Kristina Kasparian, a writer, discovered after her first surgery for endometriosis that surgeons had filled her abdomen with gas to make it easier to see her organs. However, because the gas did not leave her body immediately, the trapped gas caused her “tremendous discomfort, radiating into the ribs and up to the collarbone” while she was recovering.
She was also surprised to learn that anesthesia can continue to affect you for several days after surgery, making you groggy.
Kasparian has had three more surgeries for endometriosis since then. “Because I didn’t know what to expect,” she says, the first was the most difficult to recover from.
She now understands that “preparing the body and mind is beneficial for a smooth recovery.”
What Is Endometriosis Surgery?
Endometriosis causes tissue similar to that which grows inside your uterus (endometrial tissue) to grow outside of it, covering other organs. This can result in severe pain, irregular bleeding, diarrhea, constipation, and infertility. The location of the tissue in your body can affect your pain and symptoms. If you have endometrial tissue on your bowel, for example, it can make bowel movements painful. During your period, any pain you have tends to worsen.
Who Needs Endometriosis Surgery?
While diet, exercise, acupuncture, physical therapy, cognitive behavioral therapy, hormonal contraceptives, and NSAIDs (nonsteroidal anti-inflammatory drugs) can help many patients manage their endometriosis symptoms, for some, the pain is so severe that surgery is required to remove the tissue from areas of the body where it should not be. Surgery can also increase the likelihood of pregnancy.
How to Manage Anxiety Before Endometriosis Surgery
Psychological preparation for surgery, such as gathering as much information about the procedure as possible, participating in therapy sessions, or practicing relaxation techniques such as deep breathing or hypnosis, not only reduces anxiety, but may also reduce pain after surgery and shorten recovery time, according to a 2016 Cochrane Review that evaluated the findings of more than 100 studies on the topic.
“The best thing you can do before undergoing surgery is find out as much as you can about the procedure,” says Micahel Acton PsyD, MEd, a psychologist and author who has helped patients in hospitals manage chronic pain. He suggests speaking with your nursing staff, ward doctors, anesthesiologists, and even friends who have undergone the same or similar procedures.
“They are the pain experts,” Acton says.
Kasparian advises making a plan to call your doctor shortly after surgery to discuss how you’re feeling and any next steps, “so you’re not left wondering and worrying.”
She also spends time “thinking of if-then scenarios and asking my physician all of my questions in advance,” which she claims helps her relax before surgery. Consider printing and bringing the questions at the end of this article with you!
Breathing Exercises
Breathing exercises are one of the most effective methods for reducing stress and anxiety and focusing on the present moment. Acton specifically mentions an exercise that he claims can help calm your racing heart or mind: inhaling for five seconds, holding your breath for five seconds, and then slowly exhaling it all out.
Kasparian enjoys “box breathing,” which involves breathing in for four seconds, holding for four seconds, breathing out for four seconds, and holding for another four seconds. She also claims that diaphragmatic breathing, a technique in which she places one hand on her chest and the other on her belly and deliberately breathes to inflate and deflate her stomach, is beneficial “especially after laparoscopic surgery where gas pain can radiate to the collarbone.”
How to Prepare Your Home for Recovery
- Make sure you have plenty of clean, comfortable clothes with loose waistbands. Button-down shirts can help you avoid reaching over your head after surgery.
- Prepare by cleaning your house ahead of time.
- Make sure you have easy access to a bathroom. You will initially have very little energy. You might want to avoid taking the stairs.
- Pamper yourself by washing your hair, painting your nails, or engaging in other forms of self-care that make you happy.
“You may not be able to do these things for a few days or weeks” after surgery, writes Endometriosis News columnist Kimberli Davino.
- Pets can be a great source of comfort while you’re recovering, but you might not be able to put their food bowls on the floor, go for walks, or clean litter boxes. Ascertain that you have someone to assist you in caring for your pets. If they are likely to jump for joy when you return home, you may want to have them stay at someone else’s house for the first few days to avoid accidentally bumping your wounds.
- Davino also suggested keeping items you use frequently, such as toothpaste or snacks, at waist level in your home
“You will not be doing any lifting, bending, climbing, or reaching.”
- Prepare easy-to-digest meals and snacks ahead of time. Pre-cut fruits and vegetables, applesauce, Jell-o, and ready-made soups are among Kasparian’s favorites. She also keeps ice cream in the freezer because it “does wonders for her mood.” Because you may feel nauseous or constipated after surgery, prepare lighter meals and snacks.
- Set up an email and/or phone auto-response so you can relax instead of worrying about responding to messages.
- Have pillows or blankets on hand to help you get into a comfortable position in bed.
What to Bring to the Hospital
According to Michael Tahery, MD, a Los Angeles-based surgical uro-gynecologist, patients who can go home to recover in their own beds tolerate pain better and have smoother recoveries, but you may have to stay in the hospital overnight on occasion.
Even if you don’t stay long, you should be able to stay comfortable while you wait to return home!
You should bring the following items:
- You should bring menstrual pads because you are likely to bleed after surgery.
- Your phone and a long enough charger to reach your bed
- Clothing that is comfortable and does not have a tight waistband
- When it’s time to go home, a small pillow to protect your abdomen from the seatbelt.
- To help protect yourself from hospital-acquired infections, bring a toothbrush and hand sanitizer.
- You want to bring something special with you.
- Acton described hospitals as “very clinical, hard places.” A special blanket, stuffed animal, photo, or other comfort item may aid in your relaxation.
Consider who you will want to drive you home or visit you if you must stay. Consider who will assist you in advocating for yourself and keeping you calm.
How to Manage Pain After Endometriosis Surgery
Endometriosis is a painful condition that often requires the use of opioid pain relievers. Opioids are prescribed to some people who never have surgery, but the majority of these prescriptions are filled at the time of endometriosis surgery, according to a 2019 study. Unfortunately, the study also discovered that more than 11% of patients received more than a 30-day supply of the drugs, with 5.5% receiving a three-month supply. According to the study’s authors, the longer you use opioids, the greater your risk of developing a substance-use disorder.
“Most pain care is now, to some extent, elective,” Acton says. He and Tahery both recommend using the following pain-management strategies in addition to or instead of opioids or NSAIDS (non-steroidal anti-inflammatory drugs).
To alleviate pain, try the following:
- Ask your doctor to go over all of your pain management options, not just opioids.
- As directed, apply cold and/or heat therapy to the incision area.
“Heat is extremely effective for pain management,” Acton says.
- Tahery claims that abdominal binders can relieve pressure when you cough or get up and walk around.
- Divert your attention. Watching TV or listening to music can help distract you from your pain. Kasparian, on the other hand, says she sometimes removes distractions, such as her phone, in order to focus on mindfulness techniques.
“I check for areas of tension and try to relax my muscles,” Kasparian says. “Normally, I hold tension in my pelvic floor or in my neck.
- Eat.
“Even if it’s only scrambled eggs or oatmeal.” “Make sure you’re getting nutrients into your system,” Acton advises. Not eating can hasten recovery and exacerbate anxiety and pain.
- Take a deep breath. Deep breathing exercises can help reduce anxiety before surgery. Acton claims that it can also help with pain relief afterward.
- Light activity, such as walking around the house, may aid in the release of gas and the reduction of pain and discomfort.
- You may experience constipation if you use opioids or have endometrial tissue removed from your rectum or bowel. Stool softeners can help relieve this discomfort.
Acton adds that emotional support can help to “ensure you have someone or several people you can talk to who are aware of your situation.” Sometimes just talking it out is enough.
According to Kasparian, one of the most important things you can do is “give yourself as much extra time and as much permission to go as slow as possible once you return home.”
Amber Bibelheimer, another endometriosis patient, says it took her three weeks to recover from the surgery, but she was in much less pain afterward and was able to get pregnant a year later.
Questions to Ask Your Doctor
- What should I be doing in the days leading up to the surgery?
- Should I discontinue any medications I’m currently taking?
- What should I expect when I arrive at the hospital for the procedure?
- What exactly is the procedure? How much time will it take?
- What are the risks of general anesthesia for me?
- Are there any other options, such as regional anesthesia, that might be appropriate for me?
- What happens after the surgery? How will I react?
- What should I do when I get home to ensure that I heal properly?
- What are my pain management options following surgery?
- How much and how long should I expect to be in pain?
- Which pain relievers are most commonly prescribed?
- Is a stool softener required? If endometrial tissue needs to be removed from your bowel or rectum, this can be useful. Opioids can also cause constipation because the opioid receptors that the drugs bind to in your brain to block pain are also present in your digestive tract, where the drugs can slow your digestion.
- Who is my primary point of contact? When I get home, who should I call if something doesn’t feel right?
