'Everything I wish I knew before my laparoscopy for endometriosis'
In August 2023, after spending a decade plus dreading the arrival of my periods so painful I'd routinely spend days in bed guzzling Nurofen, I sat in a gynaecologist's office as he explained that he believed that endometriosis was the cause of my excruciating monthly issues.
I'd landed here, trying to absorb all the of the information being offered by the doctor, after a trip to A&E with suspected appendicitis in the March of the same year. The medical team didn't find an exploded organ – just some fluid in my pelvis. The next day, I came on my period; the agony actually being the result of my womb lining starting to shed.
To diagnose me with endometriosis, he, the gynaecologist explained, would have to perform a laparoscopy – a type of key hole surgery.
An incision would be made in my belly so that a camera could be inserted to look around my organs and check for signs of endometrial tissue growing. Any such tissue could be removed in the same swoop, hopefully causing some respite from my savage symptoms.
It took 11 months for that surgery to happen (as you'll know if you've tried to get treatment for a female health condition, these lengthy stretches are currently normal – gynaecological waiting times are up by more than double pre-pandemic levels, according to new research from the Royal College of Obstretics and Gynaecology).
I spent a lot of that time thinking about the surgery and its aftermath. What would it feel like, when I came around from the anaesthetic? Was there anything I could do ahead of time, to help me heal? When would I be able to get back to my beloved weight training? Trying to find more information, I Googled incessantly.
Surprise surprise, all that scrolling didn't leave me feeling much better off. Not because I was presented with horror stories from people who had the same treatment. Rather, because it was digital tumbleweed.
Despite the fact that thousands of women have this procedure each year – as well as a way to diagnose and treat endometriosis, laparoscopy is used to remove fibroids and cysts, as well as to deal with non-gynaecological problems such as hernias and appendicitis – most of the information I found online was ill-informed or inconsistent.
An NHS page on the matter simply says that recovery 'usually takes up to five days if you had it to diagnose a condition, or up to six to eight weeks to fully recover if you've had surgery.'
Other websites said that you can go for a short walk the next day but that you shouldn't lift more than 2kg or run for up to three months post-op. As a fitness trainer and devoted exercise lover, this felt like an incredibly long stretch of time.
It seemed clear from my browsing that the advice about prepping for and recovering from laparoscopic surgery isn't tailored for younger, fit women. So, desperate for advice to fit my specific lifestyle, I set out on a mission to discover to best support my body, both before and after the op.
What is a laparoscopy?
Firstly, I ask Miss Mez Aref-Adib, consultant gynaecologist at London Gynaecology, to explain the details of the procedure. 'Laparoscopy is looking inside the abdomen with a telescope,' she says. 'This procedure is used to make a diagnosis and to carry out many surgical procedures, such as to diagnose and treat endometriosis and ectopic pregnancy and to perform a hysterectomy.'
During a laparoscopy, you will be put under general anaesthetic, meaning you won't be conscious or able to feel what is happening. 'A small 5mm incision – and sometimes further incisions – is made to the abdomen and a needle is inserted to inflate the abdominal cavity with gas. This is necessary to provide adequate space to perform the procedure safely.'
Next, a long tube with a camera at one end is then inserted inside the abdomen. 'The image is displayed on a television screen and all surgery is carried out under direct vision. This is often likened to painting a hallway through a letterbox. It is a complex skill acquired through many hours of practice and simulation training,' explains Miss Aref-Abid.
As it is 'minimally invasive', laparoscopy comes with a faster recovery, reduced bleeding, less pain and an easier return to normal life than with open surgery. 'But like any operative procedure, laparoscopic surgery is not without risks.
Common risks are bleeding, haematoma (collection of blood or bruising), infection, injury to intra-abdominal structures and risk of conversion to laparotomy (open operation),' says Miss Aref-Abid.
How to prepare for a laparoscopy
Experts agree that trying to calm your mind and body before a surgery – as well as feeling as healthy as possible, going in – is a smart move. Here's what you should know.
What to eat before a laparoscopy
In order to avoid any obstruction in your abdominal area, you will have to fast for at least six hours before you turn up to the hospital.
On the day of my surgery, I was asked to be at the hospital for 12:30PM, so I woke up at 6:15AM to make sure I had time to eat and digest breakfast before my operation. I kept it small with a bowl of granola and a protein shake, as the advice from the medical team was to avoid anything too heavy.
If you have a morning time slot and can't wake up in the middle of the night to eat, ensure you have a big dinner before bed to keep you feeling full and energised before your surgery.
In the longer term, eating well before your appointment is important to aid recovery. 'Maintaining a balanced diet rich in fruits, vegetables, lean proteins, and whole grains is a good idea to feel your best before surgery,' says Miss Aref-Abid. 'Ensure you get enough vitamins and minerals, especially Vitamin C and Zinc, which aid in healing and general recovery.
'You may be advised to consider a weight loss plan to reduce surgical risks and improve recovery outcomes. Avoid drastic weight loss measures but instead focus on gradual and sustainable changes around nutrition and movement.'
Can I exercise before a laparoscopy?
Long term, exercising before your laparoscopy is a good idea so that your body is fit and strong to aid recovery. 'Think practically about what your body will need post-surgery: you will need upper body strength to lift yourself up and move around as you won’t be able to activate your core as easily,' says Elspeth van der Hole, a personal trainer with endometriosis who has previously undergone a laparoscopy.
In the week or so before your op, she advises low intensity movement. 'If you’re not someone who exercises a lot, but wants to put themselves in the best place possible beforehand, I would recommend something as simple as short walks daily and stretching to keep the joints happy. You don’t have to have a strict workout plan beforehand but getting the body used to mobilisation before surgery will still aid your recovery, even if you’re not a regular gym goer.'
And if you’re someone who already regularly exercises? 'I would start to taper off your intensive exercise beforehand and turn to lower impact movement like walking, yoga and pilates – this way you can go into your operation with a well-rested and relaxed body and mind,' she adds. 'Whilst exercise is important, you want to put your body into a state of calm with repaired muscles and a soothed nervous system.'
It's best to avoid any heavy or high-impact exercise on the day of your op, too, as you don't want to give your body anything else to recover from. I did a slow walk around the park near my home to kill some time rather than sitting on my sofa worrying about what was to come.
How to reduce anxiety before a laparoscopy
It's normal to feel anxious before surgery, says Miss Aref-Abid: 'Having surgery is a stressful time for not only the patient but also their family and friends. If you can, practice stress-reducing techniques such as meditation, yoga, or deep breathing exercises. If you are experiencing significant anxiety or depression, consider seeking help through therapy or counselling and make sure to tell your hospital team.
'Remember though, it is completely normal to feel anxious in the lead up to surgery and often people have a great sense of relief when it is over.'
van der Hole found mental preparation vital before her surgery. 'As someone who uses exercise as a way of managing my mental health, I was acutely aware that I would struggle without a physical outlet after my op. So in the weeks running up to my surgery I practiced meditation more regularly and made sure I wasn’t solely reliant on exercise, but had a number of static coping mechanisms to turn to as well.'
Research has also found mindfulness before surgery can improve post-operative outcomes such as pain, psychological distress, physical limitations and sleep.
How to recover from a laparoscopy
When it comes to post-op healing, everyone's journey will be different.
Experts agree that most people will experience some similar symptoms, such as bloating and shoulder pain from the gas pumped into abdominal during the surgery, some nausea and tiredness from the anaesthetic and some pain or discomfort around your scars.
What to eat after a laparoscopy
Given the nausea and bloating, many struggle to eat initially post-op, but getting in fuel is essential for recovering.
'In the short term post-op, opting for things like peppermint tea, protein shakes, simple pastas, soups, fruit and plenty of water were helpful for me,' says van der Hole.
When you feel able to handle more food, Miss Aref-Abid advises:
Protein-rich foods, which are essential for the body to heal, such as lean meats, dairy and soy products
Foods rich in Vitamin C (citrus fruits, strawberries, peppers) are particularly important for collagen production and tissue repair. In addition, these fruits and vegetables help with bowel opening and can reduce the bloating and pain associated with excess gas
Whole grains like brown rice, quinoa and wholemeal bread to provide fibre, which helps in maintaining regular bowel movements, especially important if
you are on pain medications that may cause constipationIron-rich foods like spinach, lentils, red meat and fortified cereals. Iron is
important for rebuilding blood cells, especially if there was blood loss during surgeryYogurt, kefir, sauerkraut and other fermented foods to promote gut health. Probiotics help in maintaining a healthy digestive system, which can be disrupted by antibiotics or pain medications taken post-surgery
Hydrating properly to ease constipation and support healing
How to get back to exercise after a laprascopy
The big question on most people's minds is: 'when can I get up again?'
'In the initial recovery phase (the first few days) it is useful to prioritise rest. Gentle movements, such as walking around the house, can help prevent blood clots and promote circulation. It can be useful to perform deep breathing exercises to help expand your lungs and prevent pneumonia. Gentle stretching can help reduce stiffness and improve mobility. But avoid strenuous activities and heavy lifting,' says Miss Aref-Abid.
'After a few days to weeks (depending on the individual) it can be useful to go on walks. Start with short, slow walks and progressively extend the time and distance as you feel comfortable.'
The Royal College of Obstetricians and Gynaecologists advise that you can expect to return to your previous levels of activity within four-to-six weeks. Both van der Hole and Miss Aref-Abid believe, though, that timelines are personal.
'Ultimately your recovery will be individual to you, and the best thing you can do for yourself is not to make an assumption of whether you can or can’t do something but to take time to listen to your body and pay attention to what it needs.
'If you’re feeling unsure about how to go about this, it could be a great time to hire a coach (someone educated in steering the ship into and out of surgery prep and someone who is clued up on your health condition and the hormonal aspects, as well as mental and physical health),' says van der Hole.
With that in mind, Miss Aref-Abid suggests that, from around the two week mark, you can start to re-introduce your usual practices in a modified way, if you feel good enough to do so.
'If you usually do yoga, then start working on flexibility and balance without intense core work. Avoid poses that put pressure on the abdomen. Gradually reintroduce more challenging poses as your strength improves,' she says. 'If you like running and high-impact exercise, then start with brisk walking and slowly transition to jogging before moving on to running. Pay attention to your body's response and avoid high-impact activities if you experience pain or discomfort.'
For weight training or other gym exercises, it's best to take things back to basics with very light weights or swapping to Pilates and bodyweight-style movements. 'It’s also good to take into account that heavy lifting does not always equate to better fitness. Consider shifting focus to mobility, flexibility and functionality of the body, utilise this time to rebuild the best foundation possible for your body so when you naturally flow back into heavy lifting you’ll notice you can lift better than ever,' says van der Hole.
'It’s also a great idea to consider looking at post-natal style recovery plans, understanding the functional lines of the body and what muscles support abdominal recovery. For example, the glutes, lats, hip flexors and pectorals will support core stability. When the whole body is stabilised and working together, healing will be quicker.'
The most important part is that you stop if you experience pain, discomfort or fatigue and progress really gradually.
How to aid recovery after a laparoscopy
For other, more holistic tips of improving laparoscopy recovery, van der Hole and Miss Aref-Abid suggest the following:
Take pain medications as prescribed by your doctor. Do not exceed the recommended dose and also make sure to take regular painkillers for the first few days
Use cold packs to reduce swelling and heat packs to relieve muscle tension and pain. Do this for 15-20 minutes several times a day, but avoid direct contact with the skin to prevent skin damage
Eat small, frequent meals rather than large ones to help manage nausea and prevent an empty stomach, which can sometimes worsen symptoms
Get adequate rest and do not push yourself too hard. Allow your body the time it needs to heal
Sleep on your back to avoid contact with scars and improve mobility
Use a wrap-around hot water bottle to ease discomfort while moving around without having to hold onto it
Avoid tight and high-waisted clothing that can irritate your scars and put pressure on your abdominal
Try to get up and changed everyday, even if you don’t leave the house. Don’t fall into the trap of bed rotting - while it’s good to rest, take it to the sofa if you can
Get some good books and puzzle books so you’re not just getting lost in the doom scroll. Too much screentime whilst you’re recovering can make you feel worse, so be mindful of how you use socials
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