try lots of new things in one day.

Take your time, find your own pace. Kneel to make the bed or clean the bath. Sit to prepare meals Sit to iron, keep the ironing board set up, and do small amounts at a time. Sit or kneel to do light gardening jobs, such as weeding or potting. Hoover only the carpet you can see.

Avoid lifting

toddlers, children or pets baskets of wet washing the vacuum cleaner or lawnmower heavy shopping bags heavy furniture or machinery

REMEMBER to lift safely. NOTE: If you have had a repair, wait at least three months before lifting heavier items, and never lift children or heavy furniture.
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Driving
Check with your car insurance company when you will be covered after this major surgery. You should be safe to drive when you are able to - concentrate - do an emergency stop (comfortably) - handle the car, especially turning and reversing.

Sex
For most women this will be possible as usual once you are healed. Check with your doctor if you are unsure. Some women and their partners feel anxious about having sex again. Unless your doctor has advised you otherwise, you may prefer to wait until after your first follow-up appointment (around 6 weeks). When you do start again, try out different positions to find the most comfortable. You may, also, find it useful to use lubrication such, as Senselle or Sensilube (ask your chemist).

Returning to work
This very much depends on your job, as well as your operation and the speed of your recovery. Those doing hard, physical jobs will need to stay off work for longer than those whose jobs are less physically demanding. Look into options such as light-duties or part-time hours to start with. If you need more time off work when your hospital sick note is running out, discuss it with your GP.

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Other information available from Physio includes:

Continence (bladder control) Constipation Wind & massage Relaxation Lymphoedema

If you have any further questions, ask the Physio on your ward or get in touch with the Physiotherapy Department on 0121 627 2745.

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Birmingham Women's Health Care NHS Trust

Edgbaston, Birmingham B15 2TG Telephone: 0121 472 1377 Fax: 0121 627 2602

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