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Had burch retropubic repair, salpingo urethropexy, posterior colporrhaphy. Getting sharp pain on stitching site. Any problem?

Mar 2013
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On Feb 4, 2013 - I had the combined surgeries: burch retropubic repair, salpingo urethropexy (removal of fallopian tubes and one remaining ovary), and posterior colporrhaphy... It has been 8 weeks since my surgery and I am still experiencing the following symptoms: mobility - I can walk only about 6 - 8 blocks maximum at a moderate pace before I feel pressure/pain in my pelvic floor; I still have pain internally periodically that I can only describe as sharp pains that feel like they might be related to XXXXXXX stitching sites (mainly on the left side of my abdomen but sometimes on the right side) - when I lie down and stop moving the pain ceases; I have intense daytime hot flashes, and nighttime sweats and sleeplessness - I believe caused by the removal of my fallopian tubes and remaining ovary) - my mother died of breast cancer so I cannot take HRT but am taking black cohosh and evening primose which seems to cause a little relief but my sleep is only about 2 hrs consecutively and 4-5 hrs XXXXXXX per night; and overall my energy level is still quite sluggish - I need to take a nap every few hours in order to function for the rest of the day ... Discharge - I still have a light yellow discharge that seems to be coming from my vagina but I no longer have urinary incontintenance... I am worried about a return to work date next week (Apr 8th) as my job requires me to work long days (7:30 am until 6:00 pm) as a Human Resources leader - in a sitting position (in front of a computer), facilitating training and meetings (either standing or sitting), and travelling (either driving 3 hrs each way to locations or flying and walking through airports and taking 2 hr flights pulling a small carry on piece of luggage). I am not sure whether what I am feeling is perfectly normal with the 3 surgical procedures that I have had performed, and I want to pay attention to my symptoms in order to recover fully and heal, yet I feel that I need to return to work shortly... I do not have an option due to the level of leadership position that I hold to return to work part-time or to work partial days - I could possibly request to work remotely which would alleviate my need to drive or fly (travel) but this might be only for a short period of time... I am not sure if I what I am feeling is normal or not at 8 weeks following the type of surgical procedures that I have had?
Posted Mon, 22 Apr 2013 in Women's Health
Answered by Dr. Aarti Abraham 7 hours later
Thanks for your query.

May I ask you if the surgeries were performed laparoscopically or whether they were open ( laparotomy ).
Recovery to normal varies significantly between the two.

It usually takes about six weeks to make a full recovery from Burch colposuspension, but this varies between individuals, and also on the skill and expertise of the operating surgeon.

You will usually need to take at least six weeks off work.
This is a rough estimate, and in some individuals you might need more.
Of course, in your case, the problem is magnified because of your post menopausal status, and the resultant hormonal imbalance, which is compounding your issues.

Pain, discomfort, sleeplessness, everything is magnified in a post menopausal lady due to the lack of hormonal back up, which normally helps to smoothen the transition to recovery.

You should be able to walk comfortably by now. Also, the sharp occasional pain is fine as the XXXXXXX stitches need a few weeks to get healed, however, in your case, the discomfort is severe, so I hope you have had a follow up visit with your surgeon to rule out any infection / impaction of stitches or any other potential post surgical complications. If not please get it done.

I would also recommend a complete blood count and thyroid profile to rule out anemia and hypothyroidism - two major causes of fatigue, decreased energy levels, sleep disorders etc. Calcium and vitamin D levels also should be measured and these two supplemented as indicated.

Regarding your post menopausal symptoms, a family history of breast cancer is a relative contraindication. Some bioidentical hormones might be used in your case judiciously and under close surveillance if the benefits outweight the risks. Discuss this in detail with your gynecologist. Other alternatives to traditional hormone therapy include phytoestrogens. These are sources from plants that have weak estrogen activity. Phytoestrogens are found in grains, flaxseed, rye,
fruits and vegetables. Isoflavones, a subset of phytoestrogens, are found in soybeans. One trial found soy protein at 60grams per day decreased hot flashes in 45% of symptomatic women.

From what you have written, I am of the opinion that you need to request some leeway at work right now, even if temporarily, till you are somewhat stabilized.
Get a follow up appointment with your surgeon, a check up with your gynecologist, get the tests done as advised, and make adequate dietary and lifestyle modifications to help you tide over the transition phase.

As for what you are feeling, whether it is ' normal ' or not - normal in itself is subjective. Every individual's threshold for pain and ability to recover is subjective, and 8 weeks is by no way a very long time. What I mean is you are perfectly justified to be facing these problems at 8 weeks post surgery, and maybe your body requires a longer period of recovery and rest, which I am sure it deserves in the long run.

Also, for menopause, lifestyle modifications are a great option.
Here are a few pointers which MIGHT help you for sleeping well :

Wear sleep wear made out of fabrics that breathe easily, like cotton
Choose layers of light bed coverings
Keep a bowl of cool water with a face cloth on your bedside table so you can quickly cool yourself during the night.
Have a fan on in the bedroom. If possible, one that's easy to control without having to get out of bed. That way you can turn it off and on as needed.
Set and keep regular bedtimes.
Create a relaxing night time ritual to do just before bed.
Keep a relaxation CD and player with earphones nearby. Use it to help get you back to sleep if you're awakened.
Avoid eating an hour or two before bedtime.
Limit how many caffeinated drinks or chocolate you consume

For hot flashes :

Dress in layers.
Carry a small handheld fan in your purse.
Exercise regularly
Limit the time you spend outdoors on hot days
Avoid spicy food
Limit the amount of coffee you drink
Develop healthy coping skills for handling stress - counselling is an excellent option.
Yoga / meditation / relaxational therapies are supposed to bring great relief .

I am impressed with your insight and concern that is so obvious from the lengthy and succint question you have composed.
Am sure a motivated, involved and capable lady like you would get over this phase with great success, because, like everything else in life, you need to keep in mind, that it is a phase !

I hope I could help you a bit.
Take care, and feel free to discuss further.
Be well.
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