A pelvic exenteration is a big operation and can take between 8 and 10 hours.
Afterwards you go to the intensive care unit or a high dependency recovery unit. You usually move back to the ward within a couple of days or so.
In intensive care you have one to one nursing care. In the high dependency unit you have very close nursing care. Your surgeon and anaesthetist also keep an eye on your progress.
These units are busy and often noisy places that some people find strange and disorientating. You'll feel drowsy at first because of the anaesthetic and painkillers.
Tubes and drains
When you wake up after the operation you will have a few tubes in place. You may have a:
- drip (intravenous infusion) into your arm to give you fluids until you are eating and drinking again
- very fine tube into your spine (an epidural), containing painkillers to control your pain after the surgery
- tube into a blood vessel in your neck that your doctor uses to give you fluids and to measure your blood pressure
- tube in your tummy (abdomen) to remove fluid and blood from around the operation site (wound drain)
- tube down your nose and into your stomach to drain it and stop you feeling sick (nasogastric tube)
- tube into your bladder (catheter) to drain urine into a bag (if you’ve not had your bladder removed)
Your nurse usually takes out these drips and tubes over the next few days as you start to drink and recover from your operation.
Depending on the operation you had, you might also have:
- a tube into an opening on your abdomen (stoma) to drain urine if you’ve had your bladder removed (urostomy tube). Or you may have a bag covering the stoma to collect urine (urostomy bag)
- a bag covering an opening on your abdomen to collect faeces (poo) if you’ve had the lower part of your bowel removed (a colostomy bag)
It’s normal to have pain for the first week or so. You have painkillers to help.
Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.
Immediately after surgery you might have painkillers through a drip into the bloodstream that you control. This is called patient controlled analgesia (PCA).
Or you might have painkillers through a small thin tube that is put into your back. This tube is connected to a pump that gives you a constant dose of painkillers. This is called an epidural.
You get painkillers to take home. Follow the instructions your nurse gives you about how often and when to take them. Contact your doctor if you still have pain or if it gets worse.
You usually have a wound running up and down your lower abdomen. You may also have a wound around your back passage (anus).
You’ll have another wound on the part of the body where the surgeon took the skin and tissue from to make the new vagina if you’ve had vaginal reconstruction as part of the operation.
You have dressings over your wounds after the operation. Your nurse will regularly check the dressings to look for signs of bleeding. After a day or so they change the dressings and clean the wounds.
Your nurse removes the wound drain once it stops draining fluid if you have one. This is not usually painful, but it can be a bit uncomfortable.
You may have stitches that gradually dissolve, so you don't need to have them taken out. Other types of stitches or clips stay in for around 10 days. Your nurse may take them out before you go home. Or a nurse at your GP surgery or a district nurse can usually remove them.
Eating and drinking
Your nurse starts offering you sips of water within a few hours. Once you can cope with these, you can gradually drink more and then may try eating a light diet.
Gradually, you get back to normal over the next few days. Your nurse might give you high protein, high calorie drinks to help maintain your nutrition. Once you are drinking plenty of fluids, your nurse takes your drip out.
It can take a few days before your bowel (and colostomy if you have one) starts working again. You may get a build up of wind and feel uncomfortable. Your nurse may give you some peppermint water to help, and also encourage you to move around.
For the first few days after your operation the stoma nurse helps you look after and clean the stoma or stomas, and change the bags. They will also help you to find which type of stoma bag is the best for you.
Your stoma nurse will give you stoma bags to take home. You get more from the chemist or a local stockist. Supplies are free, but you need a prescription from your GP.
Internal urine pouch (Continent urinary diversion)
If you’ve had your bladder removed, you may have an internal pouch made inside your abdomen. This is called a continent urinary diversion. Instead of having a bag over the opening on the abdomen to collect the urine, you put a thin tube (catheter) into the stoma to drain it off.
Your stoma nurse will teach you how to do this. It may be every 2 hours at first. Gradually you will be able to extend the time you drain it so that eventually you may be able to drain it every 4 to 6 hours during the day.
Getting up and walking is likely to be difficult at first. Moving about helps you to get better, but you need to start gradually. Your nurses will encourage you to get out of bed and sit in a chair as soon as possible. Once all the drips and drains are out it will be much easier to get around.
The physiotherapist might visit you after your operation to help with breathing and leg exercises. Your nurses will also remind you to do the exercises. This helps to lower the risk of more serious complications such as blood clots in the legs (DVT).
How you might feel
You may feel weepy or down for a time after having surgery. This can be partly due to the general anaesthetic, but also because of feelings about your diagnosis and the type of operation you’ve had.
Your nurses on the ward will help support you. You can talk things through with your specialist nurse if you feel like this when you’re at home. They can refer you to a counsellor or therapist if you need more help with adjusting to the changes to your body.
You are normally in hospital for around 7 to 14 days. After this type of surgery, you will need to rest at home for at least 4 to 6 weeks after you come out of hospital. Until this time, you will not be able to:
- do heavy housework, such as vacuuming
- carry heavy bags of shopping or washing
When you can start driving again will depend on your recovery from the operation. Your doctor will help guide you about this. Remember to contact your car insurance company for advice about driving after surgery.
A short walk every day is a good idea. You will get a bit of fresh air and you can gradually go further as you regain your strength. Do take it easy at first though.
When you can go back to work will depend on the type of work you do and your recovery both physically and emotionally. The ward clerk can give you a sick note for while you’re in hospital. Once you’re at home, your GP can give you more.
Your sex life
This type of operation can affect the way you feel about yourself, and you may lose interest in having intimate contact for a while. Depending on the operation you’ve had, you may need to look for other ways of having sexual pleasure.
You may have changes in sensation during sex which may affect your ability to reach orgasm.
If you’ve had vaginal reconstruction using skin and tissue from your thigh, you might feel a strange sensation in your inner thighs when you have intercourse. Most women get used to this over time.
Your specialist nurse will help support you and your partner. They can give you details of other professionals that can help.
Follow up after surgery
You have follow up appointments to check your recovery and sort out any problems. They‘re also your opportunity to raise any concerns you have about your progress.
When you have your first outpatient appointment after surgery can vary between hospitals. You might have an appointment about 2 to 6 weeks after your operation.
Some hospitals might contact you by phone to explain the results of the surgery. Then depending on the results, you may not have an outpatient appointment until 3 months after your surgery.