After her first surgery for endometriosis, writer Kristina Kasparian learned that during surgery, surgeons had filled her abdomen with gas to make it easier to see her organs. But the gas didn’t escape her body right away, meaning that as she was recovering, the trapped gas caused her “tremendous discomfort, radiating into the ribs, and up to the collarbone.”
She was also surprised to find that anesthesia can continue affecting you for several days after the surgery, making you extra groggy.
Since then, Kasparian has had three more surgeries for endometriosis. The first was the most challenging to recover from, she says, “because I didn’t know what to expect.”
Now, she knows that “preparing the body and mind is helpful for a smooth recovery.”
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What Is Endometriosis Surgery?
When you have endometriosis, tissue similar to that which typically grows inside your uterus (endometrial tissue) grows outside of it, covering other organs. This can cause serious pain, abnormal bleeding, diarrhea, constipation, and infertility. Your pain and symptoms can vary depending on where the tissue grows in your body. For example, if you have endometrial tissue on your bowel, it can make your bowel movements painful. Wherever you have pain, it tends to worsen during your period.
Who Needs Endometriosis Surgery?
While many patients are able to manage endometriosis symptoms with diet, exercise, acupuncture, physical therapy, cognitive behavioral therapy, hormonal contraceptives, and NSAIDs (non-steroidal anti-inflammatory drugs), for some, the pain is so severe that they may need surgery to remove the tissue from various parts of the body where it should not be. Surgery can also raise the possibility of pregnancy.
How to Manage Anxiety Before Endometriosis Surgery
Psychologically preparing for surgery—for example, by gathering as much information as you can about the procedure, participating in therapy sessions, or practicing relaxation techniques like deep breathing or hypnosis—doesn’t just ease anxiety, but may actually reduce your pain after the surgery and shorten your recovery time, according to a 2016 Cochrane Review which evaluated the findings of more than 100 studies on the topic.
Before undergoing surgery, “the best thing you can do 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 recommends not just talking to your surgeon, but to your nursing staff, ward doctors,anesthesiologists, and even friends who have undergone the same or similar procedures.
“They are the pain experts,” says Acton.
Kasparian recommends making sure you have a plan to speak to your doctor over the phone shortly after the surgery to discuss how you’re feeling and any next steps, “so you’re not kept wondering and worrying.”
She said she also spends time “thinking of if-then scenarios and asking my physician all my questions in advance,” which she notes calms her down before surgery. Consider printing out the questions at the end of this article and bringing them with you!
Breathing Exercises
Breathing exercises are one of the most powerful ways of easing tension and anxiety and focusing on the present moment. Acton specifically mentions an exercise he says can help ease your racing heart or mind: inhaling for a count of five seconds, holding that breath for five seconds, then slowly exhaling it all out.
Kasparian likes “box breathing,” a technique in which you breath in for four seconds, hold for four seconds, breath out for four seconds, and hold for another four seconds. She also says that diaphragmatic breathing, a strategy in which she places a hand on her chest and one on her bellow and consciously breaths to inflate and deflate her stomach is helpful “especially after laparoscopic surgery where gas pain can radiate to the collarbone.”
Try some of these simple breathing exercises MedShadow rounded up from Instagram.
How to Prepare Your Home for Recovery
- Make sure you have plenty of comfortable clean clothes that do not have tight waistbands. Shirts that button can help you avoid reaching over your head after surgery.
- Clean your house in advance.
- Make sure it’s easy for you to access a bathroom. You will have very little energy at first. You may want to avoid stairs.
- Pamper yourself by washing your hair, painting your nails, or doing other types of self-care that feel good to you.
“You may not be able to do these things for a few days or weeks,” after the surgery, writes Kimberli Davino, a columnist for Endometriosis News.
- Pets can be a great comfort as you recover, but you may not be able to place their food bowls on the ground, go for walks, or clean litter boxes. Make sure you have someone to help you care for your pets. If they’re likely to jump for joy when you get home, you may want them to stay at someone else’s home for the first few days to make sure they don’t accidentally bump your wounds.
- Davino also mentioned making sure that items you use regularly, like toothpaste or snacks, are stored at waist-level in your home.
“You will not be doing any lifting, bending, climbing, or reaching.”
- Prepare your easy-to-digest meals and snacks in advance. Some of Kasparian’s favorites are pre-cut fruits and vegetables, applesauce, Jell-o, and premade soups. She also stocks some ice cream in the freezer, which she says “does wonders for her mood.” You may be nauseous or constipated after surgery, so consider preparing lighter meals and snacks.
- Set up an auto-response on your email and/or phone, so you can rest instead of worrying about responding to messages.
- Have pillows or blankets to prop yourself into comfortable positions in bed.
What to Bring to the Hospital
Patients who are able to go home to recover in their own beds tend to tolerate pain better and have smoother recoveries, according to the experience of Michael Tahery, MD, a Los Angeles-based surgical uro-gynecologist, but occasionally, you may have to stay in the hospital overnight.
Even if you don’t stay long, you should have what you need to keep comfortable while you wait to head home!
You should bring:
- Menstrual pads as you are likely to bleed after surgery
- Your phone and a charger long enough to reach your bed
- Comfortable clothes without a tight waistband
- A small pillow to protect your abdomen from the seatbelt when it’s time to head home.
- A toothbrush and hand sanitizer to help protect yourself from hospital-acquired infections.
- Something special you want with you
“Hospitals are very clinical, hard places,” Acton said. A special blanket, stuffed animal, photo, or other comfort item may help you feel more relaxed.
Think hard about who you will want to drive you home or visit you if you have to stay. Ask yourself, who will help you advocate for yourself and make you feel calm?
How to Manage Pain After Endometriosis Surgery
Endometriosis is often a painful condition, and many people with it are prescribed opioid painkillers. Some people who never get surgery are prescribed opioids, but the majority of these prescriptions were first filled at the time of endometriosis surgery, according to a 2019 study. Unfortunately, the study also found that more than 11% of patients were given more than a 30-day supply of the drugs and 5.5% got a three-month supply. The longer you take opioids, the higher your risk for developing a substance-use disorder, the study’s authors pointed out.
“Most pain care is now elective, to a certain degree,” says Acton. He and Tahery both recommend using the following strategies to manage pain, alongside or in lieu of opioids or NSAIDS (non-steroidal anti-inflammatory drugs).
To manage pain, try to:
- Ask your doctor to describe all of your options for pain management, not just opioids.
- Apply cold and/or heat therapy to the incision area as directed.
“Heat is very effective for pain management,” says Acton.
- Abdominal binders can counter the pressure when you cough or get up and walk around, says Tahery.
- Distract yourself. Watching TV or listening to music can help take your mind off of pain. On the flip-side, Kasparian says that she removes distractions, such as her phone, sometimes so she can focus on mindfulness techniques.
“I check where I might be holding tension and try to relax my muscles,” Kaspariansays. “I usually hold tension in my pelvic floor or my neck.”
- Eat.
“Even if it’s just some scrambled eggs or oatmeal. Make sure you get nutrients in your system,” says Acton. Not eating can slow recovery and heighten anxiety and pain.
- Breath deeply. Before surgery, deep breathing exercises can help ease anxiety. After, it can reduce your pain as well, says Acton.
- Light activity, like walking around the house, may help you release gas and reduce pain and discomfort.
- If you take opioids or if you have endometrial tissue removed from your rectum or bowel, you may feel constipated. Stool softeners can help alleviate this pain.
Acton adds that emotional support can help to “make certain that you have somebody or several people you can talk to who know about your situation. Sometimes just talking it through can make you feel more relaxed, and you won’t need a pill.”
One of the most important things you can do, says Kasparian, is “giving yourself as much extra time and as much permission to go as slow as possible once you return home.”
Another endometriosis patient, Amber Bibelheimer, says that it took three weeks for her to recover from the surgery, but afterward, she was in significantly less pain and was able to get pregnant a year later.
Questions to Ask Your Doctor
- What should I be doing before the surgery?
- Should I stop taking any medicines I’m already on?
- What will the process be like when I arrive at the hospital for the procedure?
- How exactly does the procedure work? How long will it take?
- What are my risks from general anesthesia?
- Are there other options that might be appropriate for me, such as regional anesthesia?
- What happens when the surgery is over? How will I feel?
- When I go home, what do I need to do to make sure I heal appropriately?
- What are the pain management options after surgery?
- How much pain should I expect and for how long?
- Which pain medications are usually prescribed?
- What are their side effects?
- How long would I take them?
- When can I choose when to stop taking it?
- When I stop taking them will I be able to stop immediately or will I need to taper off of them?
- What are my options if I don’t want to take opioids?
- Do I need a stool softener? This can be helpful if endometrial tissue needs to be removed from your bowel or rectum. If you choose to take opioids, these can also cause constipation because the specific type of opioid receptors that the drugs bind to in your brain to block pain are also prevalent in your digestive tract, where the drugs can slow your digestion.
- Who is my point person of contact? Who should I call if I go home and something doesn’t feel right?
