A surgery journal: hysterectomy and prolapse repair

If you want to know what a hysterectomy, bilateral salpingectomy, uterosacral ligament suspension (changed on the fly from a sacrospinous ligament suspension), and vaginal vault repair are like, this is the post for you.

In English, they took out my uterus, cervix and fallopian tubes, stitched the top of my vagina to the ligaments that used to hold up my uterus, cut away some of the excess skin of my vagina and tried to create scar tissue that would hold up my bladder and rectum. This was done to repair three prolapses: bladder (cystocele), rectum (rectocele) and uterine, all trying to escape through a too-big vaginal opening (which they also made smaller).

This is mostly narrative, punctuated by lists, but I’m starting with lists as there’s not much to say about the pre-surgery experience. Well, except maybe this: I walked through as much of the grief of losing my uterus as I could ahead of time. I did my what-ifs and imagining another newborn in my arms (and all of the things I’d have to re-buy that wouldn’t fit in the basement anymore) to make very sure I didn’t want that. I cried sporadically. I marked my last period (if only to myself). And this really set me in good stead for the healing process, because my struggles were mostly physical. The emotional/existential part was as done as it ever is.

So back to the nuts and bolts.

1 week before surgery

• quit all supplements
• remove pessary
• start TheraCran supplement (believed to cut risk of a post-surgical urinary tract infection from 2 in 5 to 1 in 5, and I’ll take those odds.)

Night before surgery

• shower with antibacterial soap
• eat a lot of carbs

Day of surgery

• Shower with antibacterial soap
• Arrive at the hospital at an unreasonably early hour

My mom drove me to the hospital and walked with me to the waiting room. We’d hardly sat down when the tech came to get me. I was fighting back tears, afraid of the pain, sad that my mother couldn’t be there for me when I came out of surgery in these COVID times, and mourning the loss of my fertility in its final hour.

I got ahold of myself through the prep as I changed into a hospital gown, peed in a cup for my last pregnancy test (which felt a little cruel, but it’s better to be sure). I sent my mother a text to say that I was OK so that she wouldn’t spend the surgery thinking of my eyes full of tears. I got hooked up with monitoring electrodes and an IV and swallowed 1000mg Tylenol.

I was very happy not to have a vasovagal reaction with the IV, which was inserted correctly the first time. Stab my veins when my stomach is empty and my blood sugar is low, I’m likely to go full Victorian lady in need of a fainting couch, as I’ve learned twice from giving blood and from another procedure.

But I wobbled when one of the techs, nurses or anesthetists suggested that I would be able to have a visitor after surgery, raising my hopes. She was wrong. I told myself to stop crying — I’m a grown-ass woman and I could survive surgery without my mother. The professionals around me, all women, were very nice about the whole thing.

I remember getting my emotions back in check, but I don’t remember the anesthetist putting me under. My timeline skips straight to the post-op room, where I came to with a deep ache where my uterus used to be. I gave them a fairly high pain rating, and someone said they’d give me fentanyl, fed through the IV. This alarmed me because the only thing I know about fentanyl is how easily it can kill you. But as a pain reliever, it was awesome. It was the last time I’d be pain-free for days. However, it also made the room spin and made me nauseous. They have drugs for nausea too.

Once the fentanyl wore off around noon, the ache was unrelenting, oscillating between bad menstrual cramps to hours-long labor contractions. It turns out that ordinary opioid painkillers don’t work for me as a rule. One oxycodone did nothing and two still did nothing but make me nauseous, as Vicodin had years before. Thank goodness for the anti-nausea meds, as vomiting is a bad idea after pelvic floor surgery.

Eating was a terrible chore, made bearable only by the fact that the kitchen staff provided me with four perfect strawberries that I enjoyed after I had choked down my chicken noodle soup diluted with white rice. This I had ordered off a menu that mostly contained foods that seemed obscenely rich and impossible to eat (things I remembered eating with gusto after the births of my children).

I stayed in bed four or five hours before getting up to do the “voiding trial” to see if I could pee. This involved sitting on the toilet while the nurse used the catheter to fill my bladder with fluid and then see if I could pee it back out. If not, the catheter would stay in.

There was a chance that I would have to go home the next day with a catheter, so I was very glad when I succeeded. It also meant I could wear hospital underwear and no longer bleed directly onto a pad on the bed. That said, it was like my body had forgotten how to pee. There was something a little convulsive about the process, like I was tightening more muscles than needed to to get the job done.

The exertion of all this left me shaking uncontrollably, so I got back in bed, accepting the warm blanket that the nurse offered, and she turned up the thermostat too. I began getting up to use the toilet about every hour, still not quite right about it, and the shaking returned every time into the middle of the night. I believe the shaking is a reaction to the unrelenting pain, as I shook the same way during my first labor.

At some point in the late afternoon, after it became clear that the opioids weren’t working, the nurse offered me a heating pad. I had been wishing for one but hadn’t thought to ask. She brought me two rounds of disposable heat packs before it arrived from somewhere else in the hospital, but when it did, it was magnificent. It used water to provide the heat to a flexible pad like a personal boiler-radiator set. I spent most of the next twelve hours with this device wrapped around my lower abdomen, dozing for an hour, getting up to pee, settling myself in the bed, and dozing again.

In the night, punctuated by the taking of vitals and the giving of meds by friendly nurses, the pain began to ease. I stopped shaking after each toilet run. I also got hungry for the first time in the early hours of the morning, eating the pretzels and plain raw vegetables I hadn’t been able to face earlier.

At breakfast, I was still forcing myself to eat more than a mouthful or two at a time, but I managed an omelet with vegetables and cheese, which would have been unimaginable the day before. By the time I left at 10:30 AM, I no longer needed the heating pad.

Day 2, first day home

The pain morphed from the overwhelming ache in my lower abdomen that had drowned out all other pain to the ache around the stitches, where the flesh had been torn and sewn back together. I didn’t feel this internally, but rather where the stitches left my vagina for the perineum. They must have removed some of the scar tissue from one of my labor tears (after all, if you’re removing tissue, why not remove the stuff that’s already messed up?).

Anyway, this created a deep ache in my bottom, which turned into the primary pain bothering me. Mostly, I could get relief lying down in bed. Sitting hurt after a while, and standing could only be tolerated for short periods. I highly recommend getting all your over-the-counter pharmacy stuff ahead of time so that you can use the drive-through for any prescriptions (I could have saved myself the whole post-surgery trip).

Here’s what I needed:

• Cotton menstrual pads
• Miralax (laxative)
• Colace (stool softener)
• Ibuprofen — 200 mg type
• Acetaminophen (Tylenol) — 325 mg type

Because the weather was mild, I made a point of getting into the sun. But meals were best taken in bed for me, and kept fairly light as well. Hummus, crackers, soup, and so on. Although, shortly before bed, I was starving after another tiny meal had worn off, and I had to eat more before I could sleep for fear of what the ibuprofen would do to a stomach that empty.

I kept crackers and nuts by the bed so that I’d be able to eat something with the overnight meds. I slept well except for the period when the 6 PM meds wore off and the 12 PM meds hadn’t kicked in yet, when I was awake for a couple of hours.

The bleeding isn’t bad, just spotting, so I replace the pads about every 8 hours. Considering that wound bandages only get replaced about once a day, that’s probably more than necessary.

Meds (roughly):
12:00 PM — 600mg ibuprofen, 650mg acetaminophen
2:00 PM — 17g Miralax
6:00 PM — 600mg ibuprofen, 650mg acetaminophen, 100mg Colace

Day 3

The pain in my bottom got worse on this day, possibly due to the extended time spent standing at the pharmacy the day before. I became more careful about how many times I climbed the stairs, but I made a point of drinking my afternoon Miralax in the sun. The sun is good for convalescents.

I was still cheating my pain meds back a few minutes with each six-hour span between doses, although I don’t show this in the rough dosing plan below. The pain was still high for the two hours between the last dose wearing off and the new dose kicking in, and it got higher as the day wore on.

I began to get the convulsing with urination under control with slow breaths out. A nurse called and put the fear of God into me about getting that first bowel movement done (and also about emptying my bladder completely). My mother made another run to the pharmacy for milk of magnesia, as that is what I was supposed to take if I hadn’t managed by evening.

Lucky for me, that movement came within the hour that I intended to take the milk of magnesia. It was more solid than it should have been (the surgical team said the goal was “a consistency like toothpaste”) and my body still couldn’t quite remember the mechanics of how bowel movements are supposed to work, so it was worryingly convulsive, but it was a start. And I didn’t tear my stitches.

As for food, I began to get my appetite back, although there were still many things I couldn’t imagine eating. I began to get used to the idea that I’d have to call for my meals in bed like a damn queen for a few days.

At night, I didn’t sleep as well, staying up for several hours waiting for the 12 PM meds to kick in.

Meds (roughly):
12:00 AM — 600mg ibuprofen, 650mg acetaminophen
6:00 AM — 600mg ibuprofen, 650mg acetaminophen, 100mg Colace
12:00 PM — 600mg ibuprofen, 650mg acetaminophen, TheraCran
2:00 PM — 17g Miralax
6:00 PM — 600mg ibuprofen, 650mg acetaminophen, 100mg Colace

Day 4

Urination became more normal, and I had my first pain-free time while on my feet. I used this to take a shower. My morning appetite was better and I managed a small bowl of oatmeal. My mom went home on this day, so my partner was left as sole domestic support.

Miralax in the sun again, and a normal (too solid) bowel movement in the afternoon.

The evening was very painful even though I had tried to be very judicious with movement during the day. Still mostly ate and drank in bed and spent some time sitting on an ice pack.

The night was good — I woke by alarm for the pain meds for the first time, rather than waking ahead of the alarm, and I did not need to spend more than an hour reading before the pain had subsided and I felt sleepy again.

Meds (roughly):
12:00 AM — 600mg ibuprofen, 650mg acetaminophen
6:00 AM — 600mg ibuprofen, 650mg acetaminophen, 100mg Colace
12:00 PM — 600mg ibuprofen, 650mg acetaminophen, TheraCran
2:00 PM — 17g Miralax
6:00 PM — 600mg ibuprofen, 650mg acetaminophen, 100mg Colace

Day 5

My appetite began to approach normal. After having more than one sufficiently loose bowel movement in the morning, I decided I could skip the Miralax and had lunch outside instead.

My pain-free period in the morning was longer, but as the day before, it didn’t quite repeat in the afternoon. That said, the afternoon was less painful and didn’t land me on the ice pack again. This was the first day I opened a computer and started writing again, rather than just reading books or watching movies to take my mind off the pain. I also had dinner at the table for the first time.

I was OK when it turned out my toddler needed an unplanned bath at bedtime, which I couldn’t have handled even the day before.

Overnight was good, only awake briefly for meds and by alarm rather than pain.

Meds (roughly):
12:00 AM — 600mg ibuprofen, 650mg acetaminophen
6:00 AM — 600mg ibuprofen, 650mg acetaminophen, 100mg Colace
12:00 PM — 600mg ibuprofen, 650mg acetaminophen, TheraCran
6:00 PM — 600mg ibuprofen, 650mg acetaminophen, 100mg Colace

Day 6

My appetite was normal, and my pain-free periods were long. Having developed diarrhea, I quit the Colace. (The diarrhea could also be because I suspect citric acid gives me diarrhea, and I was taking the Miralax with juice.) I did a load of laundry, taking care to make sure I didn’t lift more than ten pounds at a time, and resting a lot.

Overnight was nearly pain-free.

Meds (roughly):
12:00 AM — 600mg ibuprofen, 650mg acetaminophen
6:00 AM — 600mg ibuprofen, 650mg acetaminophen
12:00 PM — 600mg ibuprofen, 650mg acetaminophen, TheraCran
6:00 PM — 600mg ibuprofen, 650mg acetaminophen

Day 7

Because I had nearly no pain while one dose of painkiller wore off and the next kicked in on Day 6, I dropped the acetaminophen. Also, because I’d been gradually shifting my painkiller intake forward as the times between got less intense, you’ll see my meds schedule shifted by an hour. Then I shifted it by another hour just by forgetting to take them.

I did another load of laundry and showered again. Still had diarrhea.

Meds (roughly):
1:00 AM — 600mg ibuprofen
7:00 AM — 600mg ibuprofen
1:00 PM — 600mg ibuprofen, TheraCran
8:00 PM — 600mg ibuprofen

Day 8

The night leading into this day was the first that I skipped the overnight dose of pain meds. I took 600mg ibuprofen in the morning more as a precaution, so I wouldn’t have to increase my time spent in bed. Then 400mg in the afternoon and 400mg before bed.

The stitches were dissolving by now, with the blood spotting more or less replaced by the discharge that the surgeon said would come with the stitch-dissolving process. The regular cotton pads are overkill, and I change them twice a day now.

I slowly continued increasing my activity, getting my own food from the kitchen, walking around the yard. I also managed to give a kid a bath.

Day 9

On this day, I quit the ibuprofen. But I still didn’t tolerate sitting on hard surfaces very well.

Day 10

By now, I was able to do some food prep for the kids as well, but I still tired very easily and spent time in bed (part of this might be not sleeping well, unrelated to surgery). Washed another kid.

Day 11

I realized that I may be reacting to the TheraCran and decided to stop taking it. Not many people react to citric acid, so most people will be fine with the TheraCran.

I also swapped my partner’s and my winter clothes for summer clothes, as these boxes are fortunately on the floor of our bedroom and can be slid around. The task did not require any lifting. I rest after doing things like this.

I managed my first walk around the block in the evening.

Day 12

I was sore in the morning from the walk, so I took it easier on this day.

Day 13

I did a little bit of (very) light work in the yard and another load of laundry. I had almost no pain, except that anything moving toward the end of my colon is very painful. So the tissues around there are still pretty mad if they get pushed on.

Also, I get very tired, and I get back in bed in mid-afternoon for a rest most days.

Supervised the older kid in the bath, as he learns to wash himself.

The third week

Week 3 after surgery proceeded on a good path, with more walking (up to a mile), more laundry, more bathtimes, less fatigue. After a shopping trip, I was surprised to see maybe half a teaspoon of dark red blood in my pad, as I hadn’t bled in more than a week by that time. But the surgeon’s assistant said that’s no big deal if the bleeding isn’t continuing, and if I don’t have pain with it. Apparently blood can get stuck somewhere, only to break free when you start moving more again.

The most intense pain I experience is holding in a bowel movement, probably because of that still-healing rectocele repair. Hopefully that will go away with time.

I still get tired early in the evening and sometimes need to go sit down or lie down.

It’s too soon to know the extent to which the surgery worked (I don’t think my bladder has been totally cooperative, but walking comfortably without a pessary is amazing). I still have physical therapy ahead of me. But since I go back to work part-time starting tomorrow, I’ll go ahead and post this. Otherwise it could be years before I get around to it.