Post-Myomectomy Concerns: Abdominal Changes, Menstrual Irregularities, and Discharge

Postoperative care after uterine fibroid surgery?

Hello Doctor: I underwent a traditional abdominal myomectomy in mid-September due to a 13 cm fibroid located at the back of the uterus, which was compressing my kidney and causing hydronephrosis, along with five other smaller fibroids.
I have the following questions:
1.
After the surgery, my lower abdomen (referring to the area just above the pubic bone, about four fingerbreadths in range, which is exactly where the surgery was performed, two fingerbreadths above the pubic bone, not the lower abdomen) has not flattened and looks similar to before the surgery, appearing somewhat pregnant.
However, when I lie flat on my back, the protrusion flattens, but I can feel a long, raised area extending from the surgical site towards the sides of my lower back (it appears more pronounced when standing).
There are also oval-shaped areas on both sides that I couldn't feel before when there were no fibroids, as it was flat.
I expected that removing the fibroids would make my lower abdomen as flat as it was before.
Will the protrusion above the pubic bone eventually shrink and flatten?
2.
Prior to the surgery, I did not experience dysmenorrhea, heavy bleeding, or frequent urination, and for about ten years, I only used regular absorbency sanitary pads, even during the first two nights of my period.
The next day, my menstrual flow would not fill or leak out; it was simply due to the fibroid compression and hydronephrosis that the doctor recommended surgery.
However, during my first menstrual period after the surgery, the flow was much heavier than I expected, and I experienced pain for three days, requiring the use of extra-long, high-absorbency pads at night.
Is this normal? (My first menstrual period after surgery came approximately 28 days later.)
3.
It has been about seven weeks since the surgery, and I continue to have discharge every day.
For the first month post-surgery, the discharge was red and brown, and I have also experienced yellow-green or white discharge.
In the past few days, it has been clear.
Is this a normal post-operative condition? How long can I expect to have discharge?
Thank you, Doctor, for your response.

Niming, 40~49 year old female. Ask Date: 2022/10/31

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, regarding the wound issue, it is advisable to consult the original surgeon for more accurate information.
After surgery, menstruation can sometimes be irregular, so it's best to observe for a while.
If the discharge remains excessive, it is recommended to see a gynecologist.
Wishing you good health.

Reply Date: 2022/10/31

More Info

After undergoing a myomectomy, it is common for patients to have concerns regarding their recovery, including changes in abdominal appearance, menstrual irregularities, and discharge. Let's address your questions one by one.

1. Abdominal Changes Post-Surgery: It is not unusual for the abdomen to appear slightly distended after a myomectomy, especially if the surgery involved the removal of a large fibroid. The presence of swelling or a bulge in the lower abdomen can be attributed to several factors, including postoperative inflammation, fluid accumulation, and the healing process of the surgical site. The fact that your abdomen appears flatter when lying down suggests that the issue may be related to the position of your body rather than a permanent change. Over time, as the swelling decreases and your body heals, you may notice a reduction in the protrusion. However, if the bulging persists or worsens, it is advisable to consult your surgeon to rule out any complications such as seromas or hernias.

2. Menstrual Irregularities: Experiencing heavier menstrual bleeding and increased pain during your first period after surgery can be expected. Surgical interventions can sometimes lead to changes in menstrual patterns due to hormonal fluctuations, the physical trauma of surgery, or the removal of fibroids that may have previously affected your menstrual cycle. It is important to monitor your symptoms; if the heavy bleeding continues or if you experience severe pain, you should reach out to your healthcare provider. They may want to evaluate you for any potential complications, such as retained tissue or other issues that could be contributing to these symptoms.

3. Postoperative Discharge: The presence of discharge after a myomectomy is also common. Initially, the discharge may be red or brown as the body expels blood and tissue remnants from the surgical site. As healing progresses, the discharge may change in color and consistency, transitioning to yellow, green, or clear. This can be a normal part of the healing process, but it is important to monitor the discharge for any signs of infection, such as a foul odor, increased pain, or fever. If you notice any concerning symptoms, it is crucial to contact your healthcare provider. Generally, light discharge can persist for several weeks post-surgery, but if it continues beyond six weeks or becomes bothersome, a follow-up appointment may be warranted.

In summary, while some of the symptoms you are experiencing can be typical after a myomectomy, it is essential to maintain open communication with your healthcare provider. They can provide personalized advice based on your specific situation and ensure that your recovery is progressing as expected. Regular follow-ups are important to monitor your healing and address any concerns that may arise during your recovery process.

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