Today you can go home. We hope that your stay in our hospital was as good as possible. Below you will find some rules to help you take care of yourself at home. This information is in addition to the conversation you had with your doctor.

General guidelines

• After keyhole surgery (laparoscopy), you may have shoulder pain for a few days. This happens because of the gas that was used during the operation to fill your belly. This gas irritates the muscle under your lungs (the diaphragm). The gas will go away on its own, and the pain will also stop within a few days.
• Do not lift heavy things (more than 5–10 kg) for the first 6 weeks. Walking and using stairs is fine. After 4 weeks, you can slowly start doing sports again. You can do housework and ride a bike when you feel ready. If you have pain or feel very tired, take a rest.
• Do not have any sexual activity for the first 6 weeks. If your uterus (womb) was removed, do not have penetrative sex for 10 weeks.
• For good wound healing, do not swim or take a bath for the first 2 weeks. You can take a shower. After showering, dry your belly carefully by patting it gently. Do not rub.
• You will still have some belly pain in the first few days after the operation. This will slowly get less. If the pain suddenly gets worse, please contact us.
• You may have some vaginal bleeding or dark discharge for a few weeks. This comes from the small wound at the top of the vagina. Please contact us if the bleeding is more than a normal period.
• If contrast fluid was used during the procedure, your urine or stool may look green or blue. This is normal.
• Driving a car: we advise you not to drive yourself for the first 2 weeks, until you can concentrate well again and you no longer have pain. You must be able to make an emergency stop. Of course, you can ride along as a passenger, but not for longer than two hours in a row.

Important information about pain relief

Your belly will feel sore or sensitive after the operation. Please follow these tips for pain relief (if you do not have an allergy or intolerance):

We recommend the following for the first three days after you leave the hospital:

• Paracetamol 1000 mg, 4 times a day, together with:
• One anti-inflammatory painkiller (NSAID), 3 times a day: ibuprofen 600–800 mg, or naproxen 250–500 mg, or diclofenac 50 mg.

Always use paracetamol together with one of these medicines. After 3 days, only take pain medicine if you need it. Do not wait until the pain becomes very bad. Sometimes you may get a stronger painkiller (opioid) for extra pain relief. This is not always needed and can slow down your bowels. Always follow the advice of your doctor or nurse. If the pain clearly gets worse or moves to a different place, please contact us.

Wound care

You can remove the wound plasters (if there are any) the day after the operation. If the small wounds are no longer leaking, you do not need to put new plasters on them. Wounds heal faster and better when uncovered. If adhesive strips (steri-strips) were used, leave them on until they come off on their own. This usually happens after 5 to 10 days. If they have not come off by then, you can remove them yourself. The stitches used are dissolvable, so they do not need to be removed. Keep the wounds clean and dry.

Urinary catheter

Sometimes you need a bladder catheter to let your bladder rest after the operation. Our nurse will explain how to use the catheter at home. The catheter is a thin tube that goes through the urethra into the bladder and drains the urine. At the end there is a small balloon filled with water to keep the catheter in place. The urine flows through the tube into a bag that is attached to your leg. You will usually keep the catheter for 1–2 weeks.

When it is time to remove the catheter, we will check at the ward or outpatient clinic that you can urinate on your own again. We do this by checking how much urine is in your bladder a few hours after removal, using an ultrasound. This is called a TWOC (trial without catheter).

JJ stent (ureteral stent)

Sometimes you need a JJ stent. This is a thin internal tube between the bladder and the kidney that keeps the ureter (the tube from kidney to bladder) open. Urine can then flow from the kidney to the bladder. The JJ stent gets its name from the curled ends that look like the letter J. These curled ends keep the stent in place. The stent usually stays in for several weeks.

If you have bladder cramps, you will get medicine to take home for these spasms. The urologist will tell you when the JJ stent can be removed. Removal is usually done at the urology outpatient clinic with a flexible cystoscopy. This is a short and simple procedure.

Because of the JJ stent, you may experience the following symptoms:

• Pain or a feeling of pressure in the side and the bladder
• Frequent urge to urinate
• Urinating often (small amounts)
• A burning feeling
• Light bleeding when urinating (for example after physical activity, such as walking)
• A pressing or warm feeling in the kidney area, especially while urinating

These symptoms can be annoying, but they are not immediately alarming.

Follow-up appointment

After 2 weeks, a nurse will call you to ask how you are doing. If tissue was removed during the operation, the nurse will also discuss the results with you. Your check-up with the gynaecologist and urologist will be 6 weeks after the operation. You will receive these appointments by email. You can also view them in the Reinier de Graaf patient portal.

When to contact us

If you are back home and you have one or more of the following problems, please contact de Nederlandse Endometriose Kliniek:

• Fever: 38.5 degrees Celsius or higher
• Increasing pain or questions or doubts about pain
• Heavy vaginal bleeding, more than a normal period
• Your wound looks red or swollen, or there is pus coming out
• Vomiting, not being able to eat or drink