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    Post Hysterectomy Problems
    CatMommy1966 posted:
    I just had a laproscopic partial hysterectomy last Tuesday, July 27th. In the days that followed, I was able to go to the bathroom without problems. Now, at almost a week later, I'm having severe pain and cramping when I go to the bathroom.

    I am severely anemic, which is why the hysterectomy was recommended in the first place, and my regular MD prescribed a second iron pill for me to take each day, and I have just started taking them a couple of days ago. I'm certain the constipation is related to those, due to the fact that I was going normally beforehand.

    I also found out, post surgery, that I had a UTI, the presence of e coli in my urine sample, and was catheterized during my surgical procedure.

    My gynecologist's office told me it was okay to take a stool softener, which I did, and have been able to go to the bathroom, but I am having the most severe pain when my bladder is full and when I have a bowel movement. Cramping, gas, and sharp stabbing pains are present when I go to the bathroom, either urinating or having a bowel movement.

    My MD prescribed nitrofurantoin for the UTI, and I've been taking it faithfully since I got the prescription two days after surgery.

    Should I be worried about the pains I'm having now? Is there anything else I can do that I'm not already doing? Oh, I stopped the second iron pill, for the time being, because I don't think making myself constipated will help my recovery any.
    Jane Harrison Hohner, RN, RNP responded:
    Dear CatMommy: So you are now a week post-op and being treated for a hospital acquired E-coli UTI. Despite an easy first few days you are now having continuous pain with urination and bowel movements---hope I am tracking you correctly.

    Yes, you did the correct thing in adding a stool softener as both the extra iron pills and pain medications can exacerbate constipation and slow bowel function (eg cramping, gas). It sounds like you are doing everything possible to eliminate constipation/slowed bowel function on your own. Yet the pain continues to be severe.

    The continued pain with a full bladder can also be attributed to a bowel problem such as constipation or fecal obstruction. Other causes of bladder pain can include interstitial cystitis (less likely), or an incompletely treated UTI.

    PLEASE go back in to see your surgeon for follow up on the continued pain. A test of cure or follow up urine culture can be done. A flat plate X-ray can look for fecal obstructions. A surgical complication can be ruled out. Here is an overview citation on laproscopic procedures from the National Library of Medicine site:

    Minim Invasive Gynecol. 2007 May-Jun;14(3):284-92.
    Major complications of operative gynecologic laparoscopy in southern Taiwan: a follow-up study.

    Tian YF, Lin YS, Lu CL, Chia CC, Huang KF, Shih TY, Shen KH, Chung MT, Tsai YC, Chao CH, Wu MP.

    Department of Surgery, Chi Mei Foundation Hospital, Tainan, Taiwan.

    STUDY OBJECTIVES: This follow-up study examined the major complications among 4307 operative gynecologic laparoscopies. The overall complication rate and each individual category were compared with those of our previous study period. The clinical outcome and salvage procedures were correlated with the time of recognition and the severity of initial procedures in the individual injury type. DESIGN: Retrospective, comparative study based on medical record reviewing (Canadian Task Force classification II-3). SETTING: Tertiary teaching hospital, Chi Mei Foundation Hospital in southern Taiwan. PATIENTS: Records of women (n = 4307) aged 40.5 /- 11.7 years (mean /- SD [95% CI 40.1-40.5>) who underwent operative gynecologic laparoscopies from January 2000 through February 2006 were reviewed in this study. The complications were compared with those of our previous study based on 1507 laparoscopies performed between December 1992 and November 1999 for follow-up comparison. INTERVENTIONS: Gynecologic laparoscopic surgeries. MEASUREMENTS AND MAIN RESULTS: Thirty-four complications occurred in 31 patients requiring repair procedures, 3 of whom had multiple complications, with an overall complication rate of 0.72%. There were 13 bladder injuries, 7 bowel injuries, 3 cases of internal bleeding, 4 vaginal stump hematomas or abscesses, 3 ureteral injuries, 3 major vessel injuries, and 1 trocar site hematoma..... The major complication rate decreased compared with that of the previous study.... (p = .005). The overall complication rates were not significantly different between laparoscopic hysterectomy (LH) group and non-LH group. However, bladder injury happened more frequently in the LH group, whereas bowel injury was more common in the non-LH group. In addition, the severity of the original injury, timing of recognition, and accompanying salvage procedures correlated with the clinical outcomes. CONCLUSION: The significantly decreased major complication rate, as compared with that of our previous study period, confirms the importance of experience accumulation and use of preventive maneuvers in reducing the complication rate. There were no significant differences among the individual injury category during these 2 study periods. The manifestations of bowel injury were highly variable and individualized. The accumulation of surgical experience with the aid of preventive maneuvers is helpful to reduce the complication rate significantly.

    gailinflorida replied to Jane Harrison Hohner, RN, RNP's response:
    Dear Jane,
    I had a laparoscopic hysterectomy 6 weeks ago. The doctor said it would be safe to resume sexual intercourse with my husband. After the first try, my husband stopped because he felt stitches inside me and was afraid of hurting me. How long does it take for stitches to dissolve? Should we be worried about this? Thanks for your help!

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