After the completion of the operation, the vagina and perineum are cleaned with sponges moistened with saline or a mild antiseptic solution. A sterile perineal pad is then applied and held in position by a T binder. When constant bladder drainage is desired, a Foley catheter is inserted and held by adhesive tape anchored to the thigh. The drapes are removed, and the legs are withdrawn slowly and simultaneously from the stirrups to prevent disturbances in blood pressure and straining of the sacroiliac joints.
The immediate postoperative care is similar to that following abdominal procedures, with certain added perineal precautions. Indwelling catheters are not necessary. The patient may be catheterized every 4 to 6 hours, depending on the fluid intake, until she voids voluntarily. Postvoiding residuals should be checked. Values less than 50 mL usually indicate satisfactory emptying. These patients should take in extra oral liquids to ensure a liberal urine output. Antibiotics may be given if a urinary tract infection occurs. The daily intake and output are recorded during the hospital admission.
The perineum is kept clean and dry with a peri-pad and is rinsed with clean water after urination and defecation. Warm, moist applications or dry heat to the perineum may be used to relieve pain. Sitz baths promote comfort and stimulate voiding. A stool-softening preparation is given starting either on the evening of surgery or the first postoperative morning. After procedures requiring extensive tissue dissection, bowel movements are often delayed for 3 to 5 days. The principle of early ambulation is followed.