4 top tips that you might not have considered, for preparing for laparoscopic surgery

Sometimes it seems a little scary that I have so much experience with surgery! I have had multiple laparoscopies as well as other procedures over the years, in fact, many of my friends usually ask me what to expect as they know it’s something I am all too familiar with. 

Working closely with Endo patients over the years, I recognise how important the lead up to surgery can be to improve outcomes and set them up for success, so I wanted to share some thoughts on ways to prep for surgery that you might not have heard about from other health professionals…

Hand written questions:

I recommend taking along to your appointment a hand written list of questions. I think it is important to spend a good 10 minutes, possibly with a friend or family member, writing down all the questions you have about the plan for your surgery. Handwriting lights up more areas in the brain than typing, and it helps to avoid distraction, so tapping the list into your phone might not be as effective when you’re coming up with your questions, as writing it out with pen and paper. I also think holding a piece of paper as you walk through the doctor’s doorway shows that you are prepared with questions and allows you to lead the discussion.

When we understand what is happening in our bodies, it calms our mind. Often navigating Endo can be tough, scary and confusing. After many years of being told “its normal” to have period pain and associated symptoms, many of us lose trust in doctors. We might have experienced dismissal by friends or partners who don’t believe or understand our symptoms, or how much our symptoms impact our lives and decisions.

So what kind of questions should you ask?

Ask about the exact surgery they are suggesting. What tools are used. What is the process that they use to determine the extent of the disease. What is the likelihood everything will be excised Vs ablated. What is your surgeons experience with this surgery. How often does it result in full excision. How often do they need to repeat surgery. If you are not well following surgery how can you get in touch with your doctor? Will you be given their phone number or email address for direct contact?

Ask questions about your body, like will you need to do any preparation for the operation like a bowel cleanse. Where will your cuts be. Will you be put on medications after surgery like pain meds or antibiotics. Do you need to have laxatives on hand in case the pain meds cause constipation? Are there any routine test done during or after the surgery?

Also ask questions about your hospital stay, the costs associated with it, who determines when you are discharged from hospital and how long you will need to rest after surgery. How long should you expect to need off work. Will you be able to lift your child afterwards. Will you be able to drive. When will you receive biopsy results and when is your follow up with your surgeon.

Ask your doctor if they feel you are a good candidate for surgery. Do they recommend you seek some help from a dietician or pelvic physiotherapist before surgery. Are you too “sensitized” for surgery right now. What is their experience with patients who are in high levels of pain prior to surgery.. How do they recommend managing the potential for pain escalating after surgery.

Ideally, take a support person along with you to this appointment. It can help you feel more settled and safe, which will make engaging with your doctor easier. As the patient you’ll often have lots of thoughts and feelings emerging as you listen to the answers to your questions, which sometimes can distract us from hearing all the details being described. Having an independent person attend with you, allows them to hear the answers in a more neutral way. That way, you can debrief with your buddy to check that they heard what you heard, and what they thought about the answers.

Soothe before surgery

When we undergo surgery, our body is poked and prodded. This is all part of what is needed for diagnosis and treatment of Endo, and lucky for us the body has an amazing way of healing itself. However, during this time of healing, the body releases inflammation to assist with regeneration and healing. This is natural and SHOULD happen. However, it can also mean that our body feels pain from this process. Pain is not always “bad”, in fact, it was designed as a warning signal to help us protect ourselves. For example, it’s important that we don’t leave our hand on a hot stove! The pain signals to us to pull away.  However, sometimes our body’s cannot decipher the difference between helpful “protective” pain and being overprotective. If our body believes it’s under threat, it can cause us to be more sensitive to normal stimuli. This means that we pull away from things that should not cause pain, nor are damaging to us. 

When we have surgery, there will be some pain with healing that is helpful and SAFE, telling us to slow down for a little while as our tissues heal. However, when we have experienced pelvic pain for many years, especially frequent bouts of high pain with no real answers to what’s going on, our nervous system is wired to perceive pain messages from the pelvis as dangerous threats, and our system is on high alert to try and protect us.  Therefore, when surgery is performed, often our body responds with highly protective pain messages, sometimes causing a much greater increase in pain after surgery than just the healing pain. This can be really confusing as surgery is meant to “help” our symptoms, and it can be disappointing when pain persists after surgical treatment.

The best thing we can do for our nervous system in the lead up to surgery is to soothe it. To make it feel safe. To make it understand that it does not have to be over protective. That it can CHILL. I have found that many of my patients who go into surgery well informed, well prepared both physically in their pelvis and mentally in their ability to find relaxation and ease in difficult moments, have improved outcomes after surgery. It only makes sense that we need to prepare ourselves for surgery to reduce the “shock” to our system when it undergoes invasive procedures.

How can we soothe our system? We can understand what is going to happen, we can use gentle movement, mindfulness practices and deep relaxation to help drop our nervous system away from feelings of stress and fear and towards feeling more safe and settled in body and mind, even in the presence of discomfort.

Nourish

Many of us might prepare for surgery by cooking up meals for the freezer to use post-op. However, have you considered if you’re preparing your body for surgery through nourishing practices… What food will you be fuelling your body with? What is your sleep quality like? And are you moving your body enough to ensure it’s fit for surgery?

Dietary choices have been shown to improve symptoms of chronic pain. Diet has also been shown to be an effective way of managing symptoms of IBS. Diet doesn’t need to be super strict and limiting, but a healthy association with food, and a tendency to eat nutrient rich whole foods will prepare your body for the impact of surgery. I would always recommend a dietician to assist with forming a pre-surgery nutrition plan. The list shouldn’t feel restrictive but should offer a wide variety of foods that will help your body prep for surgery. It should also be rich in fibre to assist with bowel changes from the impacts of surgery and medications, and adequate water intake to keep things moving!

Sleep can be a tricky issue, especially when pain is high. We know we need to sleep well to rest our body, support our immune system, optimise our gut health and manage stress and mood (which all feed into our pain experience), but then pain gets in the way of falling or staying asleep - which stresses us out more - it can be a hard cycle to break! 

Problem solving your sleep will giving your body its best chance to spend quality blocks of time overnight in healing mode before surgery. Interestingly, it’s not just about what you do right before bed that will help you sleep - it actually starts when you wake up! 

Cortisol, commonly known as our stress hormone,  is also our ‘get up and go’ hormone. We need levels to rise in the morning to help us wake and start the day, and taper in the evenings to allow melatonin levels to rise and sleepiness to emerge. If you are exhausted in the mornings, then wired in the evenings, your cortisol levels might be to blame. This is called HPA axis dysregulation, and it’s common in people with persistent pain. Our cortisol levels are all over the place, from pushing out so much of it with the stressor of pain, heavy flows and its consequences on your day to day life. Optimising our cortisol levels - higher in the mornings and lower in the evenings, is an important component of helping us get off to sleep and stay asleep.

Paying attention to your morning and evening routine can be a great place to start. Are you holding your wake and bed times stable? Can you get your eyes into sunlight as soon as you wake to help set your circadian rhythm, which will help set the time that sleepiness will emerge. Perhaps sitting outside with your morning warm drink, or going for a short walk outdoors, or some mindful movement near a bright window, can help your system get revving for the day. 

In the evenings, can you dim bright lights, and let your eyes see it getting dark outside. Can you avoid screens, take a warm magnesium bath and explore some relaxation or yoga nidra practices to help you evoke the relaxation response, and turn that cortisol pump off, and allow melatonin levels to rise. Creating consistency is key, and giving your body and mind time to wind down and then following the cues of sleepiness to get into bed, can start to create shifts that can then spiral into even better sleep. 

Knowing what practices help you sleep better pre-surgery, will be a fantastic addition to your toolkit for managing in those early days and weeks post surgery. 

Exercise is an important component of everyone’s life. Exercise doesn’t mean sweating or pushing your body to its limits. It means movement, it means time away from screens, time away from work. It has a physiological impact on your body and brain, producing healthy chemicals in our brains which make us feel happier, calmer and clearer. 

Exercising with Endo can have its complexities. Some of us feel better working at high intensities, others will find high intensity exercise sends us straight into a fatigue and pain flare. It is important to find what is right for you, and what is right at different times of the month or at different points in your recovery.

We recommend starting with walking and low intensity yoga and pilates style exercises as a first step. Be mindful that at times the abdominal load in Pilates can impact Endo symptoms, especially if you are already overactive or tight in these areas. So it’s often best to skip the abs at first and focus on full body mobility, releasing tension, and feeling SAFE with movement, then build from there.  If you have no pain, or even low level amounts of pain during or after exercise, that doesn’t last more than a couple of hours, this probably indicates that choice of exercise is a good choice for you. If however, you find that you are in pain afterwards, that the pain is moderate to strong, or that the pain continues into the evening or the next day, that is usually a sign that the exercise choice is not agreeing with your system at that time. Our move and soothe sessions in the EVOLVE course offer lots of variety from gentle stretches and mobility work up to more targeted strengthening, so there’s lots to try out to see what works for you. 

Pelvic Health Physiotherapists should be on your Pre-hab plan

Pelvic Health Physios aren’t just important after surgery, we can help you BEFORE surgery to assist in some pelvic pre-hab! Whether you have a diagnosis of Endo or are still awaiting your diagnosis, if you’re experiencing Pelvic symptoms including pain, bladder or bowel troubles, sexual symptoms, or menstrual symptoms - all of which are SO common to Endo warriors- then a Pelvic Health Physio should be on your treatment team!

Pelvic Health Physios are experts in muscular patterns in and around the pelvis.  Often these muscles have been building up tension over time, trying to protect the pelvis and pelvic organs when pain and inflammation have recurred cyclically over many years. As a result, these muscles don’t simply “let go” when Endo is removed, and consequently surgery can sometimes seem “ineffective” when it might be that these pelvic floor muscles need localised treatment themselves. Pelvic Health Physios can begin to work on the muscle patterns found in your pelvis prior to surgery, which can provide relief pre-surgery and optimise the outcomes of surgery.  Treatment may also allow you to empty your bladder and bowel with more ease, and help you connect with your body so that you can become aware of different sensations around the pelvis and understand where and why pain is occurring. Pelvic Health Physios are also well placed to monitor and prescribe specific individualized exercise plans for you, so they can be a great source of guidance pre and post-operatively.

We wholeheartedly believe preparing for surgery is essential in achieving better post-operative outcomes. Endo Online’s Evolve Course is absolutely suitable for you, even if you haven’t had your “official” Endo diagnosis via surgery. If your symptoms align with those of Endo, it is highly likely that you will benefit from the self-exploration and self-management strategies taught in our 8 week course. A wonderful way to set yourself up for success in your journey towards surgery!