- Anus – back passage
- Bladder – where urine (wee) is stored Bowel – where your faeces (poo) is stored
- Catheter – a tube that drains urine directly from your bladder into a bag to prevent you using the toilet.
- Intra-abdominal pressure – an increase in pressure in your tummy which is exerted downwards on your pelvic floor
- Pelvic floor muscles – the muscles running from the front to the back of your pelvis, held in place by ligaments
- PVR – post-void residual urine – left in the bladder after emptying.
- TED stockings – special support stockings which reduce the risk of blood clots
- TWOC – Trial without catheter
- Urinary incontinence – uncontrolled leakage of urine Uterus – womb
- Vagina – a muscular canal that goes from the outside of your body to your cervix.
This information provides advice on the following:
- getting moving after surgery
- breathing exercises to help avoid chest problems
- how to exercise abdominal and pelvic floor muscles
- discharge home, and regaining fitness.
You may have had your surgery through your abdomen (tummy), groin, or vagina. How quickly you recover will depend on the type of surgery you had, your age, lifestyle and general health.
Deep breathing
It is important to complete breathing exercises after your surgery, to make sure your lungs stay well expanded, and to enable you to clear any phlegm. You may also find it helps with relaxation, nausea, and trapped wind.
You can do breathing exercises while sitting or lying. Take a deep breath in through your nose, and then gently breathe out through your mouth. As you breathe in, try to relax and feel your tummy.
Aim to repeat this three times every hour.
Huffing
This breathing technique will also help you clear any phlegm from your lungs. Using a rolled-up towel or pillow, support your wound sites. Then, take a normal breath in, and breathe out through your mouth quickly, as if you are steaming up a mirror. Repeat twice, after the deep breathing exercise above.
Coughing
Your scar and stitches won’t be harmed by coughing. However, you may find it more comfortable to cough by supporting your wound with a pillow or rolled up towel. If your wound is around your vagina, you can use a sanitary pad, and support through this instead.
Turning over in bed
Try to keep your knees close together, bend both knees and keep your feet on the bed.
Moving your shoulders and knees at the same time, roll onto your side. You may find it more comfortable to place a pillow under your tummy or in between your knees.
Getting out of bed
Roll over onto your side.
Then, swing your legs off the bed, and use your arms to push down into the bed and push yourself up.
Sit on the edge of the bed for a moment, taking your time to get used to sitting upright, especially if it is the first time you have done so after your surgery.
Using your hands to push up from the bed, slowly stand up.
Standing
In standing, try to maintain good posture. This can be difficult due to discomfort from your wound site, but it is important to stand upright to prevent back pain.
Sitting
When you are sitting down, ensure your back is well supported by the chair. You can use pillows for your lower back if needed.
Ensure your feet are touching the floor or are on a footrest.
Foot exercises
You will probably be asked to wear TED stockings during your hospital stay. You should also regularly walk around, to help maintain blood flow in your legs and avoid blood clots developing.
Wiggling your feet and ankles up and down briskly for 30 seconds every hour when you are resting in bed or sitting in a chair will also help your circulation.
Getting back into bed
Stand with the back of your knees against the bed. Reach back towards the bed and bend forward as you sit.
Once you are sitting on the edge of the bed, lower your head and shoulders on to the pillow sideways, and at the same time lift your legs onto the bed. Try to keep your knees close together during this. You will now be lying on your side and can roll onto your back keeping the knees bent.
After your surgery you will wake up with a urinary catheter. The catheter may be removed during your inpatient stay, or you may be discharged home with one for a few weeks. You will then be required to attend the Mesh TWOC clinic and an appointment will be arranged for you.
TWOC process:
- Once the catheter is removed, the first few voids will be measured.
- After each void, the nurse will scan your bladder to assess your post-void residual (PVR) to check for any urinary retention.
- The goal is for you to be able to safely empty your bladder once the catheter is removed.
- If you are unable to pass urine or have high PVR's, a catheter will be reinserted, or you may be taught how to perform self- catheterisation.
You should continue to move about, and go about your daily life, with the catheter in.
You may experience some incontinence of urine once the catheter is removed. You may need to wear incontinence pads. There are exercises to help with this (see above). You can also get help from the specialist nurse or physiotherapist within the mesh team.
It is always important to avoid passing small volumes of urine for the “just in case” times, as this can form a habit which can be difficult to break.
It is important to drink around 1.5 to 2 litres of water a day, but this is especially important after surgery. Aim to drink this amount unless you have been advised otherwise by your doctor.
When opening your bowels (going for a poo) you might find that some support will make you feel more comfortable. Some women find it helpful to apply pressure with their hand to their perineum (the skin between your vaginal opening and the back passage, anus) Also, when on the toilet, you can try sitting with your feet elevated on a small stool.
Do not strain and try to breathe out as you open your bowels or pass urine. If you are having difficulty opening your bowels, you can ask your nurse or doctor for some medication to help.
Early exercise and getting moving soon after your surgery are very important for your recovery. Sitting out in a chair and mobilising within 24 hours of your surgery has been shown to reduce your recovery time and complications after surgery, such as sickness, chest infections and blood clots.
Pain after your operation can make exercise difficult. Often doing a little bit of exercise, often, is more manageable than trying to do lots at one time. If you feel your pain is not well controlled, you should speak to your nurse or doctor, who may be able to offer more medication.
Exercise Alley
It is also important to get started with some gentle general exercise after your surgery, which can be achieved on the ward in the form of Exercise Alley.
You will be inducted to Exercise Alley by your physiotherapist or ward nurse when you are able to walk there safely and independently. You will also be given a booklet with the exercises in, so you can complete them at your bedside, and continue when you go home.
Your pelvic floor muscles are an important muscle group to strengthen following your surgery. Your pelvic floor muscles help to:
- support your pelvic organs, your bladder, bowel and uterus
- help with control of your bladder and bowel, preventing any leaking of urine or faeces/wind
- stabilise your lower back and pelvis
- help with sexual function.
You may have been taught pelvic floor muscle exercises, or Kegel’s, before. These exercises are important to maintain and improve the strength of your pelvic floor muscles.
You can start these exercises as soon as your catheter has been removed, and they can be done while lying, sitting or standing.
However, do not complete these while you are on the toilet.
A pelvic floor muscle contraction is the squeeze and lift of your pelvic floor muscles, from the back passage (anus) round to the front (vagina). You should feel the lift of the muscle, as if you are stopping yourself passing wind and urine at the same time. Try to avoid holding your breath while you are doing them.
There are two types of pelvic floor exercises.
Short holds
Complete a pelvic floor muscle contraction, then fully relax the muscle.
Long holds
Squeeze your pelvic floor muscle and try to hold it for 10 seconds. If you can’t manage a full 10-second hold, you can build up to this slowly.
Aim to complete 10 long holds and 10 short holds three times a day, unless advised otherwise by the team looking after you.
Your physiotherapist can provide help and support with these and make them more individual for you.
‘The knack’
Squeeze your pelvic floor muscles before any activity that increases your intra-abdominal pressure, such as sneezing, coughing or laughing. This may help to reduce leaking of urine.
Gently massage an emollient type moisturiser into and around your external scar, once the scabs have dropped off, twice a day for two to six months. This can be followed up using either a silicone gel or silicone sheet/ strip for two to six months, which can be purchased online. These will help reduce water loss through the scar and may help a smaller scar to form.
If you have ongoing scar problems, you may benefit from specialist scar massage therapy. This can be sought from independent scar therapy practitioners.
Returning home can feel daunting after your surgery, so it is important to make sure you have prepared as much as possible before your hospital admission.
Before your hospital stay
Try to put utensils or belongings you use every day in easy to reach places, to save you having to reach up high or bend down low to get them.
Prepare some food for you to have on your return home which can be frozen before you come into hospital and then reheated as and when you need it.
Going home
When getting into the car, lower yourself slowly onto the seat and try to keep your knees close together as you turn to face forward.
If you have family and/or friends around to help, it could be helpful to make sure someone has a spare key and remember to ask them for help if you need it.
If you have a shower over the bath, make sure to be careful when you get in, lifting your legs one at a time into the bath. You can have a stool next to the bath, then in sitting you can bring your legs into the bath, one at a time. If you feel unsteady, you may want to ask somebody to help you in and out, or to be around whilst you are showering, so you can ask for help if you need it.
You can ask your doctor to provide evidence of the surgery and a “sick note” if you need to be off work. The medical team will be able to specify how long that they recommend you should be off for.
If you feel you may need support from social services for care when you are discharged home, please let the team know as soon as possible. This will be discussed with you, and appropriate help can be arranged following an assessment by a physiotherapist or occupational therapist on the ward.
If you have carers or social services support already in place, please notify them before your hospital admission. If they are privately funded, it will be your responsibility to have this support restarted upon your discharge from hospital.
The first six weeks
For the first six weeks, avoid any heavy lifting (generally, nothing heavier than a kettle), and ensure you are getting plenty of rest and sleep. You can slowly begin to increase the distance you walk, providing you feel comfortable to do so.
Deep abdominal exercise
Your abdominal muscles help form your “core”, which supports your spine and internal organs. It is important that these stay strong. This can help reduce back ache, which can sometimes be felt following surgery.
In a sitting or lying position breathe in, then slowly out. As you breathe out, draw your belly button towards your spine. You can place your hands on your tummy and feel the muscles engage. Gradually, you can progress this to standing.
6 to 12 weeks
By six weeks, you should be able to start low impact, low intensity exercise again, such as yoga or Pilates, if you wish.
Although swimming is a low impact and low intensity exercise, please make sure that your wound site has been checked, and that the healthcare professional responsible for this has confirmed you are safe to return to swimming.
You will receive an invite for outpatient women’s health physiotherapy appointment around this time. This will be sent to you via the MyCare App, a letter or a telephone call from the Mesh admin team (see below for contact details).
12 weeks +
After 12 weeks, you may be able start more high intensity physical activity. It is important to speak to your physiotherapist or nurse specialist about this first.
At 16 weeks after your operation, you would usually have an appointment with the surgical team.
Sexual activity
You should only have sex when you feel ready to. You will usually be advised not to have sex for at least six weeks after surgery – but you may be given other advice by your doctor.
If, when you do have sex, it is difficult or painful, you should discuss this with your physiotherapist or nurse specialist.
Driving
Before returning to driving, it is important you check with your insurance company to see what your policy allows.
Physically, you should be able to:
- Comfortably wear a seatbelt
- Complete an emergency stop – to make sure you can press the brake hard enough you should practice this while stationary first.
- Look over your shoulder and turn the steering wheel without pain.
UCLH is a teaching trust, and you may be asked if medical or nursing students can observe or assist with your care.
We are also a major centre for medical research. If you are interested in taking part in research projects, ask the person who is caring for you.
If you do not wish to take part in teaching of students and/or research, please tell us when you arrive. Not taking part in teaching or research will not affect your care.
Image on correction position: Reproduced and distributed with the kind permission of the co-authors, including Wendy Ness, Colorectal Nurse Specialist. Produced as a service to the medical profession by Norgine Ltd. ©2017 Norgine group of companies.
- Mesh service: 020 3447 5895, Mon–Fri, 8am to 4pm
- Switchboard: 020 3456 7890 Email: uclh.
meshpatients @nhs.net - Response time: within 24 hours; at busy times this can be three to five business days.
- Website: https://www.uclh.nhs.uk/our-services/find- service/womens-health-1/gynaecology/london-complex-mesh- centre
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Page last updated: 10 June 2024
Review due: 01 September 2026