RETURNING HOME FOLLOWING BOWEL SURGERY Information Leaflet Your Health. Our Priority. www.stockport.nhs.uk Surgery and Critical Care | Stepping Hill Hospital Page 2 of 8 When will I be discharged home? If your bowel surgery has been performed as an emergency the length of time it takes to recover in hospital may vary, most patients are discharged home between 5 to 10 days after their surgery. Patients who have elective surgery can be discharged between 4 to 10 days. You will not be discharged until your pain is managed comfortably with oral pain killers, you are managing to eat and drink and you have passed flatus (or wind). You may be discharged home before your bowels have opened. You will also be assessed to make sure your mobility is back to the level it was prior to your hospital admission. If you have a stoma: Whether you have a permanent or temporary stoma, you will need to be managing this independently before you are discharged. The Stoma Nurse Specialist will visit you at regular intervals throughout your stay to give you support and help you manage your stoma care. The ward nurses are also there to help and support you caring for your stoma. This is to enable you to feel confident and ready to manage it independently at home. What happens when I return home? Complications do not happen very often, but it is important that you know what to look out for. During the first two weeks after surgery, if you are worried about any of the following, please phone the telephone numbers at the end of this leaflet. If you cannot contact the people listed, then ring your GP. Abdominal pain It is not unusual to experience griping pains (colic) during the first week or two following major bowel surgery. The pain usually lasts for a few minutes and will come and go away in spasms. If the pain becomes severe and lasts for several hours it may indicate a problem such as a leakage of fluid from the area where the bowel was joined together. This can be a serious complication that can occur within the first two weeks after surgery. This happens only very rarely (3-5% of all major bowel operations). This risk can be higher in patients with other conditions such as, diabetes, pre-existing heart disease and those with inflammatory bowel disease for instance, Crohns disease. Should this occur, it may be accompanied by a fever and sweating. You should contact us on the telephone numbers provided. Passing urine Sometimes after bowel surgery you may experience a feeling that your bladder is not emptying fully, especially after the catheter is removed after the operation. This usually improves with time. If it does not, or if you have excessive stinging when passing urine, please contact us or you GP as you may have an infection. Wound care/infections Depending on the surgical approach, the wounds on the abdomen are closed differently. For open surgery the wound is often large and runs down the middle of the abdomen, this is generally closed with clips which are removed approximately 10 days after surgery. For laparoscopic surgery, keyhole sites and/or smaller wounds running down the middle of the abdomen are often closed using ‘skin glue’. In this instance the skin glue dries and falls off naturally over time. In either situation stitches maybe used, some are dissolvable and some require removal approximately 10 days following surgery. www.stockport.nhs.uk Surgery and Critical Care | Stepping Hill Hospital Page 3 of 8 If you are discharged prior to the clips/sutures being removed or in some cases, your wound may have partially broken down and is being managed with dressings only, the ward nursing staff will assess the wound, advise on the type of clips/stitches and dressings which have been used and depending on your individual situation refer you to the district nurses, either at home or your GP surgery, to remove these on their first visit or provide daily dressing changes. It is not unusual for your wounds to be slightly uncomfortable during the first one to two weeks. Please let us know if your wound becomes inflamed, painful or swollen, or starts to discharge fluid. If your wounds have healed continue to shower and bath as normal and pat dry your wounds. Bowel habit Your bowel habit may change after the removal of part of the bowel and may become loose or constipated or alternate in bouts from one to another, particularly in the first few weeks after surgery. The effect of your surgery on your bowel function will be dependent on the type of surgery you have had. The advice in this leaflet is general so please contact your Colorectal Nurse Specialist and they can provide you with a leaflet tailored to your specific health needs. Right Sided Surgery one of the functions on the large bowel or colon is to absorb the liquid or water from the stools. It can take time for the body to readjust to a section of the bowel being removed and you may find you initially have loose stools. If this is more than three to four times a day then we may advise taking medication such as Loperamide or Codeine Phosphate. Please contact us for advice and guidance. Reduced colon length to absorb water – can cause loose stools/diarrhoea As we are removing a length of colon and rectum, so we will reduce the amount of colon that can pull water out of the liquid stool to bulk it up. This means that you may find your stool is very loose or watery. This can sometimes lead to leakage of stool from your bottom (incontinence). Left Sided Surgery If you have had surgery on the left side of your bowel then it may take a while for your bowel habit to settle down to a more established ‘new normal’ pattern. However, it is likely that your bowel habit long term will never quite be as it was before your surgery. Or Total Colectomy A small number of patient may have had all their colon removed and may only have their rectum remaining. These patients will have altered bowel function and specialist advice and information leaflets tailored to their need are available from the Colorectal Nurse Specialists. The surgery to remove your tumour can alter a number of things: Reduced storage capacity of rectum - can cause urgency to go and www.stockport.nhs.uk Surgery and Critical Care | Stepping Hill Hospital Page 4 of 8 frequency of visits The storage capacity of your rectum may be less and not able to hold as much stool as it did before the surgery. This may cause a feeling or urgency (when you have to rush, as you cannot hold on for long) and may mean that you need to go more often. This can sometimes lead to leakage of stool from your bottom (incontinence). We have joined the remaining rectum with the colon with extremely strong staples and this may cause a feeling of something being ‘stuck’ inside your rectum or you may have the feeling that you are not completely empty when you have opened your bowels. This will usually improve over time. You may also, at the beginning, find it difficult to distinguish between stool and wind being in the rectum and may have some difficulty in holding onto wind. This will also usually improve over time. It is important to remember that the changes to your bowel function after surgery are normal and should improve over the 12 week period following your discharge from hospital. if you feel that you are not coping or managing these changes please contact your Colorectal Nurses for help and advice. Is there any special diet I should have? After having an operation on your bowel there are no dietary restrictions on what you can eat and drink including alcohol in moderation. However, it is important to continue to eat a wellbalanced, varied diet of fruit, vegetables and whole wheat cereals and bread. Introducing more protein such as, meat, chicken, fish and dairy products, will help your recovery and aid tissue repair following surgery. If you are finding it difficult to eat you may benefit from taking high calorie drinks such as Build up or Complan (available in supermarkets and chemists) to supplement your food. If you are suffering from diarrhoea then it is important to replace the fluid loss and to drink extra fluids. The non-fizzy sports drinks such as Lucozade Sport are very useful in these circumstances. Can I exercise? We encourage activity from day one following surgery. You should plan to undertake regular exercise several times a day and gradually increase during the four weeks following your surgery until you are back to your normal level of activity. The main restriction we would place on exercise is that you do not undertake heavy lifting until six weeks following your surgery as it usually takes this amount of time for the deeper muscle layers of the wound to heal. This includes carrying heavy shopping, doing housework like vacuuming. In addition, if you are planning to restart a routine exercise such as jogging or swimming that you wait until at least four weeks after discharge and start gradually. It is recognised that you are likely to have times when you feel tired and need to rest; it is advised to rest on your bed free from distractions. www.stockport.nhs.uk Surgery and Critical Care | Stepping Hill Hospital Page 5 of 8 Common sense will guide your exercise and rehabilitation. In general, if the wound is still uncomfortable, modify your exercise. Once the wounds are pain free you can normally undertake most activities. When can I return to work? Many people are able to return to work within four to six weeks following their operation. If your job is a heavy manual job then take advice from the medical staff about when to return to work. If your surgery has been performed for cancer then further treatment such as chemotherapy may be required, if this is so please contact the Colorectal Nurse Specialist team for advice regarding return to work. Contact number available at the end of this leaflet. If you are in any doubt about returning to work please discuss it with your surgeon or GP. Sick notes can be obtained from the ward nursing staff to cover your stay in hospital and from your GP for the rest of your time off work. When can I drive again? You should not drive until you are confident that you can drive safely. Once you have got back to most of your normal activities you should be able to drive. However, we recommend that before you drive for the first time, sit in the driver’s seat and hit the brake pedal hard as if you are performing an emergency stop. If you get any abdominal pain when performing this then do not drive. It is important that any pain has resolved sufficiently to enable you to perform an emergency stop and turn the wheel quickly in an emergency. You may also find it helpful to drive short distances to start with and to have a companion with you when you first go driving again. It is advisable to contact your insurance company before you start driving again. For patients who have had a stoma (colostomy/ileostomy) formed: Having a stoma does not exempt you from wearing a seat belt. You are strongly advised to continue wearing a seat belt to prevent injury. When can I begin sexual relations again? 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 your 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 in maintaining an erection. In women, discomfort or vaginal dryness may occur. If you have a perineal wound it may take longer to feel more comfortable. These problems are usually temporary, due to inflammation and swelling after surgery, but in some instances may be permanent. If you do experience any problems of this nature please discuss this with your Surgeon or Colorectal Nurse Specialist as specialist help is available. www.stockport.nhs.uk Surgery and Critical Care | Stepping Hill Hospital Page 6 of 8 When can I go on holiday? There is no reason why you should not go on holiday but wait until you have your post-operative appointment, which is approximately 6 weeks after you go home. Patients that need to have additional treatment, for instance chemotherapy, please seek advice from your Colorectal Nurse Specialist. Follow up An appointment for follow up clinic will be arranged for you. You will be notified by post and this usually takes place 6 weeks post operatively. However, if you are awaiting results then an earlier appointment (a minimum of 2 weeks) will be given to you and you will be informed of this usually by telephone and/or via mail. For patients who have had a stoma formed: The Stoma Care Sister will also arrange to visit you approximately 24 – 48 hours after you leave the hospital (this does not include weekends) to see how you are coping and to give advice and support. We hope that after your operation you will not have any problems. Contact us After you go home from hospital you may continue to feel tired but you should feel progressively better every day. This means that your appetite should improve, your pain level should go down and you should be able to slowly increase your daily activity. If you are not making progress towards what is normal for you, or you feel unwell or anxious, please do not hesitate to contact the ward where you were an in-patient. Other numbers provided below can be used for advice and support. In an emergency you may be asked to come to the Surgical Admissions Unit for assessment. Ward B6 0161 419 5942 or 0161 419 5259 Ward B3 0161 419 5936 or 0161 419 5233 Ward C6 0161 419 5953 or 0161 419 3062 Colorectal Cancer Nurse Specialists www.stockport.nhs.uk Doreen Dooley, Jill Taylor, Rebecca Costello 24 hour answer phone: 0161 419 4088 Pager through switch: 0161 483 1010 Surgery and Critical Care | Stepping Hill Hospital Page 7 of 8 Stoma Care Nurse Specialist Jean Sellars, Caroline Dowson, Janet Land 24 hour answer phone: 0161 419 5052 0161 419 5059 Contact via switchboard: 0161 483 1010 Consultant Surgeons Mr M Saeed Secretary: 0161 419 4267 Mr E Clark Secretary: 0161 419 2028 Mr S Rai Secretary: 0161 419 4268 Mr F Reid Secretary: 0161 419 4275 Mr M Marsden Secretary: 0161 419 4265 Dr Hasan Secretary: 0161 419 4233 www.stockport.nhs.uk Surgery and Critical Care | Stepping Hill Hospital Page 8 of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number Publication date Review date Department Location www.stockport.nhs.uk SUR24 March 2015 March 2017 Surgery and Critical Care Stepping Hill Hospital Surgery and Critical Care | Stepping Hill Hospital
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