Perforated Uterus - not a play on words

Hopefully no one is offended by this information but I sincerely believe that we can all learn from each others experiences and this has been mine for the last several weeks. If you are a man, perhaps your wife/girlfriend will benefit from your knowledge and if you are a woman perhaps this can help you be informed when making your own decisions. This was originally posted on a blog for potential IUD users so it isn't a story.



When this has been posted you will know where I have been the last few weeks. :)

I will try to make this as easy skim for information as possible. This is here for educational purposes and for those who have perforations and come looking for information. I had difficulty finding much useful perforation information when I was looking.

IUD of Choice: Mirena

Insertion:
Where: Planned Parenthood in NC
Cost: Free - because I agreed to allow a medical student to try first under supervision (I would want someone to do this for me when I am in that situation)
Pain During Insertion: Highly painful, nearly passed out, couldn't unclench hands or legs for several minutes, nauseated, never felt pain like that before in my life pain
Pain After Insertion: After 20 minutes left and drove to school used 800mg Ibuprofen that day and the next
No sonogram used for insertion

Other than that it my uterus would "bite" me if I stood wrong or walked wrong or sat wrong. Just a short painful cramp. Had cramping of my lower colon come to find out it was sitting against my lower bowel. Also had alternating diarrhea and slight constipation. This may be different for women who's IUD is sitting in a different place in their abdomen.

How I realized it was out of place:
Checked a week or so later and could not find the strings. Felt all around my cervix, no strings coming out or around it. Spent two days in and out of the University Women's Health Clinic, Planned Parenthood and Dr's office, lots of waiting.

Day's leading up to surgery:
1. Women's Health couldn't find strings either, didn't have sonogram so sent me back to Planned Parenthood
2. Planned Parenthood checked with sonogram couldn't find it in my uterus (used Plan B since it had been 80 hours since sex)
3. Women's Health for an x-ray to find the missing IUD - found near my hip
4. Dr's to talk about surgery and get questions answered
5. Hospital to get blood test to make sure I wasn't pregnant

Had two Ob/Gyn Dr's say that it wasn't an emergency to have it in my abdomen and since it was the Mirena it was roundy and unlikely to puncture anything else but also said there is little information out there on this happening as it doesn't happen that often. They did not give any special instructions on what to do not to do while waiting for surgery. I chose to move carefully as I didn't want it moving around my abdomen any more but that was MY choice. Dr who did insertion was very kind and apologized profusely also after much uncertainty the hospital the Dr was employed under agreed to pay for my surgery and care in connection with the IUD incident.

If I had been pregnant the Dr who inserted the IUD said they would wait until a later trimester to remove the IUD since they didn't want me under general anesthetic while in early pregnancy OR I could have a therapeutic abortion. I have been on birth control for 17 years so it was unlikely I was pregnant but just in case. Conversely surgeon stated that if I were pregnant they would still want to get it out right away and allow me to continue my pregnancy if I so chose. SO not sure which of those would have happened.

Dr said that complications for later pregnancies is highly unlikely. There should be no problem with implantation as they worry about that only with multiple D and C's and large amounts of scar tissue. Also I should not have to have a C-section but should be able to deliver vaginally but they would look at uterus while they were in surgery. I continued to have cramping in my bowel, alternating diarrhea and slight constipation. Again my days were spent waiting, waiting to hear when surgery was, waiting to hear who would pay for the surgery etc etc. It is very busy business to be sick actually and I got very little done but running to the hospital for tests and trying to figure out the details.

Pain: cramping in uterus, light bleeding, light overall abdominal pain all these were from Plan B I assume. Still have colon/rectal cramps and diarrhea/constipation

Surgery - Laparoscopy:
I was called the day before surgery and told not to eat after midnight and to drink only apple juice/water up to 3 hours before surgery. Dr suggested I could eat 8 hours before surgery since I struggle with low blood sugar levels. So I ate breakfast 7.5 hours before surgery and drank water up to three hours before surgery.

Had told me I would be kept in the hospital a day after surgery but then they decided to do it outpatient. I was glad about this, I would rather be home then laying in a hospital bed. But we packed over night items just in case. Here is what we took to surgery with us and it was helpful.

1. Contact Case/Solution
2. List of questions and things to tell each the anesthisiologist, dr and nurses
3. Loose clothing for after surgery, nothing tight around tummy and able to be sagged really low below lowest incision, also a loose t-shirt and heavy sweatshirt (it was almost summer but this was a real fortunate choice! I needed it)
4. Friend to drive
5. Lots of people who care about you

Anesthesiologist (things you may not think to ask your anesthesiologist):
- I have veneers on my front teeth do not allow a student to intubate me or use a LMA (rubber hose for airways much gentler) (answer: must intubate because organs are pushed against diaphragm and it is difficult for patient to breath)
- I don't drink or take medication very often so child Benedryl is affective (ie I am what they call a "cheap date" little to nothing and I'm out)
- Can I be put under before they start the IV? (answer: no :) )

Surgeon (things you may want to ask your own surgeon):
- Length of surgery (answer: 10 minutes - reality for me was around 1 hr 30 min)
- Risks of surgery (answer: damage to internal organs, infection, death lots of lovely things)
- Post Op expect what (answer: should be able to do sit ups in 2 days if all goes as planned - didn't happen)
- Visualize Uterus for damage? (answer: yes)
- Visualize path IUD took through intestines? (answer: can't tell but will check as much as possible for any damage)
- How many holes (answer: one through my belly button and hopefully just one by my hip)
- Can I walk up the two flights of stairs to my apartment after surgery

Arrived for my surgery 1 hr before the surgery. My sweet husband and a dear friend accompanied me.
1. Peed into a cup
2. Changed into a long cloth tie back gown, funny mesh disposable undies and thick socks with tread
3. Taken to Pre-Op chair which in the facility was a two person room with curtains between.
4. Nurse asked lots of questions and took vitals, started IV
5. Brought in my husband and friend
6. Anesthesiologist stopped by to answer questions, Surgeon stopped by, my Dr stopped by, Nurse who attended in the OR stopped by, whole parades of people came through a few forgot to tell me who they were so I had to ask...don't be afraid to ask. It's your body. Also keep your contacts in until the parade is over. I took mine out and my only recollection of my surgeon is this fuzzy blob person. :) It made me feel more out of control.
7. I become nervous and scared by this time. They took my BGL it was 71 which is fairly low or quite low depending on what scale you use.
8. They pushed 2-3 drugs into my IV - I don't know right now what they were but I would like to find out...probably Versaid and Valium...but I could be wrong.
9. Announced it was time and trundled me off
10. Everyone was in the room, OR table was shaped something like a cross (sorry not a positive connotation but the easiest way to explain). It allowed them to strap my arms up and away from my body and allowed them to get in as close to my body as possible. Very cool actually. It tips up so that my feet were above my head and my organs would fall up onto my diaphram so they would have as much room to work as possible. This is why intubation was necessary.
11. I laid on the table they began to strap me on and *ding* that's the last thing I remember

Post-Op:
Operation was 1.5 hrs much longer than anticipated. They have told me it is because I am thin and healthy and it made it more tricky to get into my abdomen...less room I guess to work in there. They had to pump me up with CO2 twice. The CO2 allows them to expand the abdomen and have more room to do the laparoscopy.

Woke up with my husband and friend there. I shivered and shook uncontrollably. This was supposedly part of coming off the general. I was very cold although they said my temp was normal. They had me drink soda - ginger ale but I can't recall it tasting like anything. I recall most of my first conversations but I was VERY sleepy. At some point they dressed me in my pajama's and sent me home with three warm blankets and my husband blasting the heat in the car. I slept most of the way home. I almost slept all the way up the stairs. It made me nauseated and I nearly threw up when I got into the apartment - but I didn't and fell asleep in bed.

Slept most of the next few days. Took Darvocet N 100 (much gentler than Percocet or Hydrocodone) and Ibuprofen 800mg every 4 hours and staggered so when I was coming down from one I had full dose of the other. The general anesthetic knocked me out pretty hard.

Tried to stop all pain meds 3 days after wards and could not. Pain was tolerable to me but was still bad enough to make me nauseated (means I didn't feel it as bad as it was in my body I guess from what they say).

Pain etc:
Lots of back aching, abdominal aching, shoulders aching.
Taut abdomen. They did not get enough of the CO2 out and it presses against the internal organs and causes referred pain. Still have it after 5 days. My abdomen is like a barrel and I generally have a flat stomach (yeh my fat goes to my hips :) )
Constipation from the anesthetic and Darvocet
- used prunes/prune juice
- lots of water
- fruit
- more water

Use a pillow to put back pressure on your incisions when coughing or moving your bowels. It is much more comfortable and provides support.

Only get stool softeners with Darvocet if recommended by Dr!!! This is different then Percocet or others I believe.

Slept on a pillow ramp partially sitting up and have had to get up every night and pee at least once.

Should have taken a walk around the apartment complex sooner then I did (day 3) it would have helped the CO2 dispurse more quickly and after pushing myself to walk I have gotten better feeling exponentially.

End of Day 4 - Pain med 2 Ibuprofen 400mg, still ache in my back and abdomen. Sleep only on my back still. Incisions still somewhat painful but stopped leaking around Day 3 or 4.

From what I read it could take 2+ weeks to get all this CO2 out of my abdomen and I believe much if not most of my pain is from this with less coming from the weird feeling of my intestines being a little "loose" and stirred around and some from the incisions themselves.

Found during surgery:
Could not find exit hole from uterus
Uterus points off to right and down so they would not recommend another IUD being placed without sonogram to watch that it is going on the correct place.

RECOMMENDATIONS:
- CHECK YOUR OWN IUD I know some Dr's recommend against it, I do not, my Dr does not. It's YOUR body and you should know what's going on not just have to "trust" the Dr (and yes I plan to be one in the near future). Learn how to check for your cervix if you don't know. Don't be afraid to ask for it to be checked by the Dr if you can't find it and then if they find it, have them show you how. They were amazed I caught it so early and it made surgery much easier because it hadn't adhered to the colon which makes it more tricky to remove.

- Have the first one placed with a sonogram. There are those few women who's uterus is pointing in strange directions and they are more at risk for perforation. I didn't know until it was too late. In my life I'm all about minimizing risk when possible and this is an easy way to minimize risk.

- My Dr agrees with this one and it was her idea: Only have an experienced provider place the IUD if you are NP. They can tell because of experience whether its puncturing the side or not.

Otherwise enjoy your new IUD!!! I will not be getting one any time soon, I have too much to do to risk anything else. I have an MCAT to take in a few weeks and all my classes are sitting at incomplete.