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Gynaecology Enhanced Recovery After Surgery Class

 

On This Page

 

About GERAS

Advice for the first day after your surgery

Get Moving

Things to consider - going to the toilet

Early Exercise

Hospital to Home (Up to Six Weeks Post-Op)

Returning to Normal Activities (Six Weeks Onwards)

Helpful Links


About Gynaecology Enhanced Recovery After Surgery (GERAS)

 

Gynaecology Enhanced Recovery After Surgery (GERAS) is a UK wide patient-centred care pathway. The aim of GERAS is to improve patient recovery while ensuring a high standard of patient care.  

 

Physiotherapy Specific GERAS Information

 

Advice for the first days after your surgery

 

Breathing Exercises

This exercise is helpful if you have mucus to clear from your chest after surgery. It may also help you relax, relieve nausea and move any trapped wind.

  • In sitting or lying, take a deep breath in through your nose, hold for two seconds and then slowly sigh the air out through your mouth. You should feel your tummy rise then fall
  • Try this two to three times and then rest
  • Repeat this every hour

 

 

Huffing

This breathing technique will also help to clear any mucus.

  • Support your wound with your hands or a rolled up towel, take a deep breath in, and then breathe out quickly and forcefully through your mouth, making a huffing sound as if you were going to steam up a mirror.
  • Repeat when necessary

 

Coughing

You will not harm your stitches or scar when you cough. You will feel much more comfortable and able to cough if you support your stitches with your hands, a folded up towel or a pillow. If your surgery is through the vagina place your hand firmly over your sanitary pad.

 

 

Circulation Exercises

When in hospital, we will probably ask you to wear TED stockings. These stockings are special support stockings to reduce the risk of blood clots. However, you should also do the following exercises to help maintain blood flow in your veins and help prevent blood clots developing.

  • When you are resting in bed or sitting in a chair bend your feet and ankles up and down briskly for 30 seconds every hour

 

 

Getting moving

 

As part of the ERAS pathway, we encourage early mobilisation. However, depending on the type of surgery you've had and your Consultant's post-operative recommendations, the time in which you mobilise from your bed may vary person to person.

 

Benefits of Early Mobilisation

  • Reduces risk of respiratory complication
  • Reduces risk of blood clots
  • Reduces risk of infection
  • Reduces length of stay in hospital
  • Enhances your recovery

 

 

To turn onto your side from lying on your back

  • Bend one knee up keeping your feet on the bed followed by the other
  • Support your abdomen with your forearm
  • Take care to move your shoulder and knees at the same time to roll onto your side

 

To get out of bed

  • Roll on your side as described as above
  • Push your body up by pushing down onto the mattress with your upper hand allowing your feet to go down to the floor
  • Sit on the side of the bed for a minute
  • Stand by pushing up with your hands and legs. Stand tall and support your wound if it helps you feel more comfortable

 

 

To get into bed

Stand with the back of the knees against the bed

  • Support your abdomen with one hand and put the other on the bed behind you
  • Bend forward as you sit
  • Lower your head and shoulders sideways on to the pillow while lifting your legs onto the bed
  • Keeping your knees bent, roll onto your back

 

Sitting

  • When sitting in bed or in a chair, sit right back
  • Place a small pillow or rolled up towel behind your lower back
  • Your feet should be flat on the floor

 

Standing

Good posture will help prevent backache. You will feel better if you stand tall.

 

 

 

Things to consider - going to the toilet

 

The ideal position for emptying your bowels is shown in the diagram.

  • Relax and give yourself plenty of time
  • When moving your bowels you may find that some extra support will make you more comfortable. Try holding a sanitary towel firmly in front of your back passage keeping even pressure. Supporting your wound with a folded towel can also help
  • Do not strain. Breathing out as you move your bowels or passing urine may help

 

 

 

Early exercise

 

It is important to exercise your abdominal muscles following your surgery. They form a natural corset and help to support your back and internal organs. The following exercise can also help to relieve wind and backache both of which are often felt after abdominal surgery.

 

Deep Abdominal Exercise

Pelvic Tilt Exercise

Pelvic Floor Exercises

 

 

Hospital to Home (Up to Six Weeks Post-Op)

 

As you feel more comfortable increase the amount of walking you do about the ward and take the opportunity to get as much rest as you can. Remember recovery from surgery varies with every individual. Listen to your body.

 

Going Home

Your stay in hospital will vary depending on the type of surgery you have had. Even when your wound heals, healing continues in the deeper tissues. Take advantage of any help offered.

 

Travelling

You may be more comfortable if a towel, folded into a pad is placed across your abdomen.

 

When getting into the car

  • Lower yourself backwards into the seat by bending your knees, holding onto the frame of the door for support
  • Move yourself back into the seat
  • As you turn to face forwards lift one leg at a time into the car
  • To get out of the car reverse this procedure

 

Returning to driving will depend on the type of surgery you have had, advice from your surgeon, your recovery and your comfort. It can take as long as six weeks following major abdominal surgery before you feel able to drive.

Make sure that you:

  • Check your insurance cover
  • Can wear a seatbelt comfortably
  • Are able to concentrate as normal
  • Are able to make an emergency stop
  • Can look over your shoulder to manoeuvre

 

Exercise

  • Continue the abdominal and pelvic floor exercises are previously mentioned
  • Gradually increase the time you walk every day over the first 6 weeks. Aim to gently increase the pace and distance as you get stronger, without becoming overtired or increasing your discomfort or pain.
  • Try to take one or two short walks during the day setting yourself a target of 10 minutes for the first one-two weeks, a 15 minute walk by four weeks and by six weeks a 20 minute walk.

 

Housework

For the first six weeks after major abdominal surgery you should only lift light loads such as one litre bottle of water (1.1 kg). You can gradually increase this to three litres by 12 weeks after your surgery.

Always remember to bend your knees, pull in your deep abdominal muscles and draw in your pelvic floor muscles as you lift, this can help protect your back.

Try common daily activities in sitting instead of standing, such as preparing vegetables.

 

Rest

For the first six weeks try to take a rest every afternoon lying on your bed for a least an hour.

 

 

Returning to Normal Activities (Six Weeks Onwards)

 

You will probably have had a six week postoperative check. You may feel able to return gradually to both work and previous activities. We advise you to check with your surgeon if you are unsure.

 

Returning to Work

You may feel ready to return if your job is not physically demanding or is part time. If your job involves heavy lifting, returning to work will take longer, 10-12 weeks depending on how physically demanding it is. Your employer may offer you a phased return to work.

 

Whatever your workplace, good posture is important at all times and correct lifting habits must be remembered for life in order to protect your back.

 

Sexual Activity

The time when you resume sexual activity will depend upon the type and extent of your surgery and how you feel but it is usually around six weeks. Before you leave hospital you will need to ask your surgeon when you can resume full intercourse.

 

Swimming

You may be able to start swimming after your six week postoperative check as long as your scar has healed and any vaginal bleeding or discharge has stopped.

 

Exercise

You may be able to start low impact exercise and controlled stretches after your six week postoperative check as long as your scar has healed. You should gradually resume your preferred exercise. However, you should avoid competitive sports and high impact exercise for 12 weeks. Please contact our physiotherapy department for individual advice.

 

Helpful Links

 

For further advice please refer to

 

https://pogp.csp.org.uk/publications/fit-following-surgery-advice-and-exercise-following-major-gynaecological-surgery

 

Reproduced with permission of Pelvic Obstetric and Gynaecological Physiotherapy (pogp.csp.org.uk)