Welcome to the Enhanced Recovery Programme.
This information aims to increase your understanding of how to be an active part of your own recovery after surgery. If there is anything that you are unsure about, please ask. It is important that you understand the programme, so that you, your family and friends can be involved.
This is the programme offered by North Bristol NHS Trust for patients undergoing planned gynaecology surgery. There may be circumstances where the programme will not be appropriate for some patients and if this is the case, you will be fully informed of the alternatives.
What is the Enhanced Recovery Programme?
The Enhanced Recovery Programme is to get you back to full health as quickly as possible after your operation. The hyperlink below will take you to a short video about Enhanced Recovery called "Fitter Better Sooner". We strongly encourage you to watch the video:
Fitter, Better, Sooner Toolkit | Centre for Perioperative Care (cpoc.org.uk)
Research indicates that after surgery, the earlier you get you out of bed, exercise, eat and drink, your recovery will be quicker and with less risk of complications. Some of the benefits include:
- A quicker return to normal bowel function
- Reduce chest infections
- A quicker return to usual mobility.
- Decreased fatigue
- Reduced risk of developing blood clots after surgery
To achieve this, we need you to be partners with us working together to speed up your recovery.
What will happen?
Before you come into hospital
The medical staff will see you in the outpatient’s department to explain your operation. Following this you will be sent a date to attend the pre-operative assessment clinic, where trained staff will carry out routine tests that are required to ensure you are fit and safely prepared for surgery.
When you attend the preoperative assessment clinic, we will explain the programme to you and your family. You will be provided with written information, time to ask questions and may be referred to the anaesthetist. The nurse will discuss your arrangements at home so that together we can plan for any help you may need after your operation. All patients are screened for potential infections at this appointment.
We will discuss diet and exercise with you and if necessary, you will be referred to the dietician. For example, if you have lost a lot of weight or your appetite is poor.
It is important to keep as active as you can before your operation and if you are a smoker you should stop now. This helps reduce breathing problems after surgery. You can see your GP or pharmacist for advice on products to help you stop smoking.
Please bring:
- A supply of your own medication (these will be stored safely on the ward and returned to you when you go home).
- A dressing gown, or similar item of clothing (as there is evidence to suggest that keeping warm before surgery helps prevent infection)
- A supply of comfortable day clothes (as you will be encouraged to return to ‘normality’ as quickly as possible after your operation).
Eating and Drinking – before surgery
Prior to your surgery you will be able to eat and drink as normal unless you are required to take medication to clear the contents of your bowel. If this applies to you it will be discussed with you at pre operative assessment. It is important to have a variety of non-fizzy drinks during your hospital stay.
You may continue to eat for up to six hours before your operation and drink clear fluids for up to two hours before.
Preparing for surgery
To help prevent blood clots you will be required to wear special support stockings (TEDS). The nurse will measure your legs to choose? the correct size. You will also be given an injection called ‘clexane’ in the evening. This helps reduce the risk of blood clots by thinning the blood. The injection will be given each day you are in hospital.
Some patients at higher risk of experiencing blood clots may need to continue the injection at home. This would only be temporary and will be discussed with you when you are in hospital. Most patients can inject themselves or with the help of a relative or carer. The nurses on the ward will show you how to do the injection. If you have problems with giving yourself the injection we will arrange for a District Nurse to visit you.
For those also having an operation on their bowel: You may need an enema to empty your bowel contents on the day of your operation. After an enema, it is important to drink plenty to replace any fluid lost. Some patients may have to take medication the day before to achieve this (if this applies to you more information? will be given).
It is very important to keep yourself warm before your operation and you are advised to dress accordingly (warm dressing gown, socks, slippers, blankets etc.) When it is time for your operation you will be required to wear a hospital gown.
After your operation
DrEaMing (Drinking, Eating, and Mobilising) after your operation
You may hear the staff on the ward talk about “dreaming”. They are not talking about what happens when you are asleep! In fact, they are talking about some of the most important components to successful recovery after surgery- Drinking, Eating and Mobilising also known as DrEaMing. We know that if you can “DrEaM” within 24 hours of your surgery, you will be on track to recover quicker, sooner and better.
To help you with this we will create a rhythm to your day that follows the pattern of eating a meal in a chair, mobilising, then resting.
Drinking and eating
It is important to start drinking and eating as soon as you can after surgery. Initially some patients may find a low fibre diet more tolerable. We encourage you to sit out of bed for your meals to help build your strength and mobility.
Studies show that chewing gum after surgery can improve your recovery by assisting the bowel to return to normal. Chewing gum can also help disperse trapped wind that can sometimes occur after surgery. We advise that on the day you come into hospital, you bring chewing gum with you. After your operation chew gum for 15 minutes, a few times a day, until your bowel function returns to normal.
Mobilising
Staff will help you out of bed about six hours after your operation. We encourage you to eat all your meals sitting in a chair. After your meals we suggest that you move around the ward as you are able. The staff on the ward will assist with this if required. After this gentle exercise, it is important to return to bed for some rest.
Following your operation, it is important that you do deep breathing exercises to prevent chest infection. You will need to do deep breathing exercises every hour. To do these you will need to:
- Be in an upright position.
- Take a deep slow breath in (feel your stomach gently rise).
- Hold the breath for 3 seconds.
- Breathe out slowly.
- Repeat 5 times.
You should cough regularly to make clear your lungs of secretions. To do this, place a towel or pillow over your incision site, support it with your hands and cough.
When you are sitting in the chair or lying in bed, you should do frequent leg exercises as prevention against blood clots. To do this point your feet up and down and move your ankles as if making circles.
By being out of bed in a more upright position and by walking regularly, lung function is improved and there is less chance of a chest infection after surgery. Circulation is also improved, reducing the risk of blood clots and helping bowel function return to normal.
Try and wear your day clothes after your operation as this can help you feel positive about your recovery.
Below is a video of some examples of breathing and leg exercises:
Pain Control
It is important that your pain is controlled so that you can walk about, breathe deeply, eat and drink, feel relaxed and sleep well.
Various tablets can be used for pain for example paracetamol, ibuprofen, codeine and morphine (liquid or injections, as needed). Pain control is really important, and there are additional ways of giving painkillers if the above medicines are not sufficient. You will need to take your painkillers regularly (three or four times per day) to make sure you are comfortable.
If you are uncomfortable or in pain, then please tell the nursing staff immediately and they will be able to help you.
Sickness
After an operation and anaesthetic it is not uncommon to feel nauseated and vomit. You will be given medication during surgery to reduce this. If you feel sick following surgery please tell a member of staff who will be able to give you something for this.
Tubes and Drips
We will want to make sure that you are able to pass urine after your surgery. If we are concerned that this may be
difficult due to your operation, a tube (catheter) may be placed into your bladder so that we can check that your kidneys are working well and your urine output can be measured. If you have a catheter, it will be removed as soon as possible.
You will have an intravenous drip put into your arm to ensure you do not become dehydrated. The drip will normally be removed the day after surgery, but you may still have the intravenous port (venflon) in case we have to give other drugs through it. You may also be required to breathe extra oxygen for a short while after your operation.
Vaginal bleeding
It is normal to have vaginal bleeding after gynaecological operations. This bleeding may be like a light period. Tampons must not be used for bleeding after surgery.
Monitoring
Many different things will be monitored during your treatment including:
- Observations (oxygen levels, breathing rate, and temperature).
- Fluid in.
- Food eaten.
- Fluid out.
- When your bowel first starts working.
- Pain assessment.
- Number of walks.
- Time spent out of bed.
- Vaginal bleeding.
- Wound checks.
Please remember to tell us about everything that you eat and drink and what you pass.
Whilst you are in hospital you will be asked to participate in maintaining a ‘daily diary’ (provided by the ward), so that you
can keep a record of how well you are managing, in particular with diet and exercise after surgery. This will also help us monitor your progress.
Decisions regarding patient care are at the discretion of your consultant. Patients who are no longer able to follow the structure of the programme will revert to a traditional plan of care.
When you leave hospital
Complications should not happen very often, but it is important that you know what to look out for. During the first two weeks after surgery, if you are worried about any of the following (see information on the following page), please phone the telephone numbers on this leaflet. You should be able to reach a member of staff at any time. If you cannot contact the people listed, then ring your GP or NHS 111.
If you have had surgery on your bowel, the hospital team will phone you at home initially to check on your progress. In between these times if you have any concerns, you can contact them on the numbers provided.
Abdominal Pain
It is not unusual to suffer pains during the first week following surgery. Continue taking your painkillers regularly.
If you have severe pain lasting more than 1-2 hours or have a fever and feel generally unwell, you should contact
us on the telephone numbers provided
Your wound
The Ward nurses will remove your wound dressing before discharging you home. If you have had keyhole surgery you will have dissolvable stitches and glue over the top. You may continue to take showers or baths.
For surgery where a larger incision has been needed, either dissolvable stitches are used, or a stitch that needs to be removed. This can be taken out with the GP practice or district nurse about 5-7 days after surgery, and we will discharge you with a plan for this. It is not unusual for your wounds to be slightly red and tender during the first 1-2 weeks. You may also notice bruising.
Please let us know if your wound:
- Becomes more red, painful or swollen.
- Starts to discharge fluid / pus.
Vaginal bleeding or discharge
It is not uncommon to have some vaginal discharge or bleeding after surgery. Light bleeding like the end of a period is normal for a few weeks after surgery. This can be red, pink or brown in colour. If your bleeding is heavy, like a period, or with blood clots, you should contact the ward directly. If you have an unpleasant smell to the discharge this could indicate an infection. Please contact your GP or call Cotswold Ward for advice. Bleeding/discharge can continue for 10 days to 2 weeks following surgery, and should then settle. No tampons should be used during this time and intercourse should be avoided for 6-8 weeks.
Your bowels
In the early stages following surgery, your bowel habits may change and may either become loose or constipated. Make sure you eat regular meals 3 or more times a day, drink adequate amounts, and take regular walks the first two weeks after your operation.
Please seek advice from your GP if you are experiencing prolonged constipation.
Passing urine
Sometimes after surgery you may experience the feeling of a full bladder. This usually resolves, however if you experience any of the following problems please contact your GP, or ring Cotswold Ward for advice:
- Bladder pain or discomfort.
- If you have excessive stinging when passing urine, you may have an infection which will require treatment.
Diet
A balanced, varied diet is recommended and particularly eating 3 or more times a day. If you are finding it difficult to eat it is still important to obtain an adequate amount of protein and calories to help your body heal. You may benefit from having 3-4 high protein, high calorie drinks such as Build-up or Complan (available in supermarkets and chemists) to supplement your food. It is important to drink plenty of water.
Helpful suggestions
- Eat small nourishing snacks between meals.
- Try not to skip meals, have a snack or nourishing drink if you cannot manage a main meal.
- Have nourishing drinks during the day. Avoid drinks up to 30 minutes before meals, as they may fill you up.
- Have a selection of easy-to-prepare foods in case you do not feel like cooking.
- Make use of your freezer and cupboards to store convenience foods.
- Aim to try and have 5 daily portions of fruit and vegetables to ensure a good vitamin and mineral intake.
Exercise
We encourage activity from day one following surgery. You should plan to undertake regular exercise several times a day and gradually increase during the 4 weeks following your operation until you are back to your normal level of activity. The main restriction we place on exercise is that you do not undertake heavy lifting 4-6 weeks following your surgery. If you are planning to restart a routine exercise such as jogging or swimming we suggest that you wait until 2 weeks after surgery and start gradually. Common sense will guide your exercise and rehabilitation; in general if the wound is still uncomfortable modify your exercise. Once the wounds are pain free you can undertake most activities.
Work
When you return to work will depend on the type of operation you have had, your surgeon will guide you on this. Many
people are able to return to work within 2 - 4 weeks following their surgery. If your job involves lots of lifting we suggest you ask your employer to give you lighter duties until you are fully recovered.
Driving
It is advised that you do not drive until you are confident that you can drive safely. Usually this is when you are doing most of your normal activities. In general this will be 4 weeks after surgery. It is important that any pain has resolved sufficiently to enable you to perform an emergency stop. You should contact your insurance company to check their terms or you may not be fully insured.
Resuming intercourse (sex)
For certain types of operations, it is advisable to avoid intercourse for 6-8 weeks following surgery, please check
with your surgeon. We advise that you wait until any vaginal bleeding has stopped.
Naturally if you are not wishing to get pregnant contraception is important to consider, as you will continue to ovulate after your surgery, and you can fall pregnant quickly.
Hobbies and activities
In general it is advised that you take up your hobbies and activities as soon as possible again after surgery. It enables you to maintain your activity and will benefit your convalescence. We would not advise restricting these unless they cause significant pain or involve heavy lifting within the first 6 weeks following surgery.
Medications
You may continue with your normal medicines unless directed to stop by your doctor. You will be given a new supply of these if you do not have enough at home. You will also be given pain killers and any other medicines required, to take home.
Clinic follow up appointments
Not all patients require an appointment after their surgery if your Consultant thinks a follow-up appointment is needed, this will be sent through the post.
Follow up appointments allow the team to see how you are and talk through any further treatment.
If you have had an operation on your bowel, you will be contacted at home via telephone after your operation by the nursing team. We also encourage you to contact the specialist nurse or ward if you are experiencing problems.
Further information
Fitter Better Sooner:
Preparing for surgery – Fitter Better Sooner | The Royal College of Anaesthetists (rcoa.ac.uk)
Endometriosis UK Charity:
Your laparoscopy | Endometriosis UK (endometriosis-uk.org)
Page last reviewed December 2023
Page due for review December 2026
