A laparoscopy is an operation where a gynaecologist puts a telescope through the umbilicus (belly button) to look at the organs inside. For many girls and women, a laparoscopy is one part of their pain management plan.
Preparing well for a laparoscopy means a quicker recovery, less pain, less time in hospital, and a better health outcome. That’s definitely worth putting thought into.
Rather than a laparoscopy being the first part of your pain management plan, it is often best to settle your pelvis and sort out as many non-surgical pains first. Even if you have endometriosis, it is common that there are other types of pain present too. For example, you may have the stabbing pains which are typical of pelvic muscle spasms. You may have cramping pain from the uterus itself with periods. You may have irritable bowel symptoms or food intolerances. These all contribute to your overall pain experience.
By taking 2-3 months to prepare yourself and your body, you set yourself up best for a more comfortable hospital experience and a better laparoscopy outcome. Most pelvic pain conditions (including endometriosis) do not change quickly, so, you have time to plan well.
The advice on this page is of a general nature and may not suit every person. Your gynaecologist knows your individual situation best, so please choose their advice if their plans for you are different from ours.
In the three months before surgery
Plan to minimise as many aspects of your pain as you can, so you can arrive at the hospital in good condition, both mentally and physically.
– Take time to think carefully, and make sure that you are comfortable with your decision to have a laparoscopy. Think about what you are trying to achieve by having surgery? Which pain is your primary concern? Is this a pain that surgery can treat? If you are unsure, there is information about each type of pelvic pain in this book that explains which treatments work best for that particular pain. If you have had surgery before that did not improve your pain, or only helped you for a short time, ask yourself what will be different this time? If you are unsure about your decision to have surgery, now is the time to make an appointment with your doctor to discuss it further. Once you are sure, either way, you can feel positive and calm. You have made a decision. This reduces worry, which in turn can reduce pain.
– Minimise your periods to give your pain a chance to improve before surgery. Each period can wind up your overall pain, and the pelvic muscle spasms that causes the stabbing pains. If you use the contraceptive pill, try to skip periods, rather than have a period each month. If you find it difficult to skip periods with the contraceptive pill, ask your doctor about changing to a progestogen-only tablet like norethisterone 5mg or dienogest 2mg taken every day continuously without breaks. You can start these medications on the 3rd day of a period, but remember to take them every day without forgetting any tablets. If you do forget them, you may get bleeding and pain. If you don’t like taking these medications, consider whether it would be acceptable for you to take them just for two months before your surgery and one month after surgery?
These medications will thin the lining of the uterus ready for your surgery and reduce the aggravation of pain that happens with bleeding. Thinning the lining of the uterus is especially important if you are considering having an intrauterine device inserted. A thin endometrium (lining of the uterus) gives the intrauterine device a great start. By staying on these medications for a month after an intrauterine device is inserted, you give the intrauterine device time to settle in the uterus before a period happens.
– Time your surgery for just after a period. The best time to have surgery is just after a period. The lining of the uterus is thinner at that time, and cramps from the uterus are less common. If you have natural hormonal cycles, try to plan your laparoscopy for the first half of your menstrual cycle. If you are on the contraceptive pill, and using the pill continuously, stop your hormone tablets eight days before your surgery, allow your body to have a period, then restart the pill as usual and take it continuously until you are fully recovered from your surgery. This will give your body time to recover before your next period. If you are on a progestogen-only medication like norethisterone (Primolut) or dienogest (Visanne), then you can take these medications straight through from before your surgery, during your time in hospital and afterwards. Remember to take your medications into the hospital with you and not to miss any tablets.
– Settle down pelvic muscle stabbing and aching pain by keeping moving. We recommend the stretches on our webpage, going for a walk each day, seeing a pelvic physiotherapist skilled in helping people with pain, and using the downloadable pelvic muscle relaxation audio available through our PPFA shop. Pelvic muscle spasms are often the worst pain for people. These muscles can’t be seen at laparoscopy, and the stabbing pain this causes isn’t treated by surgery. Sometimes the muscle relaxant drugs and anaesthetic drugs used during surgery can improve this type of pain for a short time, but surgery doesn’t provide a long-term fix for this pain.
– Improve your bowel function. Bowel symptoms, including constipation, will aggravate other aspects of your pelvic pain, particularly the stabbing, aching pains of pelvic muscle spasm. Options including obtaining advice from a dietitian, avoiding foods that don’t suit you, or generally eating more ‘plants’ can help your bowel function and your pain. Aim for a bowel action like a soft banana that you can pass without straining. You may need to talk to your doctor about how to achieve this.
– Treat pain sensitisation. This is the change in nerve function that makes your pelvis so sensitive. If you have pain on many days for more than six months, you have pain sensitisation. Sensitivity worsens with inactivity, using regular opioid medications and stress. Keep your mind busy with things that matter to you, and ask your doctor if a trial of a low dose of amitriptyline may help you. It suits around 1 in 2 people with pain and is particularly worth taking before, during, and after an operation. Using amitriptyline at this time improves your recovery, and reduces your need for other medications. It reduces the chance that your surgery can aggravate your pain sensitisation, and it also helps sleep and headaches.
– If you are anxious or depressed, ask your doctor whether a psychologist may help you. Anxiety worsens pain, and an operation is an added cause of anxiety for some people. Plan your calendar to have a low-stress time in the weeks leading up to your surgery.
– Make a plan to stop smoking. Smoking is never a good idea, and before an operation is a particularly good time to quit. As smoking is not permitted in hospitals, and the urge to smoke is less after an anaesthetic, an operation is also an excellent time to permanently change your life. Become a non-smoker and make another step towards health and well-being.
Eight days before your surgery
– Plan whether you will have a period before your surgery (see above). Generally, this is a good idea, as it means you won’t have a period during your recovery, and the surgery will be taking place at a time when the pelvis is calm, and the endometrium is thin.
– Use anti-inflammatory medications such as diclofenac or ibuprofen for pain relief at this time. However, it is best to avoid these medications in the 5-7 days before your surgery. Using them just before your operation can increase the amount of bleeding you have at the operation. You may wish to ask your doctor if you can try these as a suppository, rather than a tablet, as these work better, and for longer.
– Thinking positively. Remember that you have made the decision to have a laparoscopy carefully and that you can feel positive about your hospital admission. Thinking positively and using positive language will all improve how you feel about yourself and your surgery.
3 Days before your laparoscopy
– Plan your bowel preparation. An empty bowel makes surgery easier for your doctor and more comfortable for you. Your gynaecologist will have explained the plan for your individual bowel preparation, depending on the surgery that is planned. If more severe problems are expected, they may recommend a bowel prep. This usually takes 2-3 days before the surgery to complete. For most women, a bowel prep may not be necessary. Even so, it is still more comfortable for you if you have an empty bowel when you have your surgery. This reduces the chance of constipation after your operation. Coloxyl with Senna, an Enemax or a Glycerine suppository can help for two days before surgery.
– Pack your hospital bag. Things to take include your current medications, hospital paperwork, socks or slippers, toothpaste and toothbrush, throat lozenges, phone charger and headphones, book or magazine, peppermint tea or oil, lip balm, face wash or wipes, body wash, deodorant, hairbrush and dry shampoo, heat pack, pads and loose high waisted period undies, slip-on shoes/sandals and comfy clothes to wear home.
– Eating a healthy diet during this time, will help settle your bowel symptoms, another great way to prepare your body for surgery.
– Plan who will take you to the hospital, and who will pick you up from the hospital when it is time to go home after your surgery.
The day before your surgery
– Make sure you have time to go for a walk, do your stretches, and plan some enjoyable activities. Being calm and relaxed when you go to hospital is a great start.
– Fasting. Make sure you know when you have to fast from before your surgery. This will depend on what time your surgery is planned. There may be a different time for fasting for food (this includes milk in hot drinks), and fasting for water. If fasting for long periods can make you feel unwell, then ask the hospital staff if you can have an intravenous drip inserted while you wait. This can be especially important for women with diabetes or certain medical conditions.
– Anaesthetist questions. If you have questions for the anaesthetist who will put you to sleep, it is best to write them down on a piece of paper to have with you. That way you won’t forget them.
When you are admitted to hospital
Hospitals can be scary places for people who are unfamiliar with them. They don’t need to be. The hospital staff are there to look after you, and both your anaesthetist and your gynaecologist will stay with you throughout your operation.
Once you check-in at the front desk, you will be admitted and taken to your room. The process of hospital admission, and preparation for surgery can take some time, so it’s best to take a book or music to listen to. If you prefer, you could ask a friend or family member to wait with you, chat, or bring an activity you can do together. The nursing staff will ask you to put on a hospital gown and ask you questions to check everything is ready for your laparoscopy. When it is time for your laparoscopy, you will be taken to the operating theatre.
In hospital when talking to your anaesthetist
The anaesthetist is the doctor who will put you to sleep and care for you until you wake up. They also manage your pain medications. You will meet the anaesthetist either in your room on the ward, or when you are taken to the operating theatre.
If you are not already on these medications, ask whether any of the following medications would improve your recovery:
– 10mg amitriptyline at night, every night until you have fully recovered. You may have already chosen to start this in the lead up to your surgery
– 100mg diclofenac suppository twice daily for the first few days after surgery, especially if you have had an intrauterine device inserted
– a medication for your bowels to avoid constipation, with a backup plan if needed
– 5mg of diazepam as a suppository or as a tablet for occasional use if your stabbing pains are a problem after the operation
– a tablet to reduce stomach acid while you are taking anti-inflammatory medications, especially if you have an easily irritated stomach or pain in your upper abdomen
Ask your doctor if you can keep taking your contraceptive pill or progestogen medication every day on time so that your period stays away while you are recovering.
In hospital during your recovery
The length of your surgery depends on what is found. If all looks normal, then your laparoscopy will usually take around thirty minutes. If you have endometriosis, or other conditions that require removal, then the surgery will take longer, depending on what needs to be done. Laparoscopic surgery is delicate work using small instruments near sensitive structures, so it takes time.
After your laparoscopy, you will wake up in the recovery ward. This is a special area near the operating theatre where patients are cared for by nursing staff until they are more awake and feeling comfortable. This usually takes one or two hours, depending on what type of surgery you have had, and how quickly you wake up. You will be attached to an intravenous infusion (you may have heard it called a drip) that provides water, salt and any medicine you need, into one of the veins in your arm until you can eat and drink normally.
Get up to go for short walks when you can. This will help your pelvic muscles move, and they will be less likely to go into spasm. If you have stabbing, aching pains, ask for a heat pack, do the pelvic muscles stretches, use the pelvic muscle relaxation strategies you’ve learned, go for a short walk if you can, or ask whether a diazepam tablet or suppository is available. These are for occasional use only, not regularly.
Your gynaecologist will come and explain to you what was found at your operation. If you have particular questions you want to ask, it is best to write these down on a piece of paper before your doctor arrives, or even before your surgery, as you might still be a bit sleepy, and it is easy to forget what they say. If so, you can ask them to write down what they found so you can read it later.
There are many types of pelvic pain, and most women have more than one type of pain. Some pains can be seen at a laparoscopy, but many pains can’t be seen. The best outcome for your long-term health and fertility is to find that your pelvis looks normal, with either no endometriosis or small amounts of endometriosis. This doesn’t mean that your pain isn’t real. It is very real. Your laparoscopy is normal because your pain is a pain that can’t be seen at a laparoscopy. There are many other non-surgery treatments for pelvic pain, and you may wish to look again at the book or other pages on this website.
Remember to tell the nurse if you think you are constipated. They can help you. Ask them what to do if you haven’t opened your bowels after three days once you are at home and ask when your doctor’s follow-up appointment will be.
Once you go home
Go for a walk every day. Even if the first walk is just around your garden. It is important to keep moving. The next walk maybe one block, and you will gradually build up.
Constipation is common after a laparoscopy. As well as the laxatives your doctor may have recommended, think carefully about your diet. Psyllium husk in liquid, kiwi fruit and drinking lots of water will help keep your bowels soft. If you have a sensitive bowel, then drinking peppermint or ginger tea, and using sterculia (normacol) or movicol daily may suit you better.
Three days after your surgery
Aim to have stopped all opioid medications within 2-3 days of your surgery. This includes codeine, oxycodone, fentanyl, tapentadol and any other opioids. Taking these medications for more extended periods will prolong the number of days you have pain for, as they sensitise the pain system, and they can cause constipation which aggravates pain. Read more about opioids here.
You can continue to use anti-inflammatory medications, paracetamol, and amitriptyline. If you have not opened your bowels, use the plan that you discussed with the nursing staff or your gynaecologist in hospital.
Your post-operative visit with your gynaecologist
Before your visit, it is a good idea to write down the 2-3 questions you want to be answered at your visit.
Most gynecologists take pictures of your pelvis during a laparoscopy. They also write down what they find on an operation sheet. This is important information for you. If possible, ask for a copy of your laparoscopy photos and your operation sheet, and keep this information stored carefully away for future. This way you’ll understand more about your pain condition, and you’ll have the information to provide to other health practitioners in the future.
Importantly: Remember the two pelvic pain myths!
Myth 1: If you have pain, there must be something to see at a laparoscopy. Many types of pain can’t be seen. Endometriosis is often present in women with pain, but it doesn’t need to be. You can have lots of pain and no endo, or lots of endo and no pain.
Myth 2: If something is found at laparoscopy, then that is the cause of the pain. It may be that your worst pain is a pain that can’t be seen at a laparoscopy. There may be changes to see, but they may not be your worst pain.
All the best with your operation and recovery.
