PHYSIOTHERAPIST ADVICE FOLLOWING DELIVERY

Physiotherapy advice following hysterectomy, repair and other gynaecology operations

Day 1 onwards To reduce the effects of a general anaesthetic, practise the following exercises hourly throughout the day. Deep breathing exercises Be sure that you have adequate pain relief because deep breathing could be uncomfortable. Practise the breathing exercises sitting up in bed, supported by pillows, or out in a chair. Take a deep breath in through your nose, hold for two seconds and then sigh the air out of your mouth. Repeat four times then try to ‘huff’ the air out. Huffing Take a deep breath in, then breathe out quickly and forcefully through your mouth as if you were steaming up a window. This will help loosen any phlegm if needed. Coughing Be sure that you can cough strongly and effectively if needed after your operation to clear any excess secretions. Don't worry, your stitches and staples are very secure. You may find it more comfortable to cough in the same position as for your deep breathing exercises. Support your abdominal incision by holding a small towel or pillow firmly over your tummy. If your operation is through the vaginal route, place a hand over the pad between your legs. Circulatory exercises These are designed to improve circulation in your legs whilst lying in bed or sitting in a chair. Try to do them exercises every hour. Ankles Bend and stretch the ankles up and down firmly and quickly. Repeat 10 times. Knees Tighten your thighs by pushing the backs of your knees down against the bed. Repeat five times. Buttocks Tighten your buttocks regularly to relieve pressure from your bottom. Repeat five times. From Day 2 onwards Start all exercises by lying with your head on a pillow, knees bent and a shoulder- width apart, feet flat on the bed. 1. Abdominal exercise Gently place your hands on your lower tummy. Breathe in through your nose and as you breathe out, gently pull your tummy away from your hands towards your back. Feel the muscles tighten, try to hold for a count of 3 and then relax. Breathe in and out normally. Practice this exercise 3 times a day. You will gradually be able to hold for longer until you reach 10 seconds and can repeat 10 times. 2. Pelvic Tilting Place your hands in the hollow of your back. Tighten your tummy muscles (Exercise 1), flatten your lower back onto your hands and tilt your bottom. Breathe normally. Hold for three seconds and release gently. Try to progress this exercise by tightening your tummy muscles and also pulling up your pelvic floor before continuing as above. 3. Knee rolling Tighten your tummy muscles (Exercise 1) and gently lower both knees to one side as far as is comfortable. Bring them back to the middle and relax. Repeat to the other side. 4. Knee bends Tighten your tummy muscles (Exercise 1). Keep your back flat on the bed and bend one hip and knee up as far as is comfortable. Try to hold up to the count of 10 and then replace the leg, so the foot is back on the bed. Repeat with the other side. Repeat each of these exercises four times, three times a day, and then do more as you feel able. To get out of bed Bend both knees and roll onto your side by moving your shoulders and knees together. Push up by pressing your upper hand down onto the bed while you lower your feet to the floor. Sit on the edge of the bed and then stand by pushing up with your legs and hands. Posture and back care It is very important to be aware of your posture and to take special care for about six weeks after your surgery. A good posture will help prevent backache. Sitting Sit upright in a supportive chair, with both feet on the floor. Do not slouch. You may find it helpful to place a small cushion or rolled towel in the small of your back to give support. . Standing or walking Avoid holding your tummy with your hands and slouching forwards. Stand upright with shoulders back, and bottom and tummy tucked in. Lifting Do not lift heavy objects. Try to pull up your pelvic floor, tighten your tummy muscles and breathe out as you lift. Remember to bend your knees and keep your back straight. Hold larger objects close to your body. ·         If you are suffering from back pain after your operation, seek further advice from your physiotherapist. ·         If any exercises cause pain, discontinue and seek advice from your physiotherapist. ·         Your consultant may also wish you to practise pelvic floor exercises. If so, a separate exercise sheet is available. Before you go home The need for continued pain relief at home is very individual. Please discuss this with your nurse. If you have any worries or concerns, please talk to the physiotherapist or nursing staff . Advice on discharge Exercises Continue with exercises taught for at least six weeks, preferably three months. Rest Take a daily rest on your bed for about an hour. Continue for as long as necessary. Walking This is a very valuable exercise. Try to walk for about 20 minutes at least once a day. Hills and stairs are quite safe, but build up speed and distance gradually. Driving Check with your consultant but do not expect to drive for about four or six weeks, depending on your surgery. Make sure you can wear a seatbelt comfortably and perform manoeuvres and an emergency stop without undue pain. Work You should not expect to return to full-time work until after your post-op appointment with your consultant (six weeks). Always get approval from your doctor to return to work. Sports Also get approval at this appointment to return to sports, swimming, aerobics etc. Gardening Avoid gardening for a few weeks. Start slowly. Sexual Intercourse You should refrain from sexual intercourse for about six weeks. Household Activities 'Dos and don'ts' DOS: Independent personal hygiene; light housework, such as dusting, ironing, making drinks; washing and drying dishes; preparing light meals. Don’ts: Decorating; heavy lifting; shaking the duvet or heavy bedding; cooking a large meal using the oven; heavy housework. Take things slowly. Be very careful for the first six weeks after your operation. Gradually build up activity over the next six weeks until you feel able to resume your normal lifestyle.