About Your Posterior Pelvic Exenteration Surgery

This guide will help you get ready for your posterior pelvic exenteration surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery.

Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

About Your Surgery

Posterior pelvic exenteration surgery is a surgery that removes organs from your gastrointestinal and gynecologic systems. You may be having this surgery because you have cancer in your cervix or another organ in your gastrointestinal or gynecologic systems.

About Your Gastrointestinal System

Figure 1. Your gastrointestinal system

Figure 1. Your gastrointestinal system

Your gastrointestinal system includes your mouth, esophagus, small and large intestines, rectum, and anus (see Figure 1).

During the surgery, part of your large intestine (colon) will be removed. Your rectum (bottom section of your colon) and anus will also be taken out. This means you will need a new place for stool (poop) to leave your body.

The end of your remaining large intestine will be brought to the outside of your abdomen (belly). This creates a colostomy, which is a new place for stool to leave your body. The opening itself is called a stoma. A pouch will cover the stoma to collect your stool. Your healthcare team will teach you how to care for the stoma as you recover. Read the resource Caring for Your Ileostomy or Colostomy for more information about living with a colostomy.

About Your Gynecologic System

Figure 2. Your gynecologic system

Figure 2. Your gynecologic system

Your gynecologic system includes your ovaries, fallopian tubes, uterus, and vagina (see Figure 2).

During your surgery, your ovaries, fallopian tubes, and uterus will be removed. This means that you won’t be able to have children. If you would like more information about fertility (ability to get pregnant) options and your cancer treatment, read the resource Fertility Preservation: Options for Women Who Are Starting Cancer Treatment. All or part of your vagina may also be removed. Your doctor will discuss this with you if it’s necessary.

For some people, the vagina can be reconstructed. Ask your doctor if this is an option for you. If this is an option, you will meet with a plastic surgeon to discuss this surgery. The reconstruction would be done at the end of your surgery. Your plastic surgeon will create a new vaginal canal from the muscles and skin of other areas of your body. Your nurse will tell you about the care of your new vagina. If you don’t want your vagina reconstructed, the area can be closed or covered with a flap of skin.

If your vagina isn’t removed, you should be able to have vaginal intercourse (sex). If you have reconstruction, you should be able to have intercourse again when the area heals. If you don’t have vaginal reconstruction, remember that sex can include other forms of intimacy. Ask your doctor if your clitoris will be removed and how much feeling you will still have in your vaginal area.

Your doctor and nurse will tell you what to expect after surgery. For example, sensations in your vaginal area may not be the same as they were before your surgery. Your doctor can refer you to our Female Sexual Medicine and Women’s Health Program so that you can meet with a therapist and discuss your concerns.

Meeting with Your Healthcare Team

You will see many doctors and nurses before your surgery. Each one will describe their role in your care and answer your questions. You may see team members such as:

  • Surgeons from other departments who will work with your surgeon to complete the surgery.
  • A psychologist who works with women having this surgery.
  • The wound, ostomy, and continence nurse, also known as a CWOCN. Your CWOCN will talk to you about the stoma you’ll have.

It may be helpful for you to write down questions as you think of them. Take your list with you when you have appointments. You may also be able to speak with someone who has had the surgery. Your social worker can help plan this for you.

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Before Your Surgery

The information in this section will help you get ready for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It has important information about what you need to do before your surgery.

Write down your questions and be sure to ask your doctor or nurse.

Getting Ready for Your Surgery

You and your healthcare team will work together to get ready for your surgery.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your healthcare provider knows all the medications you’re taking.
  • I take prescription medications (medications prescribed by a healthcare provider), including patches and creams.
  • I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
  • I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I have had a problem with anesthesia (medication to make you sleep during surgery) in the past.
  • I am allergic to certain medication(s) or materials, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

  • If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help keep them from happening.
  • If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do before your surgery to keep from having problems:

  • Be honest with your healthcare providers about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea (feeling like you’re going to throw up), increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you can’t stop drinking.
  • Ask your healthcare provider questions about drinking and surgery. As always, all of your medical information will be kept confidential.

About Smoking

If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program by calling 212-610-0507.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP machine) for sleep apnea, bring it with you the day of your surgery.

Within 30 Days of Your Surgery

Presurgical Testing (PST)

Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.

You can eat and take your usual medications the day of your PST appointment.

During your appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your surgery.

It’s very helpful to bring the following things to your PST appointment:

  • A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
  • The name(s) and telephone number(s) of your doctor(s).

Identify Your Caregiver

Your caregiver plays an important role in your care. You and your caregiver will learn about your surgery from your healthcare provider. After your surgery, your caregiver should be with you when you’re given your discharge instructions so they’re able to help you care for yourself at home. Your caregiver will also need to take you home after you’re discharged from (leave) the hospital.

Complete a Health Care Proxy Form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you can’t communicate for yourself. The person you identify is called your health care agent. For more information about health care proxies and other advance directives, read the resource Advance Care Planning.

If you’re interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advance directives, bring them to your next appointment.

Do Breathing and Coughing Exercises

Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, read the resource How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.

Exercise

Try to do aerobic exercise every day. Examples of aerobic exercise include walking at least 1 mile (1.6 kilometers), swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.

Follow a Healthy Diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your doctor or nurse about meeting with a clinical dietitian nutritionist.

10 Days Before Your Surgery

Stop Taking Vitamin E

If you take vitamin E, stop taking it 10 days before your surgery. Vitamin E can cause bleeding. For more information, read the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Buy Hibiclens® Skin Cleanser

Hibiclens skin cleanser

Hibiclens is a skin cleanser that kills germs for 24 hours after you use it (see figure). Showering with Hibiclens before your surgery will help lower your risk of infection after surgery. You can buy Hibiclens at your local pharmacy without a prescription.

Buy Supplies for Your Bowel Preparation, If Needed

Your doctor may tell you to clean out your bowels before your surgery. Your nurse will tell you how to do this. You will need to buy the following supplies for your bowel preparation at your local pharmacy. You don’t need a prescription.

  • 1 (238-gram) bottle of polyethylene glycol (MiraLAX®)
  • 1 (64-ounce) bottle of a clear liquid (see the clear liquid diet menu in the section below)

Buy Clear Liquids

If you need to follow a clear liquid diet before your surgery, now is also a good time to buy your supplies. For a list of clear liquids you can drink, read the section “Follow a Clear Liquid Diet.”

7 Days Before Your Surgery

Stop Taking Certain Medications

If you take aspirin, ask your doctor if you should keep taking it. Aspirin and medications that contain aspirin can cause bleeding. For more information, read the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Stop Taking Herbal Remedies and Other Dietary Supplements

Stop taking herbal remedies and other dietary supplements 7 days before your surgery. If you take a multivitamin, ask your doctor or nurse if you should keep taking it. For more information, read the resource Herbal Remedies and Cancer Treatment.

Watch a Virtual Tour

This video will give you an idea of what to expect when you come to Memorial Hospital (MSK’s main hospital) on the day of your surgery.

2 Days Before Your Surgery

Stop Taking Certain Medications

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), 2 days before your surgery. These medications can cause bleeding. For more information, read the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Follow a Clear Liquid Diet

For People With Diabetes

If you have diabetes, ask the healthcare provider who manages your diabetes what you should do while you’re following a clear liquid diet.

  • If you take insulin or another medication for diabetes, ask if you need to change the dose.
  • Ask if you should drink sugar-free clear liquids.

While you’re following a clear liquid diet, make sure to check your blood sugar level often. If you have any questions, talk with your healthcare provider.

You will need to follow a clear liquid diet the day before your surgery. A clear liquid diet includes only liquids you can see through. Examples are listed in the “Clear Liquid Diet” table.

While you’re following this diet:

  • Don’t eat any solid foods.
  • Try to drink at least 1 (8-ounce) glass of clear liquid every hour while you’re awake.
  • Drink different types of clear liquids. Don’t just drink water, coffee, and tea.
  • Don’t drink sugar-free liquids unless you have diabetes.
Clear Liquid Diet
  Drink Do Not Drink
Soups
  • Clear broth, bouillon, or consommé
  • Any products with pieces of dried food or seasoning
Sweets
  • Gelatin (such as Jell-O®)
  • Flavored ices
  • Hard candies (such as Life Savers®)
  • All others
Drinks
  • Clear fruit juices (such as lemonade, apple, cranberry, and grape juices)
  • Soda (such as ginger ale, 7-Up®, Sprite®, and seltzer)
  • Sports drinks (such as Gatorade®)
  • Black coffee
  • Tea
  • Water
  • Juices with pulp
  • Nectars
  • Milk or cream
  • Alcoholic drinks

Start Your Bowel Preparation, If Needed

Before 5:00 PM on the day before your surgery, mix all 238 grams of MiraLAX with the 64 ounces of clear liquid until the MiraLAX powder dissolves. Once the MiraLAX is dissolved, you can put the mixture in the refrigerator, if you’d like, until it’s time to drink it.

At 5:00 PM on the day before your surgery, start drinking the MiraLAX bowel preparation. Drink 1 (8-ounce) glass of the mixture every 15 minutes until the container is empty. After drinking all the MiraLAX, drink 4 to 6 glasses of clear liquids. You can keep drinking clear liquids until midnight, but it’s not required.

The MiraLAX will cause you to have frequent bowel movements (poop), so be sure to be near a bathroom after taking it.

Apply zinc oxide ointment or Desitin® to the skin around your anus after every bowel movement. This helps prevent irritation.

Note the Time of Your Surgery

A staff member from the Admitting Office will call you after 2:00 PM the day before your surgery. If your surgery is scheduled for a Monday, they will call you on the Friday before. If you don’t get a call by 7:00 PM please call 212-639-5014.

The staff member will tell you what time to arrive at the hospital for your surgery. They will also tell you where to go. This will be the following location:

Presurgical Center (PSC) on the 6th floor
1275 York Avenue (between East 67th and East 68th Streets) 
New York, NY 10065
B elevator to 6th floor

Shower With Hibiclens

The night before your surgery, shower using Hibiclens.

  1. Use your normal shampoo to wash your hair. Rinse your head well.
  2. Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
  3. Open the Hibiclens bottle. Pour some solution into your hand or a washcloth.
  4. Move away from the shower stream to avoid rinsing off the Hibiclens too soon.
  5. Rub the Hibiclens gently over your body from your neck to your feet. Don’t put the Hibiclens on your face or genital area.
  6. Move back into the shower stream to rinse off the Hibiclens. Use warm water.
  7. Dry yourself off with a clean towel after your shower.
  8. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Sleep

Go to bed early and get a full night’s sleep.

 

Do not eat or drink after midnight.

The Morning of Your Surgery

 

  Two hours before your scheduled arrival time, drink the ClearFast PreOp® drink your nurse gave you.

After you finish the ClearFast, do not eat or drink anything else. This includes water, hard candy, and gum.

Take Your Medications

If your doctor or NP told you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.

Shower With Hibiclens

Shower using Hibiclens just before you leave for the hospital. Use the Hibiclens the same way you did the night before.

Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to Remember

  • Wear something comfortable and loose-fitting.
  • If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
  • Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
  • Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
  • Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
  • Before you’re taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.

What to Bring

  • Your breathing machine for sleep apnea (such as your CPAP machine), if you have one.
  • Your portable music player, if you choose. However, someone will need to hold it for you when you go into surgery.
  • Your incentive spirometer, if you have one.
  • Your Health Care Proxy form and other advance directives, if you have completed them.
  • Your cell phone and charger.
  • Only the money you may want for small purchases (such as a newspaper).
  • A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.

Where to Park

MSK's parking garage

MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.

To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There’s a tunnel that you can walk through that connects the garage to the hospital.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Once You’re in the Hospital

You will be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day.

Get Dressed for Surgery

When it’s time to change for surgery, you will get a hospital gown, robe, and nonskid socks to wear.

Meet With Your Nurse

You will meet with your nurse before surgery. Tell them the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Your nurse may place an intravenous (IV) line into one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it later once you’re in the operating room.

Meet With Your Anesthesiologist

Your anesthesiologist will:

  • Review your medical history with you.
  • Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia you will have.
  • Answer your questions about your anesthesia.

Your doctor or anesthesiologist may also talk with you about placing an epidural catheter (thin, flexible tube) in your spine (back). An epidural catheter is another way to give you pain medication after your surgery.

Get Ready for Your Surgery

Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to start. When it’s time for your surgery, your visitor(s) will be taken to the waiting area. Your visitors should read the resource Information for Family and Friends for the Day of Surgery.

You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you will fall asleep. You will also get fluids through your IV line during and after your surgery.

During Your Surgery

After you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. You will also have a urinary (Foley®) catheter placed to drain urine from your bladder. Your breathing tube is usually taken out while you’re still in the operating room.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery.

Write down your questions and be sure to ask your doctor or nurse.

In the Post-Anesthesia Care Unit (PACU)

When you wake up after your surgery, you will be in the Post-Anesthesia Care Unit (PACU).

A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You will also have compression boots on your lower legs.

Figure 3. Drains, pouches, and bandages after your surgery

Figure 3. Drains, pouches, and bandages after your surgery

Pain Medication

If you have an epidural catheter, you will get pain medication into your epidural space (the space in your spine just outside your spinal cord). You will be able to control your pain medication using a button called a patient-controlled analgesia (PCA) device. For more information, read the resource Patient-Controlled Analgesia (PCA).

If you don’t have an epidural catheter, you will get pain medication through your IV line.

Tubes and Drains

You will have many drains, pouches, and bandages on your abdomen (see Figure 3). They may include:

  • One or 2 Jackson-Pratt® drains (JP drains) to drain fluid from around an incision or wound. The drain is taken out when the incision stops draining.
  • A colostomy pouch on your stoma to collect stool (poop).
  • If your vagina was reconstructed, you will have bandages and drains on your upper inside thighs.
  • An IV line to give you fluids.
  • Compression boots on your calves to help blood circulate. These will stay on whenever you’re in bed until you’re discharged from the hospital.

Your abdomen will become more swollen over the next few days after your surgery, and then the swelling will go down.

Figure 4. Your stoma and pouch

Figure 4. Your stoma and pouch

Most of the drains and tubes will be removed over the next days to weeks. The stoma will be covered with a pouch to collect the stool (see Figure 4). The stoma will be swollen after surgery, but the swelling will go down over time. Your CWOCN and other nursing staff will teach you how to care for your stoma as you recover.

Visitors

Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them.

Moving to Your Hospital Room

Most people stay in the PACU overnight for observation. After your stay in the PACU, you will be taken to your hospital room.

In Your Hospital Room

The length of time you’re in the hospital after your surgery depends on your recovery. Most people stay in the hospital for 7 to 10 days after surgery.

When you’re taken to your hospital room, you will meet one of the nurses who will care for you while you’re in the hospital. Soon after you arrive in your room, your nurse will help you out of bed and into your chair.

While you’re in the hospital, your nurses will teach you how to care for yourself while you’re recovering from your surgery.

If you had vaginal reconstruction, you won’t be able to sit for 6 to 8 weeks. You can lie on your back or side, or you can stand. Your nurse will help you with this.

Your doctor will tell you when you can shower.

Managing Your Pain

You may have pain at your incision sites and your abdomen.

  • If you have an epidural catheter, you will get pain medication into your epidural space. You will be able to control your medication using a PCA device.
  • If you don’t have an epidural catheter, you will get pain medication in your IV line.
  • Once you’re able to eat normal food, you will get oral pain medication (medication you swallow).

Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell your doctor or nurse. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better.

You will be given a prescription for pain medication before you leave the hospital. Talk with your doctor or nurse about possible side effects and when you should start switching to over-the-counter pain medications.

Moving Around and Walking

Moving around and walking will help lower your risk for blood clots and pneumonia. It will also help stimulate your bowels so you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around.

Exercising Your Lungs

It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.

  • Use your incentive spirometer 10 times every hour you’re awake. For more information, read the resource How to Use Your Incentive Spirometer.
  • Do coughing and deep breathing exercises. A member of your care team will teach you how to do these exercises.

Eating and Drinking

You won’t be able to eat for 1 to 2 days after your surgery. You will get fluids through an IV line during this time. Then, you will be on a clear liquid diet. After that, you can start eating normal foods again, as tolerated.

When you’re able to eat normal foods again, it’s important to eat a balanced diet high in protein to help you heal after surgery. Your diet should include a healthy protein source at each meal, as well as fruits, vegetables, and whole grains. For more tips on increasing the amount of calories and protein in your diet, read the resource Eating Well During and After Your Cancer Treatment.

If you have questions about your diet, ask to see a clinical dietitian nutritionist.

Caring for Your Drains and Incisions

You will likely have some bleeding from most of your incisions or around your drains. You may also have some discharge and tenderness around your incisions and drains for a few days. Your nurses will show you, and tell you what’s normal and expected as they care for you. You will also begin to learn how to care for the stoma and incisions.

Some of the tubes and drains may be removed before you’re discharged from the hospital. If you have an incision that was closed with staples, the staples are usually taken out before you leave the hospital. Some people will have them removed at their first follow-up visit. If you go home with the drains, your nurses will teach you how to care for them.

Showering

You can shower while you’re in the hospital. You should wash your incisions with Hibiclens until the staples are removed.

Planning for Your Discharge

Before you go home, your nurse will give you the supplies you need to care for yourself for the first month. Then you can order your supplies from an outside source.

Your discharge nurse case manager will arrange to have a visiting nurse see you at home. The visiting nurse will help you care for your drains and stoma.

You may still have drains in when you go home. Ask your nurse or doctor when they will be removed. Your visiting nurse will help you while you’re learning to care for your incisions and colostomy.

You will get a prescription for pain medication. Take your medication as instructed by your doctor and as you need it. Don’t drive or drink alcohol while you’re taking prescription pain medication.

At Home

Read the resource What You Can Do to Avoid Falling to learn about what you can do to stay safe and keep from falling at home and during your appointments at MSK.

Managing Your Pain

People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean that something is wrong.

Follow the guidelines below to help manage your pain at home.

  • Take your medications as directed and as needed.
  • Call your doctor if the medication prescribed for you doesn’t ease your pain.
  • Don’t drive or drink alcohol while you’re taking prescription pain medication.
  • As your incision heals, you will have less pain and need less pain medication. An over-the-counter pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will ease aches and discomfort.
    • Follow your doctor or nurse’s instructions for stopping your prescription pain medication.
    • Don’t take more acetaminophen than the amount directed on the bottle or as instructed by your doctor or nurse. Taking too much acetaminophen can harm your liver.
  • Pain medication should help you resume your normal activities. Take enough medication to do your exercises comfortably. However, it’s normal for your pain to increase a little as you start to be more active.
  • Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when your pain first begins is better than waiting for the pain to get worse.

Pain medication may cause constipation (having fewer bowel movements than what’s normal for you).

Caring for Your Incision

Take a shower every day to clean your incision. Follow the instructions in the “Showering” section below.

It’s normal for the skin below your incision to feel numb. This happens because some of your nerves were cut during your surgery. The numbness will go away over time.

Call your doctor’s office if:

  • The skin around your incision is very red.
  • The skin around your incision is getting more red.
  • You see drainage that looks like pus (thick and milky).

If you go home with staples in your incision, your healthcare provider will take them out 10 to 14 days after your surgery. It’s okay to get the staples wet.

Caring for Your Colostomy

Before you leave the hospital, your nurse will teach you how to care for your colostomy. Read the resource Caring for Your Ileostomy or Colostomy for more information.

Showering

Take a shower every day to clean your incision. If you have staples in your incision, it’s okay to get them wet.

Take your bandage(s) off before you shower. Use soap during your shower, but don’t put it directly on your incision. Don’t rub the area around your incision.

After you shower, pat the area dry with a clean towel. Leave your incision uncovered or cover it with a small bandage if your clothing may rub it (such as the waistline of your pants).

Don’t take a bath for the first 4 weeks after your surgery.

Eating and Drinking

You can eat all the foods you did before your surgery, unless your doctor gives you other instructions. Eating a balanced diet with lots of calories and protein will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.

It’s also important to drink plenty of liquids. Choose liquids without alcohol or caffeine. Try to drink 8 to 10 (8-ounce) glasses of liquids every day.

For more tips on eating and drinking after your surgery, read the resource Eating Well During and After Your Cancer Treatment.

If you have questions about your diet, ask to see a dietitian.

Physical Activity and Exercise

When you leave the hospital, your incision will look like it’s healed on the outside, but it won’t be healed on the inside. For the first 6 to 8 weeks after your surgery:

  • Don’t lift anything heavier than 10 pounds (about 4.5 kilograms).
  • Don’t do any strenuous activities (such as jogging and tennis).
  • Don’t play any contact sports (such as football).

Talk with your doctor before you start doing strenuous exercise or lifting heavy objects.

Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better. Walk at least 2 to 3 times a day for 20 to 30 minutes. You can walk outside or indoors at your local mall or shopping center.

It’s normal to have less energy than usual after your surgery. Recovery time is different for each person. Increase your activities each day as much as you can. Always balance activity periods with rest periods. Rest is an important part of your recovery.

Sexual Activity

If you have a vagina or a reconstructed vagina, don’t put anything inside your vagina or have vaginal intercourse until your first appointment after surgery. At this appointment, your doctor will tell you when you can start having vaginal intercourse again.

If you’ve been told it’s okay to have vaginal intercourse and then have continuing pain with intercourse, call your nurse or doctor. They can refer you to physical therapy for an evaluation.

Driving

Your doctor will tell you when you can start driving again. Don’t drive while you’re taking pain medication that may make you drowsy. You can ride in a car as a passenger at any time after you leave the hospital.

Going Back to Work

Usually, most patients can return to work after 8 weeks. Talk with your doctor or nurse about your job and when it may be safe for you to start working again. If your job involves lots of movement or heavy lifting, you may need to stay out a little longer than if you sit at a desk.

Traveling

You shouldn’t travel for 2 weeks after your surgery. After 2 weeks, talk with your doctor or nurse about when you can start traveling again.

Managing Your Feelings

This surgery will change your body, and it will probably take time for you to get used to these changes. You may feel scared, angry, or worried. You may have questions or fears about how this surgery will impact your sexuality. These feelings are normal, and many people feel the same way.

Each person gets used to these changes in their own way. For some people, it can take a few months to get used to their changed body image. For other people, it can take longer. As time goes on, you will get stronger. You will be more confident in caring for your incisions and pouch. Your appetite and energy will get better. And eventually you will be able to resume most of your normal activities.

We have many resources to help you. Your doctors and nurses will answer your questions. We also have social workers, psychologists, psychiatrists, and CWOCNs who have helped many people through this change. You can have one-on-one counseling, or you can join one of our online or in-person support groups. We also have clergy available for spiritual support. You may be able to meet with other people who have had this surgery, and who can talk with you and answer your questions. Talk with your nurse if you’re interested in this.

To address issues with sexual health and intimacy, you can see someone from our Female Sexual Medicine & Women’s Health Program. For more information or to set up an appointment, call 646-888-5076.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal account. You can use MyMSK to send and receive messages from your healthcare team, view your test results, see your appointment dates and times, and more.

If you don’t already have a MyMSK account, you can sign up by going to my.mskcc.org. For more information about signing up for a MyMSK account, watch our video How to Enroll in the Patient Portal: MyMSK. You can also contact the MyMSK Help Desk by emailing mymsk@mskcc.org or calling 800-248-0593.

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Contact Your Doctor or Nurse If:

  • You have a fever of 100.4° F (38° C) or higher.
  • You have chills.
  • You’re having trouble breathing.
  • The skin around your incision is warmer than normal.
  • The skin around your incision is getting more red.
  • The area around your incision is starting to swell.
  • You have discharge coming from your incisions.
  • You have a bad odor coming from your incisions.
  • The swelling around your incision is getting worse.
  • You have pain that doesn’t get better with pain medication.
  • You have vaginal bleeding or bad-smelling vaginal discharge.
  • You have burning when passing stool.
  • You’re not able to pass stool into your stoma or pouch.
  • You have any problems you didn’t expect.
  • You have any questions or concerns.

Monday through Friday from 9:00 AM to 5:00 PM, contact your doctor’s office.

After 5:00 PM, during the weekend, and on holidays, call 212-639-2000 and ask to speak to the doctor on call for your doctor.

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Support Services

This section contains a list of support services that may help you get ready for your surgery and recover safely.

Write down your questions and be sure to ask your doctor or nurse.

MSK Support Services

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you’re interested in donating blood or platelets.

Bobst International Center
888-675-7722
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.

Chaplaincy Service
212-639-5982
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

Counseling Center
646-888-0200
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Food Pantry Program
646-888-8055
The food pantry program provides food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service
646-888-0800
Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or speak with the library reference staff to find more information about your specific cancer type. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org.

Patient and Caregiver Education
www.mskcc.org/pe
Visit the Patient and Caregiver Education website to search our virtual library. There, you can find written educational resources, videos, and online programs.

Patient and Caregiver Support Program
212-639-5007
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient and Caregiver Support Program, you’re able to speak with former patients and caregivers. These conversations may take place in person, over the phone, or through email.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or if you have concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nursing Office
212-639-6892
You may request private nurses or companions. Call for more information.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can have an impact on your sexual health. MSK’s Sexual Health Programs can help you take action and address sexual health issues before, during, or after your treatment.

Our Female Sexual Medicine and Women’s Health Program helps women who are dealing with cancer-related sexual health challenges, including premature menopause and fertility issues. For more information, or to make an appointment, call 646-888-5076.

Sillerman Center for Rehabilitation
646-888-1900
515 Madison Avenue, 4th Floor
(Entrance on 53rd Street, between Park and Madison Avenues)
Our rehabilitation specialists help people regain their strength, mobility, and functional independence.

Social Work
212-639-7020
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for more information.

Virtual Programs
www.mskcc.org/vp
MSK’s Virtual Programs offer online education and support for patients and caregivers, even when you can’t come to MSK in person. Through live, interactive sessions, you can learn about your diagnosis, what to expect during treatment, and how to prepare for the various stages of your cancer care. Sessions are confidential, free, and led by expert clinical staff. If you’re interested in joining a Virtual Program, visit our website at www.mskcc.org/vp for more information.

For more online information, visit the Cancer Types section of www.mskcc.org.

External Support Services

General Support Services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medications that they have trouble affording.

Gynecologic Surgery Support Services

United Ostomy Associations of America, Inc (UOAA)
www.ostomy.org
800-826-0826
Volunteer group who supports people who have or will have an ostomy and provides educational resources.

Women’s Cancer Network: Gynecological Cancer Foundation (GCF)
www.foundationforwomenscancer.org
312-578-1439
Nonprofit organization that provides education and supports research on gynecologic cancers.

Wound, Ostomy, Continence Nurses Society
www.wocn.org/page/PatientResources
888-224-WOCN (888-224-9626)
Provides patient resource from nursing members who have special training in the care of people with wounds, ostomies, and continence problems.

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Educational Resources

This section contains the educational resources that were referred to throughout this guide. These resources will help you get ready for your surgery and recover safely after surgery.

Write down your questions and be sure to ask your doctor or nurse.

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