Discharge Information — Abdominal Surgery

🏥

After Your Abdominal Surgery

Recovery guide for caesarean section and abdominal hysterectomy

Patient Name

Date of Surgery

Procedure Performed

Abdominal surgery involves a larger incision and requires more recovery time than keyhole procedures. While the skin heals within days, internal tissue and fascia take 6–8 weeks to regain strength. Following these guidelines carefully will protect your healing and reduce complications.

💊 Pain Management

Step	Medication	Schedule
Foundation	Paracetamol 1 g BF SAFE	Every 6 hours (max 4 g/day)
Foundation	Ibuprofen 400–600 mg BF SAFE	Every 6–8 hours with food
If needed	Opioid (as prescribed)	Breakthrough only — max 3–7 days

Schedule doses — don't wait for pain to become severe. Start oral analgesia before your spinal/epidural wears off. Hold a pillow firmly over the incision when coughing, laughing, or sneezing. If breastfeeding: avoid codeine and tramadol. Paracetamol should be the last medication stopped.

🩹 Wound Care

Incision Care Instructions

Dressings can be removed after 7 days
Shower with soap and water — pat dry gently
Do not apply creams, ointments, or antiseptics
If abdomen overhangs the incision — lift several times daily for air circulation
Wear loose clothing and cotton underwear
Sutures removed at 6–7 days

Signs of Wound Infection

Increasing pain, redness, heat, swelling, green/yellow discharge, or unpleasant smell. On darker skin, redness may appear as darkening of the skin colour. Report immediately.

⚖️ Lifting & Driving — Non-Negotiable

Lifting Restrictions

First 2 weeks: Nothing heavier than the baby (~3.5–5 kg)
Weeks 2–6: No lifting >4.5–7 kg
No lifting toddlers or older children — arrange help
Internal fascia takes 6–8 weeks to heal — early heavy lifting risks hernia and wound breakdown

Driving

Generally 2–3 weeks. You must be able to: sit comfortably with seatbelt, perform an emergency stop without pain, look over your shoulder freely, and be off all sedating medications. Test with the car stationary first.

🦵 DVT Prevention — Critical

Blood Clot Risk is Elevated After Surgery

VTE risk is 5× higher postpartum, and caesarean section doubles this further. Prevention is essential:

Walk within hours of surgery once anaesthesia has worn off
Ankle pumps: push foot up and down 10× every hour in bed
Wear compression stockings as prescribed
Take blood-thinning injections (Clexane) if prescribed — typically 10 days
Don't sit or lie for >2 hours at a time while awake

📅 Recovery Timeline

Timeframe	What to Expect
Day 1	Walk with assistance. Catheter out. Begin eating & drinking. Breastfeed (C-section: football hold or side-lying).
Days 2–3	Discharge (C-section 3 days; hysterectomy 3 days). Dressing removed.
Week 1	Hardest period. Short walks. Regular analgesia. Sutures removed (C-section day 5–7).
Weeks 3–4	Energy improving. Longer walks. Light housework. Possible part-time desk work.
Week 6	Postnatal/post-op check. May resume jogging, swimming, sexual activity with clearance.
Weeks 8–12	Internal healing continues. Gradual return to vigorous exercise.

🍎 Diet & Constipation Prevention

Bowel Protocol — Start Immediately

Eat and drink as soon as awake — early eating is safe and speeds recovery
Chewing gum in the first 24 hours stimulates bowel motility
Stool softener from day one: docusate 100 mg 2×/day
Lactulose 15–30 mL daily if needed
8–10 glasses of water daily
High-fibre foods: prunes, pears, leafy greens, whole grains
Do not strain — support wound with pillow
Seek help if no bowel movement by day 4–5

📞 Contact Your Doctor Urgently For

Increasing wound pain, redness, or discharge
Fever >38°C with feeling generally unwell
Swelling, redness, or pain in one leg (DVT)
Unable to pass urine or burning with urination
Persistent vomiting with inability to pass gas/stool and abdominal distension (ileus)
Severe headache after spinal anaesthesia (post-dural puncture headache)
Worsening mood or thoughts of self-harm

🏃‍♀️ Return to Activity

Activity	C-Section	Hysterectomy
Gentle walking	Day 1	Day 1
Light housework	Week 2–3	Week 3–4
Driving	2–3 weeks	2–4 weeks
Swimming	6 weeks	6 weeks
Sexual activity	6 weeks	6–8 weeks
Vigorous exercise	8–12 weeks	8–12 weeks

Pelvic floor exercises: Begin gently from week 1. Work up to 10–15 repetitions, 3× daily. Continue for life. Consult a women's health physiotherapist before returning to high-impact exercise.

📞 Practice Contact Numbers

Dr Nienaber's Rooms: +27 18 468 6214
Accounts: +27 18 468 6228 · accounts@drnienaber.co.za

🚨 Emergency Contact Numbers

Wilmed Park Hospital: +27 18 468 7700
Life Anncron Hospital: +27 18 468 0000
ER24: 084 124 | Netcare 911: 082 911
SADAG (mental health): 0800 567 567

🌿 Remember

Full recovery takes time — skin heals in days, but internal healing takes weeks. Be patient, accept help, and don't push yourself. Every recovery is different. You are doing an incredible job.

🩺 Procedure-Specific Notes

Caesarean Section

Breastfeeding positions: Football hold (baby at the side) or side-lying to avoid incision pressure
Afterpains during breastfeeding are normal and more intense in subsequent pregnancies
Contraception: you can conceive as early as 3 weeks postpartum
Discuss birth debriefing if the C-section was unplanned — feelings of disappointment or guilt are common and valid

Abdominal Hysterectomy

Recovery takes 6–8 weeks — be patient with yourself
Nothing in the vagina for 6–8 weeks (vaginal cuff healing)
Light vaginal bleeding/discharge is normal for up to 6 weeks
If ovaries removed: surgical menopause occurs immediately — discuss HRT
Histology results discussed at follow-up appointment

🧠 Emotional Wellbeing

Your Feelings Are Important

After C-section: Disappointment, guilt, or "failure" feelings are common after unplanned surgery — these are unfounded but real. Ask to discuss the reasons for your caesarean.
Baby blues (80% of mothers) peak around day 4, resolve within 2 weeks
Postpartum depression (10–20%) persists beyond 2 weeks — this is not your fault
After hysterectomy: Grief about fertility and identity changes is valid. Many women also feel significant relief from symptoms.
Emotional fatigue makes recovery feel harder — tearfulness is normal for up to 6 weeks
Seek help early if mood does not improve

📅 Follow-Up Schedule

Your Appointments

C-section: Suture/staple removal at day 5–7, postnatal check at 6 weeks (physical recovery, mood screening, pelvic floor, contraception).

Hysterectomy: Post-operative review at 6 weeks (wound check, histology results, activity clearance, HRT discussion if applicable).

Dr CS Nienaber