What to Expect: Diagnostic Laparoscopy for Endometriosis

After over two years of searching for a diagnosis, I can’t believe I’m sitting down to write this.

When I first started this blog, I was having chronic constipation, losing weight, and couldn’t tolerate many foods (like raw vegetables or dairy products). I saw a gastroenterologist who made me feel like I was crazy for pushing him harder. I had an upper endoscopy and colonoscopy that both came out clear. And, finally, after having my first laparoscopy at Cleveland Clinic cancelled due to COVID-19, I got on the schedule at Newton-Wellesley Hospital in Massachusetts.

This past Tuesday, I crossed the finish line. I had a diagnostic laparoscopy for endometriosis at long last, and it showed evidence of peritoneal endometriosis, and an adhesion on my left uterosacral ligament. My doc also found a pretty decently sized but benign cyst on my fallopian tube. Thankfully, it doesn’t look like my future fertility will be affected.

After seeing everything that was excised from my body, I couldn’t help but feel like it’s no wonder I was having so many symptoms. With all this tissue hanging around in my abdomen when it wasn’t supposed to be there, the constipation and pelvic pain make so much more sense.

Yet it still took me over two years from the start of my journey, and over ten years from the onset of my symptoms, to get a definitive diagnosis of endometriosis. The word didn’t even come up until a year into my constipation and painful bowel movements. No GI doctor I saw ever thought to ask me if I had painful periods. That simple question could have changed everything for me.

As frustrating as this journey has been, it makes me grateful — and emotional — to have arrived at this point. I have been through so much that I know I deserve the validation and clarity that came from this procedure. Hopefully, in the future, womxn won’t need to go through nearly as much as I have in order to get the validation and clarity that they deserve.

Sentimentality and reflection aside, you’re probably here because you want to know about the process of getting here: the laparoscopy, to be exact. Maybe you or someone you love thinks they have endometriosis and are worried about what they’ll need to go through to have it diagnosed. Or, maybe your lap is coming up and you’re getting ready to prepare for surgery. Either way, I’m here for you.

Here’s what to expect on the day of your laparoscopy, and the things that have helped me through the recovery process thus far.

The Day of Your Laparoscopy

On the day of my diagnostic laparoscopy, I was ushered into the pre-operative room basically as soon as I arrived. They called me to make sure I was here (I was waiting in the car because of COVID) and had my partner drop me off at the surgical center entrance. Then, they led me to check in, screened me for COVID, and brought me up to the pre-operative room.

Once in the pre-operative room, I was assigned a nurse and told to change into a hospital gown, leaving it open in the back. They gave me the opportunity to use the restroom before leading me back to get an IV line inserted. One thing I remember thinking was strange was that every person I met made sure to ask me what my name was and what procedure I was having. I think this is their way of ensuring that you’ve given informed consent — that you’ve not only said yes to the procedure, but that you also understand what it entails.

After the IV was inserted, I met with the anaesthesiologist as well as my surgeon. Both gave me a lot of reassurance about the procedure. Having great docs and nurses made a huge difference in my comfort and anxiety levels. I also met with the fellow who was working with my surgeon and a PA student observing the surgery.

While my surgeon mostly just wanted to check in, the anaesthesiologist asked me a lot of questions about my health history to make sure I was safe for surgery. For example, I have TMJ (an inflammatory jaw condition), so she had to adapt my intubation plan to accommodate my jaw problems.

At that point, the anaesthesiologist knocked me out. She checked my name and hospital bracelet one more time before giving me the analgesic medication. I honestly barely remember what happened. One minute, she was asking me a question and I was talking about something; the next, I was out cold and waking up in my room post-op.

When I woke up from the laparoscopy, I was given IV Tylenol, so my pain levels were not as bad as I expected. The first thing I noticed was that I was wearing a pad, which I hadn’t been wearing before. It wasn’t a surprise — that’s because they also changed my IUD during the procedure, and I had been warned to expect some bleeding — but I definitely felt it, especially since I haven’t had a period in over a year thanks to my menstrual suppressants.

My tummy felt bloated, sore, and crampy, kind of like mild period cramps, but the pain was bearable. I did have trouble sitting up on my own and needed help from the nurse. Bending at the waist in any way was the most painful type of motion. As long as I was still, I didn’t feel much pain at all, besides a bit of bloating and cramping. The worst pain was actually in my throat from the intubation. I could tell the roof of my mouth had been scraped a bit during the procedure.

I stayed in the post-op area about an hour. Somewhere along the way, I started to feel nauseous. I was given two types of nausea medication through my IV, about half an hour apart, and quickly started to feel better. I did have an episode of dry-heaving, but besides that, I didn’t have any negative side effects from the anaesthesia.

Eventually, I was able to leave the post-op area to go to the day surgical unit, where they would start to transition me toward leaving. This is a wing of the hospital reserved for people like me recovering from outpatient procedures, who are getting ready to go home soon.

Before they let you leave, the nurses have a series of steps they walk you through. They want you to eat something — usually toast or crackers. They want you to get up and walk around (which, after laying down for so long, feels like going from a cruise ship to dry land). And they want you to try to pee. Sometimes, they might even require you to pee before you’re allowed to leave so they can ensure your normal bladder function has returned, but this wasn’t the case for me.

Once I’d been through all of this and was feeling well enough to leave, the nurse allowed me to dress myself using a chair. She gathered my belongings and I was wheeled to the car in a wheelchair. Finally, I was allowed to go home! And by that point, believe me: I couldn’t wait to be in my warm, cozy bed 🙂

Tips for Recovering from Your Laparoscopy

My doctor did her best to prepare me for what to expect after my laparoscopy, but what helped me most was hearing about other people’s experiences recovering from theirs. Here’s what my recovery process has been like so far and what you can expect in the days following your laparoscopy.

Pain

I don’t know about you, but I was terrified of the amount of pain I would feel after my surgery. For me, the pain was worst the day after my surgery. On the day of my surgery, I still had a lot of drugs in my system from the hospital, including the anaesthesia, so I didn’t feel as sore as I did waking up the next morning. After that, the recovery process got much easier and less painful. For me, the pain has been worse the more I move around and better with rest, though it’s still important to get up and walk as much as you are able.

The pain was most annoying when I needed to sleep because it was hard to find a comfortable position. That made it especially difficult to fall asleep the first night, which ended up being the only time I took an opioid. Remember that your doctor prescribes pain medication for a reason. Opioids have a high potential for abuse, but you’re not abusing them by taking them after surgery. Don’t force yourself to suffer through the pain. However, your doctor will probably want you to take NSAIDs and Tylenol around the clock, too, to minimize the amount of opioids you use. This is because opioids can cause severe constipation — which I’ll talk more about in the next section.

Constipation

My doctor prepared me to experience constipation after my surgery, but I didn’t understand how severe it would be. Apparently, it’s normal not to have a bowel movement for up to four to five days following abdominal surgery. This is because of the combined effects of opioids on your digestive system and the fact that your digestive organs were manipulated during surgery. Your digestion slows to accommodate the surgery and healing process, and it can take some time to speed back up again. Plus, many people feel nauseous from the anaesthesia in the days following surgery and may follow a low-fiber diet that can contribute to constipation.

My doctor started me on a stool softener in the days before my surgery, then told me to increase to two or three a day afterwards. When that wasn’t working, I started taking a dose of Milk of Magnesia each day, divided into two daily doses, until I had a bowel movement. At first, the Milk of Magnesia wasn’t working, so I tried some other dietary and lifestyle changes. Here are my tips for keeping post-surgical constipation at bay:

  • Prunes. They sound gross and probably remind you of the elderly, but they are actually sweet like dates — and well-known for helping you move your bowels.
  • Coffee. You might not be ready to tolerate this for the first few days after surgery. Once you can, however, it can stimulate your bowels to move.
  • Walking. Your doctor will probably tell you to walk as much as you are able to move the gas from the procedure out of your body, but it can also help get your digestive system going again.
  • Fluids. You may not feel like drinking a lot of water or liquids if you are feeling nauseous, but it’s important to stay hydrated. Stool softeners and many other laxatives won’t work properly if you’re not drinking the right amount of liquid.
  • Diet. As soon as possible, try to get back to eating your normal diet. Sudden dietary changes can mess up your digestive system.

Nausea

You might feel nauseous for the first few days after the procedure as the residual effects of the anaesthesia wear off. I only had one or two short bouts of nausea that were relieved with Zofran (a medication prescribed by my doctor for migraines — I had extra so I took it during my surgery recovery). Your doctor might be able to prescribe this or another anti-nausea medication if you’re struggling. There are also things you can do at home to help.

If you’re feeling sick, my mom always swore by the BRAT diet growing up: that’s bananas, rice, applesauce, and toast. These foods are easy to digest. I would also add in plain crackers like saltines or water crackers. As long as they have no flavor, crackers are a great way to settle your stomach when you’re feeling nauseous. Sometimes, I also find it settles my stomach to suck on something sweet when I’m nauseous. Hard candies or lollipops might make you feel better, especially if they have stomaach-soothing ingredients like ginger or peppermint.

Fatigue

One of the most surprising things about my recovery was how easily I tired doing ordinary things. In the first two days after my surgery, I napped on-and-off for over six hours, in addition to my regular eight hours of sleep. Things like going for a walk with my boyfriend to get the mail or riding in the car to Starbucks for a tea would drain me for hours afterwards. Now that I’m later into my recovery, this doesn’t bother me as much. I can make it through the day without a nap, but I still hit an afternoon slump.

Now that my stomach is feeling better and I’m back to eating normal foods, drinking coffee or tea gives me a little bit of a caffeine boost when I’m feeling fatigued. Most of all, though, I would say to try and embrace it. Don’t try to fight through fatigue. Sleep is when your body heals, so it’s important to nap when you feel like you need to nap. You don’t have any obligations, so you might as well — that’s why you took time off work, after all!

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