post surgery question

[kaz39]

hi doc, my mum had total hysterectomy, omentum removal, large chunk of bowel removed, along with  most of the cancer, just over 6 weeks ago, since then she has had bad pains in her tummy and sides, the oncologist and surgeon has said this is all very normal, and that some people are left with some pain permanantly, at the moment she is taking oxynorm sometimes when pain is very bad, but takes spasmanol every day for the spasms, is there anything else she can take, and do you think this could be left permanent for my mum, we thought after surgery (stage 3), she would have excellent quality of life, which isnt so as she has all this pain. many thanks in advance if you can answer my questions.

[goody444]

A related discussion, postop activity was started.

[kaz39]

hi doc, thanks very much for your very helpful reply.

[Annekathryn Goodman, M.D.]

Hi There,
It sounds like your Mum had pretty extensive surgery. That of course is quite common in the surgical management of ovarian cancer. Ovarian cancer (I am assuming she has experienced ovarian cancer)very commonly can spread to involve areas of the intestine - both small and large intestine. It is important to remove as much of the cancer as possible by surgery and that sometimes means that a person will have a bowel resection as part of their primary surgical therapy. So it sounds like she had a good surgery.

Postoperative pain can be due to many things. The most common is incisional pain. The pain of the incison is usually a big part of the experience in the first two weeks after surgery. This is treated with narcotic pain medicine. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (there are many NSAIDs available) can be helpful to augment the narcotic medicine.

Pain can also be due to gas pains. After bowel surgery, the bowel will not have its normal motility for a few weeks. The bowel can even be paralyzed and the individual may have trouble having a bowel movement and may even have vomiting. In its most severe form, this is called a postoperative paralytic ileus. This is treated at first by bowel rest which means not eating and staying on IV fluids. Then it is treated by using anti-gas, anti-spasm agents, laxatives suppositories, a heating pad, walking around. With time , it will go away.

Sometimes people will experience a sprain of their abdominal muscles as they start to increase their activity level. This usually happens 2-6 weeks after surgery. So the pain is new and not something that has been present since surgery. Treatmetn is not back off ont he activities, lie down, heating pad, pain medicine.

Now while it sometimes does take many weeks and even months  for the pain that I have been describing above to resolve, persistent pain after surgery that does not resolve is not normal. Possible reasons for abnormal pain include infection, an abdominal fluid collection, a partial blockage of the intestine or a blockage of the kidney.  It is very important for your mother to have a careful physical examination to be sure there is not an area of infection in the incison or at the top of the vagina. You should ask her doctor about the possibilty of getting an abdominal -pelvic CT scan. This will rule in or out a deep infection, and a blockage to her kidney or bowel. If that evaluation is normal, then with time her pain will resolve.