The adult Renal Service is located in the Brunel building at Southmead Hospital, on Level 1, Gate 5 (to the left of Costa Coffee as you walk in from the main building entrance).

The Renal Service is made up of a number of wards and units: the outpatient department, daycase unit, peritoneal dialysis training department, haemodialysis unit and Gate 8b. There are also satellite dialysis units spread across the South West.

When we say ‘transition’, we mean all the planning that happens when a person moves from paediatric to adult services. The aim of the transition process is to ensure you, the people close to you and your doctors are all ready for the switch.

There is no set time when it has to happen. Instead, your doctors and nurses will decide with you when the time feels right for you to move to the adult service.

Most young people will have their first clinic appointment with Dr Anjali Menon, Consultant Nephrologist, in the transition clinic. This clinic allows more individual time for you to get to know the staff and workings of the outpatients department.

Maria Langdon and Lisa Tierney, Specialist Nurses, attend most of these clinics and are available to contact with questions around your medical care. You will find their number at the back of this leaflet.

Alison Jenkins, Renal Young Adult Support Worker, also attends these clinics and is able to signpost you to services available to support you.

If you have had a transplant you will then attend the Renal Transplant Clinics (Monday, Wednesday, or Friday mornings). These are busy clinics and to make best use of your time, it is helpful to write a list of things you want to discuss to take with you to appointments. 

We recognise that the move from the children's to the adult service can be difficult and hope that having your own clinic will make the transition easier for you and your family. In response to this, over the last few years, we have set up clinics within the renal service specifically for young adults aged 16-25. These clinics also offer the opportunity to meet other young people with kidney conditions.

In Bristol the clinic runs four times a year with Dr Menon the Renal Consultant, a specialist Renal Registrar, Specialist Nurses Maria Langdon and Lisa Tierney, a Young Adult Support Worker, renal dietitian, and psychologist support.

The Renal Outpatients Department is at Gate 5, level 1 of the Brunel building. The Outpatients Department provides people with a kidney problem support and information about their condition. Routine tests can also be carried out here, such as height, weight, blood tests, and electrocardiograms (ECGs).

Clinics are here from 8.30am to 6pm on Monday to Thursday and from 8.30am to 2.30pm on Friday.

During your visit you will meet a number of team members, including doctors, nurses, dieticians, diabetic specialist nurses, transplant coordinators, clinical psychologists, and members of the patient education team.

The Renal Service is committed to research and has partnerships with several other organisations, such as the University of Bristol. From time to time you may be asked if you would like to participate in studies which may be going on within the service. If you don’t want to take part in research it is important that you feel able to say so and know that this will not have any impact whatsoever on the care you receive from the service.

From time to time you may need to be admitted to hospital because of your kidney problem. This will usually be to Gate 8b, which is on Level 4 of the hospital. If this gate is particularly busy you may occasionally need to be accommodated in another gate within the hospital. However, the renal doctors will always know where you are.

When in hospital you will be treated by consultant doctors, specialist registrars and senior house officers (junior doctors).Consultants do ward rounds twice a week, and if you or your family wish to see a consultant at other times, ask the nursing staff or make an appointment through the consultant’s secretary. You can often request to see specialist registrars and junior doctors on the gates. There might be a wait before they can see you.

Visiting hours are from 12pm to 8pm. If you need to have visitors outside of these times this could possibly be arranged by discussing it with ward manager. It may be possible for family members to stay overnight if agreed with the ward manager.

The Renal Dialysis Unit (RDU) is on Level 1, Gate 5 of the Brunel building at Southmead Hospital. The unit provides outpatient dialysis treatment to patients who live in the local area and people who need a doctor nearby whilst receiving dialysis.

The Unit has 15 dialysis stations and is open from 7am – 2am Monday to Saturday. There are 3 sessions per day: morning (7am – 2pm), afternoon (1pm – 7pm), and twilight (6pm – 2am) shifts. The Unit is closed on Sunday. Each patient has a named nurse allocated who has responsibility for their overall care on dialysis. Each dialysis station has a comfortable electrically operated chair.

Shared and Self Care is encouraged in the dialysis units you may like to take part in some aspects of your dialysis and go on to become independent in haemodialysis in a unit. The nurses will help you get to the level you want.

Satellite Haemodialysis Units

Satellite units are haemodialysis centres located away from the main hospital renal unit. They are managed by haemodialysis nurses. The six Satellite Units located in the Bristol/Bath area are:

• Cossham Satellite Dialysis Unit.
• Bath Satellite Dialysis Unit.
• Bright Satellite Dialysis Unit (on Southmead Hospital site).
• South Bristol Satellite Unit.
• Frome Satellite Dialysis Unit.
• Weston (Ambleside) Satellite Dialysis Unit.

The Community Team

Many people prefer to have their dialysis in their own home. We are able to offer people home treatment with haemodialysis and peritoneal dialysis. These home treatments are supported by the Community Care Team.

Jude Cornelius and Abi Bugler, Patient Education Nurses, are based within the Community Care Team and coordinate the patient information that is available in the department. They also provide information for people who may need dialysis treatment and help people to prepare for dialysis.

The Medical Day Care Unit is where short medical procedures, such as blood or iron transfusions, are carried out. It is on Level 1, Gate 5b of Southmead Hospital.

There is also a CAPD (Continuous Ambulatory Peritoneal Dialysis) training room situated on Level 1, Gate 8b (opposite medical day case).

As long as you are well, it is important to keep as fit as possible so that you have enough energy to live life to the full. Regular exercise will lower your blood pressure and reduce the risk of heart problems later in life.

We recommend that you avoid contact sports where you could get hit in the abdomen, such as rugby or judo.

If you are really keen on a particular sport, please talk to the team before you start doing it so we can check that it is safe for you to do.

You can speak to the renal dieticians on 0117 414 5428 if you have any questions about specific foods to avoid or eat more of.

It goes without saying that smoking is not a healthy choice. Smoking damages not only your lungs but also your heart and blood vessels. People with kidney failure are already at risk of heart and blood circulation problems so smoking will increase this risk.

If you would like support to think about not smoking, please speak to the renal staff as there is a lot of practical advice and support we could direct you to.

Sponsored by Kidney Care UK, the Young Adult Activity Weekend takes place once a year at the Mount Cook Adventure Centre in the heart of the Peak District. It is a chance to get away and meet other young adults from across the UK.

The weekend is open to any young adult aged between 18 and 30 who has Chronic Kidney Disease, including those who have had a kidney transplant or who are on dialysis.

There are a range of activities on offer each year, including archery, nature walks, high ropes, rock climbing, zipwire, arts and crafts, social events and many more.

Meals, activities and accommodation are free. All you are asked is to contribute towards the cost of the transport to and from the venue. There is a minibus which takes the young adults from Devon, Cornwall and Bristol together.

“I have haemodialysis three times a week in a unit with much older people, so spending a weekend each year sharing experiences with people my own age going through similar challenging experiences is really helpful and encouraging,” Chris, 22, University Student.

For more information about the weekend, please contact Ali Jenkins on 0117 414 5213, or alison.jenkins2@nbt.nhs.uk.

The Transplant Games takes place every year in different locations around the country. Almost all games and sports are included so do think about taking part.

In August 2024 they are being held in Nottingham. Please check the website for up to date information:

British Transplant Games 2024 

Prescription charges

If you need to buy more than 5 prescription items in 4 months or 14 items in 12 months you will find it cheaper to buy a pre- payment certificate (PPC). Your local pharmacist can give you an application form FP95. You may apply for free prescriptions if: 

• You are claiming certain benefits or allowances.
• You have diabetes mellitus controlled by medication.
• You have epilepsy controlled by medication.
• You have a permanent fistula (for example caecostomy, colostomy, laryngostomy, or ileostomy) requiring continuous surgical dressing, or requiring an appliance.

Kidney disease and its treatment are not mentioned in the law but because of the last item above it is usually considered that you will be exempt if:

• You have a permanent fistula, graft, or dialysis catheter that is currently being used for dialysis.
• You have a catheter for peritoneal dialysis.

If any of the above applies, you will need to get a FP92A form from your GP to apply for an exemption certificate. After having a kidney transplant you will no longer be exempt from prescription charges due to your renal condition.

NHS Low Income Scheme

If you are on a low income you may be eligible to receive financial help through the NHS Low Income Scheme. To do so, you would need to complete an HC1 form to apply for an HC2 certificate. HC1 forms are available from Job Centre Plus offices and most NHS hospitals. Your doctor, dentist, or optician may also be able to give you one. Alternatively, you can get an HC1 form by calling 0845 610 1112.

Whether you qualify for help is based on a comparison between your weekly income and your requirements at the time the claim is made.

You will qualify for a full help HC2 certificate (which includes free NHS prescriptions) if your income is less than or equal to your requirements, or your income is greater than your requirements by no more than half the current English prescription charge.

You will qualify for a limited help HC3 certificate if your income is greater than your requirements by more than half the current English prescription charge. The HC3 certificate shows how much you have to pay towards your health costs.

Certificates are usually valid for periods of between six months and five years, depending on your circumstances. Find out more about the NHS Low Income Scheme (LIS) and other NHS help with costs:

Check what help you could get to pay for NHS costs - NHSBSA

Personal Independence Payment

The PIP system replaced the previous disability living allowance in 2016. Since then, patients have been able to apply for PIP. This system has two patrts based on daily living and mobility, with a ‘standard’ and ‘enhanced’ payment rate in both cases.

To claim for PIP, you must be 16 to 64 years old. If you need help with transport or moving around, you may qualify for the mobility component. For the daily living component, you must be having difficulties in the following areas:

• Preparing/eating food.
• Washing/bathing.
• Dressing/undressing.
• Financial decisions.
• Communication.
• Management of medicines or treatments.

The National Kidney Federation (NKF) has a webpage which goes into much greater detail on this subject:

Benefits Information for Patients and Carers | National Kidney Federation

The following is advice for people with kidney problems about buying medicines that have not been prescribed by a doctor.

• Specialist Renal Pharmacists are available for advice on the wards and in the Pharmacy Department.
• Ensure the pharmacist is aware of your kidney problems and has a full list of your current medicines.
• Try to use the same pharmacy so the staff know you and your medicines.
• Some medicines you can buy may only be suitable for you under supervision from a doctor. Some of these are listed on the next page in the ‘avoid’ column.
• If you need to use a product frequently or for more than a few days at a time you should tell the doctor.

The following pages contain very brief general information about some common medicines. Not all medicines are listed and if in doubt you should talk to your pharmacist, doctor, or nurse.

Vitamins

Avoid vitamin A, vitamin D and cod liver oil. More specialist advice can be obtained from your dietitian or renal pharmacist.

Herbal medicines

Due to lack of information on interactions and side effects these are best avoided. Herbal medicines like St John’s Wort can sometimes cause serious side effects when taken with other medicines. If you wish to use a herbal product please contact your doctor or pharmacist for advice.

Aromatherapy

Some aromatherapy oils are unsuitable for use in patients with renal problems. Hyssop and rosemary oil should be avoided. Discuss with your doctor or pharmacist before using aromatherapy products.

Homeopathics

These are generally considered safe. Please discuss with your doctor or renal pharmacist before starting homeopathic medicines.

Useful books

• Kidney Dialysis and Transplants - Andy Stein & Janet Wild
• Kidney Failure: The facts - Stuart Cameron
• Kidney Failure Explained - Andy Stein & Janet Wild
• Oxford Handbook of Dialysis - Jeremy Levy, Julie Morgan & Edwina Brown

Useful websites 

Kidney Care UK

Kidney Care UK, the UK's leading kidney patient support charity | Kidney Care UK

Young Adult Kidney group (YAKG)

Young Adult Kidney Group (YAKG) | Kidney Care UK

National Kidney Federation

National Kidney Federation

NHS 111

Get help for your symptoms - NHS 111
Medical advice when it’s not an emergency.

Holiday dialysis information

Global Dialysis

Transplant and donation information

Home - NHS Organ Donation

CAPD Training (Continuous Ambulatory Peritoneal Dialysis) 

0117 414 8004

Dieticians 

0117 414 7555

Dr Menon’s Secretary 

0117 414 7707

Home Dialysis Team 

0117 414 8004

Patient Education Nurse  

0117 414 8004

Renal Dialysis Unit 

0117 414 3540

Renal Outpatients 

0117 414 1960

Renal young adult support worker 

(Alison Jenkins: alison.jenkins2@nbt.nhs.uk) 
0117 414 5213

Transplant Coordinators 

0117 414 7704

Transplant Specialist Nurses

(Maria Langdon, Claire Adams & Lisa Tierney) 
0117 414 5213

Renal ward 8b 

0117 414 4800

The NKF was set up in 1978. It is the only national kidney organisation for patients run by patients. It seeks to promote the welfare of patients and their carers throughout the UK who are experiencing renal disease. Funding is provided by Kidney Patient Associations, donations, and sponsorship.

Each year the NKF hosts a National Conference where several hundred patients and carers get together for a weekend to listen to specialist speakers, ask questions, and discuss problems or issues which affect them. The Federation publishes a quarterly magazine ‘Kidney Life’, which is free to members.

If you would like to know more about membership in the NKF, visit their website: www.kidney.org.uk/about-us/main-member/

This group is run by young patients for young patients aged 0-18 and 18-40 years with any form of renal disease in the UK. A quarterly newsletter is produced and there is a Pen Pal scheme and Talkline available through the NKF website.

Leaflets can be found in the inpatients department.

Contacts Helpline 0845 601 0209 – cost of a local call from a landline (costs from mobiles may vary depending on your network). Website: www.kidney.org.uk

This local charity is very supportive of the young people cared for in the trust. In addition they provide funding for our twice yearly social events as well as contributing towards the cost of transport to the weekend away. They welcome all new members. Website: www.bakpa.org.uk

This is a short film about what happens when you have a fast MRI scan. A member of the radiographers team will welcome you when you arrive for your scan. They will ask you some standard safety questions to make sure it is safe for you to have the scan and you'll be asked to sign a form to confirm your answers. Before the scan you'll be asked to change into a gown please put your personal belongings and anything you have with you that is made of metal into a locker for safekeeping.

In order for the fast MRI scan to show up cancers clearly you will need to have a dye injected during your scan. To make this possible a small plastic cannula is placed into a vein in your arm before you go into the scanning room. This is an essential part of a Fast MRI scan. You may experience a cold feeling in your arm during the injection but side effects such as mild nausea or headache are uncommon, happening just once or twice in every thousand injections. 

The MRI scanner is a large magnet you'll be asked to lie face down on a padded table placing your breasts beneath you in a special cradle called a breast coil. The radiographer will take time to make sure you are in the correct position and are as comfortable as possible. The scanner is very noisy and you likely to hear it as you enter the scanning room. The radiographer will connect the canula in your arm to a pump so that the dye can be injected automatically at the right time during the scan. You will be given headphones to protect your ears from the loud noise of the scanner and you can choose whether or not to have music played through them. You will also be given a call button that you can press to request to stop the scan at any time. Once you're in the scanner the Fast MRI can take less than 5 minutes. Please tell the radiographer before the scan starts if you're not comfortable as it is very important that you relax and keep absolutely still throughout the scan is even a small movement of the breasts or chest can stop the images from being clear.

During this time the radiographer operates the scanner so that it takes several different sets of pictures. 

“okay you're doing really well this next scan the dye is going to come into your arm”

The noise can change depending on the pictures being taken. At the end of the scan the radiographer will help you up from the table your cannula will be removed and you can get dressed again.

We hope your found the short film helpful and we look forward to welcoming you for your Fast MRI scan in the near future. If you do have any questions please call your local research team or ask a member of the radiographers team when you arrive for your scan.

There is a chance that if you are taking, or have been recently taking, Pre-exposure Prophylaxis (PrEP) that a negative test result will be a “false negative”. This means that the test would not identify the early stage of a HIV infection. It is therefore important that people who take PrEP do not rely on this screening test in the ED, and should continue to have regular HIV and sexual health testing.

How else can I access HIV and other sexual health testing?

Unity Sexual Health clinic can provide information about and tests for HIV and other sexually transmitted infections. 

You can request a home testing kit for HIV through the Unity sexual health website.

Welcome to Unity Sexual Health | Unity Sexual Health

It is also possible to talk to your GP about having these tests if you have a particular concern.

"Opting out" means you choose not to have these specific blood borne virus screening tests, you can still have other blood tests. 

If you opt out of the screening test, this decision will be recorded in your medical notes. The computer system will 'block' the tests from being done for 12 months. Therefore, it is important to tell staff each time you are having a blood test in the Emergency Department if you still want to opt out. 

What if my doctor thinks I need one of these tests? 

If your doctor or clinician feels it is important that you have a test for one (or more) of these conditions, they can still arrange that specific test for you. This specific test will not be affected if you decide to opt out of the screening test. 

What if I decide I want to have these tests later?

If you decide that you would like to talk about having tests for HIV, hepatitis B, and hepatitis C, after you visit the ED, you can speak to your GP or access testing through Unity Sexual Health clinic. You can request a test for one or all three, and you can request a home testing kit for HIV through the Unity Sexual Health. 

Welcome to Unity Sexual Health | Unity Sexual Health

HIV stands for Human Immunodeficiency Virus. ‘Immunodeficiency’ refers to the weakening of the immune system by the virus. HIV can be cauing damage silently for many years; you may have no signs or symptoms.  

For the vast majority of people with HIV, treatment is normally a fixed dose combination tablet, taking it once a day. The treatment is so effective that it stops the virus from reproducing in your body. It reduces the amount of virus in the blood to undetectable levels, meaning you cannot pass on HIV and can expect to live a normal lifespan.  

Further support and information: 

Home | Terrence Higgins Trust (tht.org.uk)

HIV and AIDS - NHS (www.nhs.uk)

Hepatitis C affects your liver and can lead to serious liver problems if not treated. You can have hepatitis C for many years and not notice any symptoms, but this does not mean it isn’t affecting your liver.  Hepatitis C is curable. Treatment is a course of tablets, taken for 8-12 weeks. You are unlikely to experience side-effects from the treatment. 

Further information and support: 

The Hepatitis C Trust | Hep C charity (hepctrust.org.uk)

Hepatitis C - NHS (www.nhs.uk)

Hepatitis B affects your liver. Most adults that contract hepatitis B recover fully, but if contracted as a child it is unlikely that the body will clear the virus on its own. Treatment is very effective and is usually in the form of tablets. Some people do not need treatment for the virus as it may not be causing damage to the liver. They will need regular check-ups though. An important other step is to vaccinate those that live with you and these vaccines can be provided free of charge by your GP.  

Further information and support at: 

Hepatitis B - British Liver Trust

Hepatitis B - NHS (www.nhs.uk)
 

BWPC are implementing new standards, processes and SAP Ariba modules to improve how we interact with our suppliers. The benefits of this include eliminating manual ways of work and duplication of effort for both parties. It will also ensure that our supplier details are current and accurate. It also allows you to self-manage your contact information and efficiently communicate this to BWPC.

Yes, the registration is a separate process that we expect all existing suppliers to complete. This allows suppliers to confirm BWPC’s standard procedures, self-manage their contact information and manage their catalogues when enabled. 

All purchase orders will be transacted through the SAP Business Network, if you wish to be integrated to receive orders via ERP then you would require an Enterprise account with SAP and then integration with BWPC. This can all be completed at a later date. Suppose you receive purchase orders from BWPC via PEPPOL / ERP systems. We are looking into a temporary alternative for go-live that won't change how you receive orders. 

Questionnaires are due to be sent out closer to the go-live date.

You can still participate with an SAP Business Network with a standard account which is free of charge. 

No, any POs sent via NHSSC will remain the same, only the products we may order directly with you will be affected by this change. 

Yes, this is correct, only purchase orders are affected by this change.

You can register for an account through this link https://service.ariba.com 

Yes, you will receive an email notification to the email associated with your SAP account.  This email will notify you that a trade relationship request is ready to be accepted. This will be sent out once we have input your details into the SAP Business Network which may take 24-48 hours.

Yes. However, if you upgrade your SAP Business Network account to an enterprise account then integrating via your ERP would be possible. Suppose you are receiving purchase orders from BWPC via PEPPOL / ERP systems. In that case, we are looking into a temporary alternative for go-live so the way you receive orders doesn't change. 

 This may be due to the volume of transactions BWPC carries out with your company, as a standard account does not offer some features such as integration and a dedicated SAP helpdesk. If you wish to continue with a standard account then this can still be completed, but please note that we won’t be able to integrate with any of your ERP systems and orders may have to be extracted manually by yourselves on your account. 

No, one SAP Business Network account can service multiple customers.

Completing our process via the SAP Ariba is mandatory. Not completing it on time could result in non-compliance and impact our existing trade relationship. For new suppliers it will also prevent BWPC from taking the necessary steps to initiate your account in our system to allow transactions to occur.

If you have more than one business that is actively trading with us, you will receive a system generated invitation to register per organization or legal entity. You will need to re-register and re-qualify each one separately.

1. You do not need to create a new Ariba Network account to respond to questionnaires or participate in events with BWPC. You can use your existing account to: 

• Respond to registration, qualification questionnaires for BWPC and other customers.
• Respond to future sourcing events.
• Potentially manage contracts. However, some suppliers may want to create an additional Ariba Network account, to manage these three processes and modules separately from the transactional account or from the account used to manage other customers.

There is no cost associated with creating a standard Ariba Network account. Suppliers can use a standard account to: 

• Respond to questionnaires.
• Participate in sourcing events.
• Manage contracts.
• Receive POs.

At any time, suppliers can upgrade from their standard account to an Enterprise account. Costs may be incurred when upgrading to an enterprise account to transact with buyers.

If you or someone else in your organisation received the SAP Ariba system generated invitation to register their email, and it should have been sent to another person in your organisation, do not simply forward it on. Contact the Supplier Enablement Lead within BWPC to have the email with the link resent to the relevant contact.

If you are experiencing this problem, it could be one of the scenarios below: 

You have already logged into your existing account and then also clicked on the link in the email for the first time. Please note, the system will view this as an attempt to log in twice at the same time. You must either click on the link and log in from there or log into your existing account and navigate to the Ariba Sourcing screen. You can not to do both. 

If you have another SAP Ariba site open in another browser tab, please close that other tab and try to login again. 

If you received a certificate error in your browser when trying to access the Ariba Network login page at supplier.ariba.com, please clear your browser cache, cookies and search history. Close the browser and then try open the page again.

If you are an existing supplier of BWPC, some of your information may be migrated, so you need only confirm it for accuracy rather than starting new. However, you may need to re-provide some information or provide additional information. This will ensure that BWPC has the most accurate, up to date information they need to do business with your company moving forward.

It is important to perform deep breathing exercises after your operation to reduce the risk of developing a chest infection. Do this by taking 3 deep breaths, feeling your lower ribs move. Repeat this every hour throughout the day. If you need to cough after your operation, place a rolled-up towel across your abdomen and apply pressure. If you have had vaginal surgery, put your hand over the pad to support the perineum (the area between your vagina and back passage(anus/ rectum)) when coughing.

Regular movement of your legs is essential while you are less active than usual. Move your feet up and down at the ankles for 30 seconds every half an hour when you are in bed or sitting. You will also be given support stockings to wear whilst your mobility is reduced following your operation.

Bend your knees up one at a time. Keep knees together and roll onto your side. Push up into sitting with your arms, at the same time lower your legs over the side of the bed. If you have had abdominal surgery you can support your incision with a rolled-up towel. 

You can expect pain after your surgery. You will be provided with painkillers on discharge. Some painkillers, such as codeine, can cause constipation. Therefore, make sure to consume a high fibre diet and drink plenty of water to avoid constipation. Taking painkillers to reduce your pain will ensure that you get out of bed sooner and will therefore speed up your recovery and reduce the risk of blood clots.

You may have a pack (small gauze similar to a tampon) in your vagina following vaginal surgery to reduce the risk of bleeding. This will be removed by a nurse while you are in hospital.

You may have some vaginal bleeding for 2-3 weeks after your surgery. This is normal. However, if the bleeding becomes heavy or smells offensive, you need to contact your GP or the hospital as this may signify an infection. Use sanitary towels instead of tampons to reduce the risk of infection.

Bladder

You may have a urinary catheter (tube into bladder to help it drain) in place after your operation for up to 24 hours until you are easily able to walk to the toilet to empty your bladder. Once your catheter is removed you can go to the bathroom to empty your bladder.

Ensure you sit on the toilet properly and relax your breathing. If you are struggling to empty your bladder it is important to speak to your nurse. They will measure how much urine you pass (pee) and scan your bladder to determine how much is left.

If you have had a pelvic floor repair especially of the anterior wall of your vagina, you may notice that your urine flow is slower and may take longer. This should settle with time. If you have problems passing urine, you may need to have a catheter for a few days.

It is important to ensure you drink enough after your operation, approximately 1.5 to 2 litres per day, little and often is best. Try to avoid caffeinated drinks, fizzy drinks, and alcohol as these may irritate your bladder and cause urgency. Drinking less frequently can make your urine more concentrated which can irritate your bladder. Also try to avoid going to the toilet ‘just in case’ even if you have fear of leaking as this can lead to poor bladder habits.

Bowels

It is important to avoid constipation after your operation as this puts extra strain on your pelvic floor muscles and potentially your operation site. To prevent constipation, make sure you drink plenty of fluid, increase the fibre content in your diet and if necessary, use laxatives. Your doctor can prescribe these for you to take whilst in hospital and at home.

Sit on the toilet with a stool under your feet, as shown in the picture below. Do not strain and keep your tummy muscles relaxed.

It is helpful to take a slow breath in through your nose so that your stomach moves outwards, and your chest remains still and then exhale through pursed lips. You may also find it useful to support your perineum (the area between your back passage (anus/rectum) and your vagina), when opening your bowels. Please see the picture below.

Your pelvic floor muscles are a sling of muscle from the pubic bone at the front of your pelvis to the coccyx and sacrum at the back of your pelvis. They help to support the bowel, bladder and uterus, maintain bladder and bowel control, support the pelvis and aid sexual function.

It is important to strengthen these muscles leading up to and after your operation. Once your catheter has been removed and you can pass urine, you can gently start these exercises.

To contract your pelvic floor, tighten your back passage – as if you are stopping yourself passing wind (farting). At the same time, tighten your vagina. Women used to be told to practice their pelvic floor muscle training by stopping the flow of urine. This is no longer recommended as it can affect your bladder function in the long term.

Try to feel the muscles lifting upwards and forwards towards the pubic bone. Feel the muscles working together. Then relax, let go and feel the muscles return to their starting position. Try not to squeeze your buttocks or leg muscles. Avoid holding your breath and just continue to breathe normally.

To begin with, especially if you haven’t practised these exercises before, you might lack confidence. Keep practicing the above and when you’ve mastered simply contracting and relaxing, move onto the next exercises.

There are two different recommended pelvic floor exercises:

Exercise 1 – Slow pull-ups

Tighten the pelvic floor muscles slowly. Continue to tighten for the length of the hold, relax, and feel the muscle let go. How many seconds can you hold the contraction for?

Aim for 5 seconds to begin with, when you let go – can you feel the muscles relax?

If not, you have held the contraction for too long, try again with a shorter hold – even just one second. Some women may only be able to only hold for 1-2 seconds. Others as many as 8-10 seconds. Don’t panic if you are not able to feel very much to start off with. It may take a bit of practice so keep going. The key is to discover your hold time, and gradually build this up to a maximum of 10 seconds. And don’t forget, keep breathing normally throughout.

Rest for roughly 5 seconds in between each contraction, to ensure that the muscles have fully relaxed. Repeat this 5 times. As it gets easier, gradually increase the length of hold, and number of repetitions (aim for 10 long squeezes for 10 seconds each).

Exercise 2 – Fast pull-ups

Tighten the pelvic floor muscles quickly. Let go straight away. Wait for a second. Repeat this 10 times and as you get more confident aim for approximately 1 contraction per second.

Pelvic floor exercise routine

Do exercise 1 and 2 at each session. As soon as you can, increase to 10 slow and 10 fast pull-ups. Aim to repeat each session at least 3 times a day. When you start, do the exercises lying or sitting. As your muscles get stronger progress to standing. 

Do not expect immediate improvement – but do not give up. As the muscles get stronger you will be able to increase your hold time and number of repetitions. Use this link to view our pelvic floor video to help guide you.

How to do pelvic floor exercises - msk (bnssg.nhs.uk)

Top tips

Try to get in the habit of tightening your pelvic floor muscles before you cough, sneeze or lift anything.

After your operation it is important to start strengthening your deep abdominal muscles called tranversus abdominis. They work together with your pelvic floor muscles to provide support for your spine and internal organs.

Deep core muscles

Lying on your back let your tummy relax, breath in gently. As you breathe out gently pull in the lower part of your tummy, hold for 5 seconds, and repeat 5 times. Do not move your back. You should be able to breathe and talk whilst exercising. This can also be done in sitting or standing.

Pelvic tilting

Lie on your back with your knees bent. Pull your tummy in and flatten your back on the bed. Hold, and then relax. Do not hold your breath. Repeat 5-10 times twice daily.

For exercise progressions please visit: POGP (thepogp.co.uk)

Do not drive until you are confident you can do an emergency stop. If you have undergone abdominal surgery, we advise you not to drive for at least 4-6 weeks but check with your insurance company regarding your policy.

You should avoid sexual intercourse for the first 6 weeks following vaginal or hysterectomy surgery, ensuring any bleeding has stopped. This will allow tissues to heal and reduce the risk of developing an infection. It is important that you wait until you feel ready and use sufficient lubrication. If you are concerned or intercourse remains uncomfortable after 3-4 months, it is a good idea to discuss this with your GP.

BNSSG Pelvic Health Physiotherapy Service : Pelvic Health Physiotherapy Service - msk (bnssg.nhs.uk)

POGP POGP (thepogp.co.uk)

RCOG Home | RCOG

NHS The NHS website - NHS (www.nhs.uk)

Squeezy NHS app for pelvic floor exercises: Home Page - Squeezy (squeezyapp.com)

BSUG (2020) Anterior vaginal wall repair without the use of mesh. 

IUGA (2020) Recovery Guide Following Vaginal Repair Surgery/Vaginal Hysterectomy

POGP (2019). Fit following Surgery advice and exercise following gynaecological surgery. 

RCOG (2015) Information for you after a Laparoscopic Hysterectomy.

RCOG (2015) Information for you after a Pelvic Floor Repair Operation.

RCOG (2015) Information for you after a Vaginal Hysterectomy.

RCOG (2015) Information for you after an Abdominal Hysterectomy.