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Chapter 25: Postoperative Care of Patients with Functional Disorders of the Pelvic Floor

Patrick A. Nosti; Andrew I. Sokol

INTRODUCTION

Key Points

  • The primary goal of surgery is to maximize surgical outcomes by minimizing intraoperative and postoperative complications.

  • Recently a shift toward evidence-based medicine has led to significant changes in postoperative patient management, although more research is needed in this area.

The primary goal of surgery is to maximize surgical outcomes by minimizing intraoperative and postoperative complications. Often, expert opinion serves as our primary guide to achieve this goal. However, the shift toward evidence-based medicine has led to significant changes in postoperative patient management. We present evidence for current postoperative recommendations, and, where evidence is lacking, discuss current practices and make recommendations. (Table 25-1).

Table 25-1

Evidence Supporting Advice, Recommendations and Future Research

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Table 25-1

Evidence Supporting Advice, Recommendations and Future Research
Advice Evidence Our Recommendations Future Research
Lifting Lifting increases intra-abdominal pressure much less than Valsalva, forceful coughing, or rising from supine to erect position5

  • 1. Patients should continue lifting patterns as before surgery

  • 2. Patients need an adequate postoperative analgesic regimen

  • 3. Preprocedure and postprocedure recommendations should be consistent

  • 1. Prospective cohort study of patients encouraged to resume regular exercise program

  • 2. Trial in which women are randomly assigned to lift weights lighter than before surgery or lift the same weights as before surgery
Climbing stairs Climbing stairs increases intra-abdominal pressure much less than Valsalva, forceful coughing, or rising from supine to erect position5

  • 1. Patients should continue climbing stairs as before surgery

  • 2. Patients need an adequate postoperative analgesic regimen

  • 3. Preprocedure and postprocedure recommendations should be consistent

 Prospective cohort study of patients encouraged to resume regular exercise program, including climbing stairs
Driving No retrospective or prospective evidence

  • 1. Patients need an appropriate postoperative analgesic regimen that does not cause a clouded sensorium when driving

  • 2. Patients may resume driving when comfortable with hand and foot movements required for driving

  • 3. Preprocedure and postprocedure recommendations should be consistent

 Prospective cohort study of women encouraged to resume normal activities, including driving
Exercise Limited retrospective and prospective evidence. Forceful coughing increases intra-abdominal pressure as much as jumping jacks5

  • 1. Patients need an appropriate postoperative analgesic regimen

  • 2. Patients may resume preprocedure exercise level

  • 3. Exercise program may need to be tailored

  • 4. Preprocedure and postprocedure recommendations should be consistent

 Prospective interventional studies to encourage women to resume exercise programs, as well as build strength and cardiovascular health
Vaginal intercourse No consistent retrospective evidence; no prospective evidence

  • 1. Women and their partners should make the decision to resume intercourse mutually

  • 2. Women should use vaginal lubricants and sexual positions permitting them to control the depth of vaginal penetration

  • 3. Preprocedure and postprocedure recommendations should be consistent

 Prospective interventional studies aimed to help women resume sexual intimacy after gynecologic surgery; such studies should capture data on incidence of vaginal vault dehiscence and its associated factors
Returning to work No consistent prospective or ...

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