Advice Following Bowel Surgery
The Colorectal Nurse Specialist has given this booklet to you; we hope it will be helpful on your discharge home from hospital.
The Colorectal Nurse Specialist will also telephone you after you have been home for a few days to check that you are managing and answer any questions you may have.
Following discharge from hospital, after bowel surgery, it is normal to experience some abdominal discomfort from either the wound or windy pain from the bowel itself. This will gradually improve over several weeks. You should continue taking the pain relieving drugs, which have been prescribed for you at the hospital, until you feel comfortable. If you need further supplies or your pain is not adequately controlled or your pain is getting worse you should see your GP.
Simple measures such as supporting your abdomen with a cushion when coughing or whilst wearing a seat belt will avoid putting strain on your wound and make you more comfortable.
You may have had your staples/stitches removed before you were discharged home from hospital. If your staples/stitches are still in place, the nursing staff on the ward will refer you to your District Nurse or Practice Nurse who will remove these 7-12 days following surgery. In some patients the would is closed with stitches under the skin which dissolve away on their own. The would will be covered with paper steri-strips, which you should leave in place until they fall off on their own.
If your would has not completely healed and there is a dressing in place, you must keep this clean and dry to reduce the risk of infection. The District/Practice Nurse will advise you further.
You will have some bruising from the operation but the can vary in degree (red and blue turning yellow). Do not be alarmed as this is quite normal and it will improve over time.
If your would becomes red, inflamed, and painful or has any discharge from it, this could indicate an infection. You should contact the GP/Practice Nurse who will be able to recommend the appropriate treatment.
Eating and Drinking
It may take a while before you get your normal appetite back. Instead of eating three meals a day it may be easier to have small and more frequent meals as you did whilst in hospital (see Enhanced Recovery Programme leaflet). After having an operation on your bowel, you should aim to gradually return to a normal balanced diet, including fruit, vegetables, whole-wheat cereals and bread, in order to maintain a healthy lifestyle.
Some people notice that certain foods upset the normal action of their bowel. Fruit and vegetables may give you loose stools, increased wind and bloating, this is usually temporary, and if it affects you, it may be sensible to start on foods which are low in fibre, gradually increasing your fibre intake over the next few weeks. There are no set rules on which types of foods to avoid – everybody is different!
Following bowel surgery your bowel habit may continue to be unpredictable. You may find that your bowel motion is looser, more frequent and/or urgent. It is important to drink plenty of fluids if you have diarrhoea to prevent dehydration. Occasionally people may experience constipation. It is normal to expect a lot of wind, sometimes associated with abdominal discomfort. This will gradually settle down over 2-3 months, although some people find that their bowel function never returns to its previous pattern.
Bowel problems often improve by simple measures such as looking at what you eat. Once again, you should speak to your Surgeon, GP, or Colorectal Nurse Specialist, who will be able to advise on diet and medication available to control these symptoms.
Bowel obstruction – following surgery, adhesions (scar tissue) form in the abdomen, which may cause a blockage to the bowel. If this occurs you may experience severe windy pain with an inability to pass wind or stool, abdominal bloating and vomiting. You should contact your GP or the emergency doctor for advice if the symptoms do not settle within a few hours.
Excessive wind or bloating – you should reduce the amount of fibre for a week or so and then try re-introducing a single item of high fibre food at a time. Fizzy drinks will cause more wind so are best avoided. Alcohol is fine in moderation, but beer and lager can produce wind.
Rest and Exercise
It is normal to feel tired and weak for up to three months after major surgery. This will gradually improve and you will become stronger each day. It is important that you rest when needed, however, this does not mean that you should confine yourself to bed.
Good nutrition in the form of a well balanced diet is essential. Having sufficient food and fluids to drink will help to keep your energy levels up and prevent feelings of weakness.
You should avoid heavy lifting, for example only do the equivalent of light housework. Start by taking a gentle walk each day, perhaps around the house or garden and gradually increase as you feel able. Remember it is best to take rest periods when needed. Short frequent periods of activity help you to avoid over exertion.
If you normally take part in sport or exercise, you will probably be able to start these after your follow up appointment with you Surgeon. You can discuss whether you are fit enough to start participating in sport or more vigorous exercise. Most people will have returned to their normal level of fitness 3 months after their surgery.
If your wound has healed you can shower and bathe as normal, but make sure you can get in and out of the bath safely. If you anticipate and problems the Occupational Therapist at the hospital will be able to advise you on the availability of bathing aids.
You should wait at least 2 weeks before starting to drive again. This will depend on your ability to perform an emergency stop without causing discomfort to your abdomen and how comfortable it is to wear a seat belt. It is advisable to check your insurance policy to ensure you are covered after you have had an operation.
Feeling tired and weak after an operation or illness naturally affects your sex drive. As you gradually start to feel well again and your energy levels return to normal so should you sex drive. It is important for you and your partner to discuss your feelings openly.
Sexual intercourse can be resumed as soon as you feel comfortable, generally about 2-4 weeks after surgery. Occasionally, following surgery or radiotherapy to the rectum or lower colon, nerve and blood vessel damage can occur. In men this may cause ejaculatory problems or result in difficulty and/or maintaining an erection. In women, discomfort or vaginal dryness may occur.
These problems are usually temporary, due to inflammation and swelling after surgery, but in some instances may be permanent. If you do experience problems of this mature, please discuss it with your Surgeon or Colorectal Nurse Specialist, as specialist help is available.
Returning to Work
It is advisable to take a minimum of 2-4 weeks off work. The nature of your occupation and the surgery you have had performed will determine how soon you can return to work. It may be wise to go back part time until you have regained your strength. At your follow up appointment with your Surgeon you can discuss when you are going to be fit enough to return to work.
It is safe for you to travel abroad when you feel ready, but it is advisable to wait to be seen for your follow up appointment with your Surgeon.
When applying to travel abroad you should be sure you are not travelling against medical advice; you may require a letter from your GP. It is best to check the insurance policy for ‘pre-existing medical conditions,’ which need to be declared for the policy to be valid.
You will be seen in the outpatient department of the hospital 6-weeks (or earlier) after your surgery. Any outstanding results will be discussed with you at this time. If you have had your operation for cancer you will be referred to an Oncologist (cancer specialist), they will then discuss with you any further treatment that may be necessary.
Who Can Help?
During your hospital stay you will have met the Colorectal Nurse Specialist who is available to provide information and give support to you and you family. Please remember that following your discharge home from hospital the Colorectal Nurse Specialist is still available to support you. If at any point you have any queries or concerns please telephone them.
The Colorectal Nurse Specialist can be contacted Monday – Friday 8.00-4.00 on 020 8321 5892.
Additional Support Available
0808 800 1234
National Association Crohns & Ulcerative Colitis
Beating Bowel Cancer
020 8892 5256
British Colostomy Association
0800 328 4257
The Mulberry Centre
020 8321 6300
Ileostomy and Internal Pouch Support Group
0800 018 4724