Frozen shoulder affects about 2-5% of people and commonly occurs in people aged 40-70. Between 6-17% of people with frozen shoulder, go on to develop it in the other shoulder, within five years of their first episode.

• Pain that limits your full range of movement. Pain often interferes with sleep.
• Joint stiffness, which limits your range of movement and daily activities.

Symptoms might become gradually worse over a number of months or years. See the stages below for more details.

These symptoms can make your everyday tasks frustrating and challenging. For example, you will likely have difficulty getting your hand behind your back for a long period of time. This movement is one of the last movements to return when you are in recovery from frozen shoulder.

The symptoms can vary over time in severity and overlap. To help guide treatment we may classify your symptoms into 2 phases:

1. Painful predominant phase - where pain is the main problem and may interfere with your sleep.
2. Stiffness predominant phase - where the stiffness or lack of movement is the main problem.

Recovery rates vary and usually last 2-3 years. However up to 40% of people can have symptoms for more than 3 years.

It is not clear what causes frozen shoulder, but there are many factors which put someone at higher risk. These include:

• Diabetes (type 1 or 2): 10-20% of people with diabetes develop frozen shoulder.
• Other conditions: hypothyroidism and hyperthyroidism, cardiac disease, Parkinson’s.
• Previous shoulder injury or surgery.
• Dupuytren’s contracture.
• Previous frozen shoulder. 

Most people with frozen shoulder will eventually get better. However, there are treatment options that can reduce pain and improve the movement in your shoulder.

The type of treatment will depend on your specific situation. It will also depend on whether the pain or stiffness limits you more.

• During the painful stage, the emphasis will be on reducing your pain.
• During the stiffness stage, the emphasis will be on improving your range of motion.

Next we will discuss hydrodistension injection which is one of the treatment options for stiffness.

• Take your normal pain relief one hour before the injection
• Inform the Radiology department if you:
• Are pregnant.
• Have diabetes.
• Feel unwell.
• Have an infection, cold, or persistent cough.
• Have any allergies.
• Are taking any of the following medications:
  • Antibiotics, aspirin, warfarin or clopidogrel or any other tablet to thin the blood (some of these may have to be stopped some days before). 

You will lie on your back, with your arm (frozen shoulder) out to the side. The skin will be sterilised and the local anaesthetic will be given. This will numb the area.

Using an X-ray, a fine needle will then be inserted into the joint. A small amount of X-ray dye (iodine contrast) will be injected into the joint to make sure we have found the best position for the needle. Once in the best position, 15-40mls of a mixture containing more local anaesthetic, steroid, and fluid (saline) will be injected into the shoulder.

You may feel some pressure and pushing. If you do feel discomfort please tell the radiologist.

General risks:

• Allergic reaction to the steroid, which may be life threatening (anaphylaxis).
• Bleeding.
• Infection: if the injection area becomes red, hot, and swollen and you feel unwell, seek help immediately.

For steroid injections

• Skin thinning, dimpling, and change of skin colour at the site of the injection.
• Facial flushing for a few days.
• Occasionally symptoms may get worse for couple of days. You can take your painkillers if you need to.

This list does not cover everything. If there are further risks or complications your consultant will tell you these before the injection.

Pain and discomfort

You may feel some moderate pain and discomfort following the injection. This typically lasts less than 30 minutes.

You will stay in the department for 15-30 minutes after the injection and then you will be discharged home.

A numb sensation in the shoulder is normal from the anaesthetic and this often lasts around eight hours. You should not drive the day of your injection; your insurance may not cover you. It is your responsibility to call your insurance company about driving after the injection.

If you have diabetes

Closely monitor your blood sugars after the procedure for 48 hours. Your insulin requirement may increase due to the steroid.

You will need to be monitor your glucose levels for 1 month after the injection. If you have any issues managing your diabetes, speak with your diabetes specialist nurse or see your GP.

Will my symptoms come back?

Research shows that 7.8% of people’s frozen shoulder may come back and may need another injection.

1. Pendulum - do this 10 times clockwise, 10 times anticlockwise. Let your arm hang, relaxed straight down. Gently swing your arm as if drawing a circle. Change direction. 

   

2. Using a broom for external rotation. Do this 10 times. Sit with both elbows at right angles. Hold a stick with both hands. Push the stick to rotate the arm outwards as far as comfortable. Keep your elbows by the side of your body as shown. 

   

3. Climbing up the wall with fingers and supporting the affected arm. Do this 10 times. Stand facing a wall. ‘Walk’ your fingers up the wall as high as comfortable. ‘Walk’ your fingers back down again. 

   

4. Using the kitchen table and walking away stretching the arms and shoulders. Do this 10 times. Standing. Hold onto a table, slowly walk backwards, moving your body away from your hands.

   

5. Using a towel to pull up the arm to the mid back (bra strap). Do this 10 times. Stand or sit. With one arm, bring a towel/belt over your shoulder, behind your back. Hold onto the towel with the affected arm. Gently pull up, bringing the lower arm up. your back as able. Hold 5 – 10 seconds.

   

Information on adhesive capsulitis

• Adhesive capsulitis - Symptoms, diagnosis and treatment | BMJ Best Practice
• Adhesive Capsulitis of Shoulder - DynaMed
• Frozen Shoulder - Adhesive Capsulitis - OrthoInfo - AAOS
• Arthrographic distension for adhesive capsulitis (frozen shoulder) - Buchbinder, R - 2008 | Cochrane Library

There are many reasons why you may have been referred to colposcopy. You might have had:

• An abnormal smear test result – or the result didn’t give enough information.
• An unusual looking cervix.
• Bleeding when having sex.
• Cervical polyps. 

Contact the clinic if:

You need to change your appointment.

• Your period is due at the time of your appointment. However, it is usually possible to attend even if you have a period. If you are taking the combined oral contraceptive pill, you could take packs back-to-back without a break, to avoid having a period if you would prefer.
• You are pregnant. Colposcopy examination is safe in pregnancy and is usually done at 14 and 28 weeks; biopsy or treatments are rarely needed in pregnancy.
• You are being treated for a vaginal infection.
• You have concerns because of a past experience with this type of examination.

Your smear test may have shown HPV which is a very common virus.

HPV affects areas like the cervix, vagina, vulva, anus, mouth, and throat. Most people get it at some point, and it usually clears up on its own within two years. Smoking can make it harder for your body to clear HPV, as it weakens the immune system.

HPV spreads through sexual contact, which can feel worrying or embarrassing but it’s very common. 8 in 10 people get it at some point in their lives. It lives on the skin and is hard to fully avoid.

There are over 200 types of HPV. Most don’t cause problems, but around 14 types (called high-risk HPV) are linked to cancer. Others may cause skin issues like warts.

We don’t normally do a colposcopy if you are bleeding heavily because we cannot see the cervix clearly. We can usually do the colposcopy if bleeding is light. Please phone to chat to our colposcopy office if you are concerned.

• We may see no cell changes. If this happens, you will be advised to have a smear test repeated either with your GP or in the colposcopy clinic. This can be between 6 months and 3 years later depending on your case.
• We might see some minor cell changes and will take 1-2 small punch biopsies (pinches of tissue). You won’t normally need any anaesthetic. You should avoid sexual intercourse (sex), using tampons, soaking for a long time in the bath, and excessive exercise for up to 3 days. Lightwalking and going back to non-strenuous work is usually fine. You may have light bleeding for a few days and 1 in 20 women have some mild pain that should settle with simple painkillers.
• In some cases you will be offered a treatment (see LLETZ treatment below)
• The colposcopist will write to you and your doctor with the results and advice on what to do next. The letter can take up to 6 weeks to arrive.

CIN has 3 grades (levels):

• CIN 1 (low grade) means that one third of the thickness of the cervix is affected. It usually goes back to normal on its own. You will have a further smear test with your GP in 12 months. If this shows it is not improving you may be offered treatment.
• CIN 2 (high grade) means that two thirds of the thickness of the cervix is affected. It goes back to normal in around 50% of women. It can be monitored and treated depending on your case and your preference.
• CIN 3 (high grade) means the cell changes are the full depth of the affected area of the cervix. We usually treat CIN 3.
• CGIN is named after the area of the cervix that is affected - the gland cells found inside the cervical canal. It is not cervical cancer. We usually treat CGIN.
• Very rarely will a biopsy show cell changes that have already developed into cancer.

If your colposcopist sees some high-grade changes, they may advise you that you should have this treated that day. The treatment is called Large Loop Excision of the Transformation Zone (LLETZ).

Cervical ectropion is where the thin layer of cells that normally line the inside of the cervical canal appears on the outside of the cervix. This is not dangerous. These cells are more fragile and cause vaginal discharge or bleeding, especially with sexual intercourse. It is particularly common in women who take the combined oral contraceptive pill and is rare in women after the menopause. In most cases, cervical ectropion goes away on its own. Only women with symptoms need to consider treatment for an ectropion.

Cervical polyps are very common. Most of the time they are harmless, but they can cause bleeding symptoms. These can be removed easily in the clinic and sent to the laboratory for assessment.

Not usually. It depends on the results of your smear test and colposcopy. If there is clear evidence of moderate to severe cell changes you may be offered treatment straight away – called LLETZ. If the changes are mild we may take a small biopsy first and decide if treatment is needed later.

LLETZ stands for Large Loop Excision of the Transformation Zone.

• We use a local anaesthetic on your cervix. This works very quicky.
• Once the area is numb, we use a thin, electrical, wire loop to remove the cell changes and seal the area.
• We will make sure the wire doesn’t hurt you by putting a pad on your thigh before treatment.
• We also circulate cool air to stop anything heating up too much.
• The procedure is very safe and will take around 15 minutes.
• Some women need this done with general anaesthetic (you will be asleep). We will discuss this with you if needed.

If you have a coil and are due for a loop excision (LLETZ) you should avoid sexual intercourse (sex) or use barrier contraception (like condoms) for 7 days before treatment. This is just in case the coil needs to be removed and can’t be replaced.

The colposcopist can often move the coil threads aside to perform LLETZ without removing it. Occasionally, the threads may be trimmed during the procedure, which can make them harder to find later. If needed, your GP can refer you to have the coil removed or replaced.

In rare cases, the coil may need to be taken out before LLETZ. If that happens, a new coil can sometimes be fitted during the same visit. If not, you’ll need to use another form of contraception (like condoms) until the cervix heals - this usually takes 4 - 6 weeks (FSRH Guidance 2023).

The local anaesthetic usually stops LLETZ being painful – but the injection can be a bit sore. Some women have period type pains for a couple of days but this can be helped with simple painkillers like paracetamol or ibuprofen.

LLETZ treatment is generally very safe, but, as with all surgery, there can be complications. Half of all women who have a LLETZ will have on average 10 days of both bleeding and discharge. This can be moderate to heavy. Most women have discomfort for around 2 days after this procedure. Bleeding is more likely after treatment if you get an infection in the treated area on your cervix. The treated area takes up to 4-6 weeks to heal.

To keep the risk of infection as low as possible, we recommend that you:

• Avoid sexual intercourse and using tampons for 4 weeks.
• Avoid swimming for 2 weeks.
• Go easy on exercise for 2 weeks .
• Take a shower rather than soak in the bath for 2 weeks.

Signs of infection include discharge that smells or heavy bleeding (heavier than a normal period). You should contact the colposcopy team or gynaecology ward and ask for a review in case you need antibiotics. In very rare cases, if the bleeding is severe, women will need admission to hospital. Bleeding can also occur a couple of weeks after treatment. 

Some women notice a change in the timing and length of their periods after their colposcopy. There is also a small risk that, as the cervix heals, the channel into the womb gets more narrow. This makes it difficult for the blood to escape when you have a period. The medical term for this is stenosis.

Following LLETZ treatment you can drive as usual, resume normal activities including very light exercise (walking), and consume alcohol in moderation.

Damage to other tissues is very rare.

A standard LLETZ (less than 15mm deep) isn’t linked to a higher risk of preterm labour or waters breaking early. Some studies suggest a small increase in miscarriage risk before 20 weeks, but this remains uncertain and uncommon.

Larger or repeat treatments may increase the chance of premature birth. If this is a concern for you, your colposcopist will be happy to talk it through.

Please note that most travel insurance companies may not provide you with health insurance following this procedure. You may wish to rearrange your colposcopy treatment (LLETZ) appointment if you are going on holiday or flying within 4 weeks of the treatment date.

This hospital usually offers LLETZ for women who need treatment for cervical cell changes. Other treatments may be available in the future.

If you are having treatment, you are welcome to bring someone with you so that they can support you and take you home after the procedure. We recommend that you take it easy for the rest of the day.

You can return to work the following day as long as it does not involve lifting heavy objects or doing any strenuous activity.

The removed tissue/cells are sent to the laboratory for examination. We do not give results over the phone, but we will send a letter to you and your GP with the results. This is usually within 4-8 weeks of the appointment. Sometimes, more treatment is needed, and we may ask you to return to the colposcopy clinic to talk through your choices.

You might have felt or still feel these symptoms.

Do not ignore them, talk to your doctor or the hospital if you have:

• A chest infection that will not go away.
• Coughing up blood.
• A cough that is changing or bothering you for more than six weeks.
• Feeling more breathless than normal.
• Chest or shoulder pain.
• Voice changes, for example hoarseness, that lasts for more than three weeks.
• Trouble swallowing.
• Feeling unwell and tired.
• Losing weight without trying.

To check your symptoms, your doctor might do some of these things:

• Check you carefully.
• Arrange a chest X-ray or CT scan (these are pictures of inside your chest).
• Talk to you about the results of the chest X-ray or CT scan or send you to the hospital.

If more tests are needed, your doctor will help you see a chest specialist at the hospital. Usually, you will get an appointment within two weeks.

You are going to see a lung doctor at the hospital because you have some symptoms that might mean you have lung cancer. There could be other reasons for your symptoms too.

The doctor will do some tests to find out what is causing your symptoms and see if you have lung cancer.

If you do have lung cancer, it's important to know how far it has spread. This means finding out if it's just in the lung or if it has moved to other parts of the body.

The Lung Cancer Nurse Specialists are trained to help people with cancer. We are part of the Cancer Support Team. We can answer your questions and give information about your diagnosis, treatment, and support during and after your care.

We will offer the following support to you and your family:

• Help during face-to-face appointments.
• Giving you special information about treatments.
• Helping you over the phone.
• Telling you about other places you can get help.
• Giving emotional support (help with feelings).

The Cancer Support Team also have Cancer Support Workers. They are trained to provide support and information about your body, your feelings, and practical concerns to help you self-manage your recovery and help you return to a healthy a lifestyle as quick as possible. 

At your first appointment, your hospital doctor might want to do some tests to help them understand what’s happening in your body.

Physical examination

Your doctor may check your body and listen to your breathing.

Blood tests

You may be asked to have some simple blood tests.

Chest X-ray

This test involves getting a picture of your chest to see if anything looks unusual. If you haven’t had a chest X ray you will need one. If you have, it may need to be repeated.

Breathing tests

You will be asked to blow into a machine that measures how well you can breathe. This test can take one hour and is done at Southmead Hospital.

Bronchoscopy

This test lets your doctor see inside your breathing tubes using a camera. They may take a tiny sample. It is done as an outpatient and usually involves attending the hospital for a morning or afternoon. This is done at Southmead Hospital.

It is important you have someone to stay with you overnight because of the sedation you may be given during the bronchoscopy. If you do not have anyone that is able to do this, please talk about this with your lung cancer nurse specialist who can look at other options. 

EBUS (Endobronchial Ultrasound)

This test that allows the doctor to look into your lungs (similar to a bronchoscopy) but uses ultrasound to look deeper into your chest. The doctor can take samples from the glands in the middle of your chest. It usually takes one day to do and you can go home the same day, but you will need someone to stay with you overnight.

PET-CT scan

This scan is done in most patients who are considered for surgery or radical radiotherapy. This scan takes about two to three hours. This scan is done at Southmead Hospital.

CT guided biopsy

This is a test that allows radiologists to take samples of abnormal areas seen on the CT scan. This helps them understand what those areas are.

It is essential you have someone to stay with you overnight who can care for you if you feel unwell or experience any problems after the biopsy. Please talk to your lung clinical nurse specialist if you need help. 

Please be aware that you cannot fly for 6 weeks after having a CT guided biopsy.

Bone scan

This is a special type of X-ray scan that checks for any problems in your bones.

USS (Ultrasound) guided biopsy

The X-ray doctor may take a small sample of one of your glands or your lung. They use an ultrasound scan to help and they will use local anaesthetic so you don’t feel anything. You are fully awake at the time.

If you have swollen lymph glands in your neck or fluid in your chest, we may want to take a sample with a syringe and needle. This is a simple test that can be done in the clinic and can help the doctors get answers faster.

Pleural tap

Sometimes there is fluid around the lung, which we may remove for comfort to help you breathe better or help the doctors find out what’s wrong. This is usually done in the pleural clinic in the lung (respiratory) department at Southmead Hospital.

MRI or ultrasound scan

In some patients these tests are also needed. This may be as well as the CT scan, or instead of, these scans. They will take place in the X-ray department, Southmead Hospital.

Mediastinoscopy

This is a small operation carried out by the chest surgeon. They can look at the area in the middle of the chest (called the mediastinum) and take samples (biopsies) if needed. This is usually done in one day, but you will need someone to stay with you overnight at home.

When the results of you test are ready, the hospital doctors will talk about your case at a weekly multidisciplinary team meeting (MDT).

At the meeting, the lung cancer team will discuss your symptoms and test results, and decide what treatment is best for you.

The team includes lung doctors (respiratory physicians), cancer treatment doctors (oncologists), chest surgeons, X-ray specialists (radiologists), the lung cancer nurse specialists and other people who care for patients like you.

The meeting takes place on a Wednesday and someone from the team may contact you after the meeting (but not routinely) if they need to talk about any future tests or appointments.

At this appointment, your doctor or lung cancer nurse specialist will tell you the result of your tests. This may be over the phone or face-to-face. They will usually be able to tell you if you have a lung cancer or not, and what is the best treatment for you if you do have lung cancer. Please note that sometimes, extra tests may need to be done to be completely sure.

If you do have lung cancer, they will tell you what type of lung cancer it is (because different types need different treatments). And whether the cancer is only in your lung or has spread to other parts of your chest or body.

They will then explain to you the treatment plan that the team decided on during the MDT meeting. This will usually mean that you need to see another doctor, like a surgeon or cancer treatment doctor.

Personalised Care and Support Planning is a talk and check-up and assessment you will have with your Clinical Nurse Specialist or Cancer Support Worker. This is to help talk about your health and feelings about your cancer. It helps them understand what’s most important to you and what help you might need. 

At North Bristol Trust we want you to be part of your choices about your care. When you and your doctors make decisions together about your health care plan and treatment, this is called shared decision making. This makes sure that you are supported to make decisions that are right and best for you. This means supporting you to choose tests and treatments based on what the doctors have found out, as well as your individual preferences, beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments.

Some questions that are good to ask:

• What are my options?
• What good and bad things could happen with those options?
• What support and information can I get to help make my decisions?

Shared decision-making matters to us. Tell us what matters to you. Your feelings and choices are important.

Doctors use different treatments for lung cancer, depending on what is best for each person. These are the three main ones:

Surgery

Some tumours (cancer) are best treated by an operation to remove them. Your doctor will only suggest surgery if they think it could cure the cancer. Unfortunately, some people with lung cancer are not well enough for surgery, or the cancer might be in a place where it cannot be removed.

If surgery is possible, the doctor might have to remove part of the lung or the whole lung. Even after removal of a whole lung, patients can have a good quality of life and are still able to do many of the activities that they did before the surgery. However, you may get out of breath more easily.

Radiotherapy

This is a type of treatment that uses X-rays to target and kill the cancer. It is the most used treatment for lung cancer. The number of treatments depends on your case, and your oncologists (cancer treatment doctors) will talk about this with you.

You should be offered the opportunity to meet the lung specialist radiographer (X-ray expert), who will give you information and support you when having radiotherapy to your chest.

Chemotherapy

This is a type of medicine that can kill cancer cells. It is given through a drip (intravenous (IV) infusion) or as tablets. There There are many different types and combinations of chemotherapy. Your oncologist will help you choose which ones are best for you. Chemotherapy is a systemic treatment. This means it travels all around the body, and if the cancer cells are sensitive to it, it kills them wherever they are.

There are other treatments like immunotherapy and anti-cancer tablets, but they don’t work for every kind of lung cancer. Your lung cancer nurse will be happy to answer any questions and help you understand your treatment.

After your treatment is finished, you will be seen regularly by your treatment team. They will check how well the treatment has worked and make sure you feel okay. You will be supported by your GP (local doctor) and other members of the community team. You can also contact the lung cancer nurses at any time, even if you are not seeing them regularly. 

If you need help or have an urgent question, you can contact the Lung Cancer Nurses:

• Phone number: 0117 414 1900
  • 09:00 - 17:00, Monday - Friday
• Email: LungCancerCNS@nbt.nhs.uk

They are not always at their desk, but you can leave your name, phone number, and a short message. They will call you back as soon as they can.

For questions about your appointments, call medical oncology on 0117 414 6385

Money and benefits advice - Citizens Advice Bureau

If you or your family are struggling to cope with the money impact of cancer, there is help available. The Macmillan benefits service at Bristol Citizens Advice Bureau can give you free and private advice on what money support (benefits) you might be able to get. Ask your lung cancer nurse if you would like help getting in touch with them. There may be money grants (extra money) that can be applied for, so please ask your team for help with this.

Blue Badge Scheme

If your illness makes it hard for you to walk far, you might be able to get a Blue Badge. This lets you park closer to shops or hospitals. Ask your lung cancer nurse or your local council for a form to apply.

Free prescriptions

If you’re getting treatment for cancer, you can get your prescriptions (medicines) for free. Ask you GP or lung cancer nurse for a free prescription certificate.

Other benefits

If you are told you have lung cancer, you might get extra support form the government. One common benefit is called Attendance Allowance. If you would like help with this, ask your lung cancer nurse will get your cancer support worker to help guide you.

NGS Macmillan Wellbeing Centre

This centre gives support to people with cancer. They offer help and information about different kinds of cancers and treatments. They also talk about money, benefits you might get, what to eat and exercises to do. If you have concerns or just want to talk with one of the team, they have time to listen and help you.

The centre offers ‘drop-ins’ for coffee or tea, and a chat or appointments for your needs.

• Opening times: Monday - Friday 08:30 - 16:15
• Phone number: 0117 414 7051

Cancer Information Session

You might be invited to a group session if you have recently been diagnosed with cancer. This session includes education and support about cancer treatment. You’ll also get to meet other people going though similar things. They will also offer you tips to help you make choices about your care.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital

Days and times: Monday 13:30 - 14:30, Thursday 10:00 - 11:00

Mesothelioma UK

Mesothelioma UK is a national specialist resource centre, specifically for the asbestos-related cancer, mesothelioma. The charity is dedicated to providing specialist mesothelioma information, support and education and to improving care and treatment for all UK mesothelioma patients and their careers.

• Website: Mesothelioma UK | Supporting people with this asbestos cancer
• Email: info@mesothelioma.uk.com
• Phone: 0800 1692 409, Monday - Friday 08:30 - 16:30

The Penny Brohn Cancer Care Centre UK

Provides complementary support for people with cancer and their families. Among other things they run residential and single day courses and provide nutritional information, massage, creative therapies and support groups.

• Website:Penny Brohn UK – Cancer wellbeing for everyone
• Confidential helpline: 0303 3000 118 Monday - Friday, 09:30 - 17:00

Carers UK advice line

Open Monday - Friday, 10:00 - 16:00

Note: listening service available Mondays and Tuesdays from 10:00 - 16:00

• Phone: 0808 808 7777
• Website: Help and advice | Carers UK

Samaritans

Whatever you’re going through, a Samaritan will face it with you. were here 24 hours a day 365 days a year.

• Phone: 116 123
• Website: Samaritans | Every life lost to suicide is a tragedy | Here to listen

Roy Castle Lung Cancer Foundation

We provide information and support to lung cancer patients. Please call our helpline on 0800 358 7200 if you have any questions about lung cancer. Open Monday - Friday 09:00 - 17:00.

• Website: Home | Roy Castle Lung Cancer Foundation

Increased risk of long-term

• Physical dependence.
• Anxiety and depression.
• Reduced effort of antidepressant medication.
• High blood pressure.
• Liver disease.
• Inflammation of intestines.
• Strokes.
• Pancreatitis.
• Stomach ulcers.
• Brain damage/dementia.
• Heart disease.
• Increased infections.

Increased risk of short-term:

• Poor concentration.
• Trembling hands.
• Malnutrition.
• Falls.
• Skin complaints.
• Stomach ulcers.
• Tiredness/lethargy.
• Reduced sex drive.
• Poor judgement and high risk behaviours.
• Blackouts/memory loss.
• Impotence (men).
• Miscarriages (in women).
• Depression/mood swings.
• Hangovers.
• Poor sleep quality.

• Feeling better in the morning, no hangovers.
• Being less tired during the day, more energy and better night time sleep.
• Feeling fitter and starting to look healthier.
• Save money and start being able to budget better.
• May stop gaining weight and may start losing weight.
• Improved mood.
• Time and energy to develop new interests.
• Improved relationships/friendships.
• Reduced risk of injury to yourself or others.
• Won’t embarrass yourself in front of friends.
• Fewer arguments.
• Improved general health and reduced risks of developing physical and mental health problems previously mentioned.

Yes there are support services– some useful numbers are on page 8 this leaflet.

Don’t be discouraged if you find you don’t do well with one particular service or group. They all work differently. Make time to find out which one will work best for you.

Try not to let stories that you have been told influence you. Just because someone you know didn’t get on with a particular organisation doesn’t mean you won’t. We are all different. Make up your own mind.

People drink for a variety of reasons. Alcohol can be a source of pleasure and enjoyment. By following the suggestions in this leaflet you can make sure you can still drink some alcohol but also reduce the risks to yourself and others.

Drink Line:
National alcohol helpline.
0300 123 1110

Drink Aware
Tools and information for alcohol reduction.
0300 123 1110
Drinkaware Home | Drinkaware

SMART Recovery
CBT based mutual aid support group.
Self-Help Addiction Recovery | UK Smart Recovery

Alcoholics Anonymous (AA)
Mutual aid support group.
Home - Alcoholics Anonymous Great Britain

BDP 50+ Crowd
Weekly group for people over 50 with past or current problematic alcohol or drug use.
The 50+ Crowd - Bristol Drugs Project

Horizons
Bristol alcohol service.
www.horizonsbristol.co.uk

DHI South Gloucestershire
South Gloucestershire alcohol service.
South Gloucestershire Drug and Alcohol Service | DHI

We Are With You
North Somerset alcohol service.
Drug and Alcohol Support in North Somerset | WithYou

Alcohol support apps

• NHS Drink Free Days
• Try Dry app
• I am sober app

It is important to perform deep breathing exercises after your operation to reduce the risk of developing a chest infection.

• Do this by taking 3 deep breaths, feeling your lower ribs move.
• Repeat this every hour throughout the day.

If you need to cough after your operation, place a rolled-up towel across your abdomen and apply pressure. If you have had vaginal surgery, put your hand over the pad to support the perineum (the area between your vagina and back passage) when coughing.

Regular movement of your legs is essential while you are less active than usual. Move your feet up and down at the ankles for 30 seconds every half an hour when you are in bed or sitting. You will also be given support stockings to wear whilst your mobility is reduced following your operation.

• Bend your knees up one at a time.
• Keep knees together and roll onto your side.
• Push up into sitting with your arms, at the same time lower your legs over the side of the bed.
• If you have had abdominal surgery you can support your incision with a rolled-up towel.

You can expect pain after your surgery. You will be provided with painkillers on discharge. Some painkillers, such as codeine, can cause constipation. Therefore, make sure to consume a high fibre diet and drink plenty of water to avoid constipation. Taking painkillers to reduce your pain will ensure that you get out of bed sooner and will therefore speed up your recovery and reduce the risk of blood clots.

You may have a pack (small gauze similar to a tampon) in your vagina to reduce the risk of bleeding. This will be removed by a nurse while you are in hospital.

You may have some vaginal bleeding for 6-8 weeks after your surgery. This is normal. However, if the bleeding becomes heavy or there is an offensive smell, you need to contact your GP or the hospital as this may signify an infection. Use sanitary towels instead of tampons to reduce the risk of infection.

Bladder

You will have a urinary catheter (tube into your bladder to help it drain) in place after your operation that will be removed in hospital or in some cases you may be required to go home with the catheter still in place.

Once your catheter is removed you can go to the bathroom to empty your bladder. Ensure you sit on the toilet properly and relax your breathing. If you are struggling to empty your bladder it is important to speak to your nurse or GP. They will measure how much urine you pass and scan your bladder to determine how much is left.

You may notice that your urine flow is slower and it may take longer to empty your bladder. This should settle with time. If you have any symptoms of a urinary tract infection (UTI), e.g. burning when passing urine, offensive smelling urine or you are going to the toilet more often, please see your GP.

It is important to ensure you drink enough after your operation, approximately 1.5 to 2 litres per day, little and often is best. Try to avoid caffeinated drinks, fizzy drinks and alcohol as these may irritate your bladder and cause urgency. Drinking less frequently can make your urine more concentrated which can also irritate your bladder. 

Try to avoid going to the toilet ‘just in case’ even if you have a fear of leaking as this can lead to poor bladder habits. There is over a 50% chance that your original urinary leakage will come back after your surgery, but this leaflet will teach you how to do pelvic floor exercises to hopefully improve this.

Bowels

It is important to avoid constipation after your operation as this puts extra strain on your pelvic floor muscles and potentially your operation site.

To prevent constipation, make sure you drink plenty of fluid, increase the fibre content in your diet and if necessary, use laxatives. Your doctor can prescribe these for you to take whilst in hospital and at home.

• Sit on the toilet a with a stool under your feet, as shown in the image on page 6.
• Do not strain and keep your tummy muscles relaxed.
• It is helpful to take a slow breath in through your nose so that your stomach moves outwards, and your chest remains still and then exhale through pursed lips.
• You may also find it useful to support your perineum (the area between your back passage and your vagina), when opening your bowels. Please see the image below.

Your pelvic floor muscles are a sling of muscles from the pubic bone at the front of your pelvis to the coccyx and sacrum at the back of your pelvis. They help to support the bowel, bladder and uterus, maintain bladder and bowel control, support the pelvis and aid sexual function.

It is important to strengthen these muscles leading up to and after your operation. Once your catheter has been removed and you can pass urine, you can gently start these exercises as soon as you are able to.

To contract your pelvic floor, tighten your back passage – as if you are stopping yourself passing wind. At the same time, tighten your vagina. Women used to be told to practice their pelvic floor muscle training by stopping the flow of urine. This is no longer recommended as it can affect your bladder function in the long term. Try to feel the muscles lifting upwards and forwards towards the pubic bone. Feel the muscles working together. Then relax, let go and feel the muscles return to their starting position. Try not to squeeze your buttocks or leg muscles. Avoid holding your breath and just continue to breathe normally. 

To begin with, especially if you haven’t practiced these exercises before, you might lack confidence. Keep practicing the above and when you’ve mastered simply contracting and relaxing, move onto the next exercises. There are two different recommended pelvic floor exercises:

Exercise 1 - Slow pull-ups

• Tighten the pelvic floor muscles slowly. Continue to tighten for the length of the hold, relax, and feel the muscle let go. How many seconds can you hold the contraction for?
• Aim for 5 seconds to begin with, when you let go – can you feel the muscles relax?
• If not, you have held the contraction for too long, try again with a shorter hold – even just one second. Some women may only be able to only hold for 1-2 seconds. Others as many as 8-10 seconds. Don’t worry if you are not able to feel very much to start off with. It may take a bit of practice so keep going. The key is to discover your hold time, and gradually build this up to a maximum of 10 seconds. And don’t forget, keep breathing normally throughout.
• Rest for roughly 5 seconds in between each contraction, to ensure that the muscles have fully relaxed. Repeat this 5 times. As it gets easier, gradually increase the length of hold, and number of repetitions (aim for 10 long squeezes for 10 seconds each).

Exercise 2 - Fast pull-ups

• Tighten the pelvic floor muscles quickly. Let go straight away.
• Wait for a second.
• Repeat this 10 times and as you get more confident aim for approximately 1 contraction per second.

Pelvic floor exercise routine

Do exercise 1 and 2 during each session. As soon as you can, increase to 10 slow and 10 fast pull-ups. Aim to repeat each session at least 3 times a day. When you start, do the exercises lying or sitting. As your muscles get stronger progress to standing.

Do not expect immediate improvement – but do not give up. As the muscles get stronger you will be able to increase your hold time and number of repetitions. See our pelvic floor video to help guide you: How to do pelvic floor exercises - msk

Top tips

Try to get in the habit of tightening your pelvic floor muscles before you cough, sneeze or lift anything. If you are unable to correctly contract your pelvic floor muscles please speak to your nurse or consultant and they can refer you to pelvic health physiotherapy for a 1:1 session.

After your operation it is important to start strengthening your deep abdominal muscles called Tranversus Abdominis. They work together with your pelvic floor muscles to provide support for your spine and internal organs.

Deep core muscles

• Lying on your back let your tummy relax, breath in gently.
• As you breathe out gently pull in the lower part of your tummy, hold for 5 seconds, and repeat 5 times.
• Do not move your back.
• You should be able to breathe and talk whilst exercising. This can also be done sitting or standing.

Pelvic tilting

• Lie on your back with your knees bent.
• Pull your tummy in and flatten your back on the bed.
• Hold, and then relax.
• Do not hold your breath.
• Repeat 5-10 times twice daily.

For exercise progressions please read: POGP Fit following surgery advice and exercise following gynaecological surgery leaflet (refer to the reference list).

Do not drive until you are confident you can do an emergency stop. If you have undergone abdominal surgery, we advise you not to drive for at least 4 - 6 weeks but check with your insurance company regarding your policy.

You should avoid sexual intercourse for the first 6 weeks following surgery, ensuring any bleeding has stopped. This will allow tissues to heal and reduce the risk of developing an infection. It is important that you wait until you feel ready and use sufficient lubrication.

If you are concerned or intercourse remains uncomfortable after 3 - 4 months, it is a good idea to discuss this with your GP.

The British Society of Urogynaecology (BSUG) 

Squeezy NHS app for pelvic floor exercises

Removal of a retropubic mesh sling

Home | The British Association of Urological Surgeons Limited

Anterior vaginal wall repair without the use of mesh

Home | The British Association of Urological Surgeons Limited

Recovery Guide Following Vaginal Repair Surgery/Vaginal Hysterectomy

Home - Your Pelvic Floor

Fit following Surgery advice and exercise following gynaecological surgery.

Resources | POGP

Leaflets from the Royal College of Obstetrics and Gynaecologists

• Laparoscopic hysterectomy.
• Pelvic floor repair.
• Vaginal hysterectomy.
• Abdominal hysterectomy.

Browse our patient information | RCOG