Colon operations need to be done for many different reasons, sometimes for benign diseases and sometimes for cancer. The operations themselves are very similar, but the work-up and follow up may be quite different. Most colon surgery is done as an elective procedure and you will stay in the hospital for 3-5 days after the operation. Sometimes emergency colon surgery is needed, usually if there is a perforation, or hole, in the colon, for severe bleeding from the colon or severe infection. For these types of surgery, recovery time is usually longer and other problems like infection and injury to other body systems is more common.
Preoperative Information
Prior to colon surgery, you will be asked not to eat or drink anything after midnight prior to your surgery. You will be given specific instructions from your surgeon or anesthesiologist about which medications you should or should not take prior to your surgery. You should not take any blood thinning medications at least 5 days prior to your operation. This should be discussed with your surgeon at your preop visit.
You may be prescribed a bowel prep in order to clean the stool from your colon before surgery. There are several different types of bowel prep and this is not always needed, depending on the exact operation you are having and the preference of your surgeon. If you are given a bowel prep, it is very important you take the full prep as directed. If you are having difficulty with the bowel prep, you should inform your surgeon.
Postoperative Information
Your recovery will vary depending on the type of colon operation you have and the disease you have. Elective operations are often done laparoscopically and your hospital stay may be as little as 2-3 days. Urgent or emergency operations are sometimes needed, which are more likely to have a longer recovery time and are a higher risk for developing other complications.
Activity
You can resume most usual activities gradually beginning shortly after surgery. You
should begin walking the night of surgery or the following morning and continue to
increase as you are able. Increased activity reduces the risk of blood clots, and
improves breathing to prevent pneumonia.
While in the hospital, you will be asked to walk several times a day, beginning no later than the morning after surgery in most cases. You will usually need assistance to get out of bed, especially the first time, since you will likely have IV tubing and sometimes drains or catheters that need to be disconnected in order for you to get around. A Physical Therapist often helps you get out of bed and regain your strength after major surgery. Walkers, canes or crutches will be made available as needed. In some cases a short stay in a rehabilitation center or short-term nursing home may be needed. This is uncommon and usually only needed for people who had to have emergency operations or had some other complications and a long hospital stay.
After discharge from the hospital, avoid lifting more than 10 pounds for 4 weeks and excessive bending or twisting for 1-2 weeks following surgery. This is to allow healing of the incisions, specifically the fascia (the strongest layer of the abdomen wall) and decrease the risk of a hernia developing. For laparoscopic colon surgery there may be less risk for developing a hernia and it may be safe to return to unrestricted activity sooner.
If you had an open colon operation, you may be given a binder to wear around your abdomen. This helps to support the area of your incision closure and may help decrease pain from any sudden movements. The binder should be worn during activity, but can be taken off at night. If the binder is irritating to your skin or causes itching, placing the binder over another T-shirt may help.
Avoid driving until you no longer need narcotic pain medication. Driving while taking them can impair your ability to drive safely.
You should be able to return to work in 2-4 weeks, depending on the operation you had and whether or not you need additional treatment or rehabilitation. If your job involves heavy lifting and light duty is not an option, you may need up to 4 weeks off work to recover.
Wound Care, Drain Care, Ostomy Care
If your colon operation was done laparoscopically, small gauze and clear tape dressings
or a small white dressing is typically placed over each incision. These dressings
can be removed 48 hrs (2 days) after the operation. These will probably be removed
before you leave the hospital. Below this dressing are small brown or white pieces
of tape (called Steri-Strips); these will fall off on their own within 1-2 weeks or
be removed at your follow-up visit with your surgeon. If your surgeon gives you specific
instructions other than this, please follow those instructions.
If your colon operation was done open, you will probably have a long white dressing or gauze and tape dressing over your incision. This dressing can be removed 48 hrs (2 days) after the operation and will probably be removed before you leave the hospital. Your incision will probably be closed with small metal staples. These will be removed at your postop visit, usually 10-14 days after your operation. If you are in the hospital more than a week, these may be removed before you go home.
For some colon operations it is necessary for a portion of the skin incision to be
left open to decrease the risk of infection. Having a colon operation can increase
your risk of infection as well, which often requires the incision to be opened. In
this case, a damp gauze dressing is placed in the wound and will need to be changed
2-3 times a day. While in the hospital, this dressing change will be done by your
surgical team or nursing staff. You and your family will be given instructions on
how to perform dressing changes before going home. Incisions that need to be treated
this way usually take 2-4 weeks to completely heal, depending on the size of the wound.
In some cases, you may qualify for assistance from a nurse who will come to your home
to help supervise these dressing changes. You may be seen by a specialized wound care
nurse who will help educate you on wound care.
Click here for more information on dressings.
If your colon operation required creation of an ostomy, you will see a specialized nurse (call a stoma therapist) during your hospital stay. They will help you to understand how to use the appliances and bags needed to control your stool output from the ostomy and be able to provide you with the necessary supplies. Many ostomies are reversible, meaning your colon may be able to be put back together to get rid of the ostomy. Talk to your surgeon about the risk of getting an ostomy prior to elective operations. If you had an emergency operation that required an ostomy, talk to your surgeon about the possibility of closing the ostomy.
You may shower after 48hrs (after the gauze and clear tape dressing is removed). It is okay to get soap and water on the incisions. Pat the area dry. You will be able to shower in the hospital after 48hrs as well. Your nursing staff can assist you if needed. It is not recommend that you submerge underwater (in a bathtub, pool, or hot-tub) for at least 2-3 weeks post-op. Even if you have an open wound that needs dressing changes, you can still shower normally. Simple remove the dressings, let soap and water run through the wound, pat the area dry and reapply the dressing afterwards.
If you notice drainage from your incisions, particularly if it is thick and foul-smelling or associated with a fever, you should contact your surgeon.
If you notice redness around your incisions, especially if it is getting worse or associated with drainage or a fever, you should contact your surgeon.
Medications - Pain Management
Pain after a large open colon operation can be significant. You will probably be placed
on a device that provides pain medication to you whenever you press a demand button
(called a PCA, or Patient Controlled Analgesia). Once you are able to start taking
an oral diet, the PCA will be weaned off and you will be started on oral pain medications.
It is very important to us that your pain be well controlled. Your pain should be
controlled well enough for you to begin getting out of bed the morning after surgery
and for you to perform deep breathing exercises. If you have pain that is not well
enough controlled to allow you to walk or breathe deeply, talk to your surgery team.
You may need to have your pain medications changed or increased.
If your colon operation is performed laparoscopically, pain is typically just around the site of incisions. However, you may have more general abdominal pain or even shoulder pain due to the air used to inflate your abdomen during the surgery. Pain from air inflation will go away in 24 to 48 hours.
You will be discharged with pain medication, typically a mild to moderate strength narcotic. Take as needed and as prescribed. You may also take over-the-counter medications such as advil for pain. Most narcotic medications prescribed are combined with Tylenol (acetaminophen) and you should not take additional Tylenol if you are taking a narcotic medication that already contains Tylenol.
Other Medications
You will likely be prescribed a stool softener when you go home. Pain medications
can cause constipation and a stool softener may help. You may also be given nausea
medication if you have experience nausea or vomiting from taking your pain medication.
Home Medications
Unless otherwise instructed, you should be able to resume your usual home medications
the night of or the morning following your surgery.
Click here for more detailed information on commonly prescribed medications.
Diet & Bowel Care
You may resume your usual diet as you feel able unless otherwise instructed. You may
have some abdominal bloating or mild nausea after your operation, so eat slowly and
only what you can tolerate. Your appetite may be less than usual but typically returns
to normal within a week or two. Be sure to drink plenty of liquids (6-8 glasses of
water or juice each day).
If all or most of your colon is removed you will likely have multiple, loose stools daily (up to 6 or 10) initially. This will usually improve as your intestine adapts. You may find certain foods will be much harder to tolerate than before and cause urgent diarrhea. If this does not improve within the first few weeks after surgery, you may need to take medication to slow the flow of stool through your intestine and improve digestion. The most important thing is to drink enough fluids to avoid getting dehydrated and to keep yourself clean. Taking a shower or using Sitz baths (warm soapy water to clean the anus) after bowel movements while limiting the amount of paper used can help keep the area clean and prevent skin irritation.
If your surgery required creation of an ileostomy you may have too much liquid stool output. If your ileostomy puts out more than a liter (about a quart) a day, you may need medications to help control this in order to prevent dehydration.
It is common to have some constipation after surgery, especially when taking narcotic pain medications. You will probably be prescribed a stool softener when you are discharged. If you are having trouble moving your bowels after surgery (if your stool is hard or you have to strain excessively) you may need a laxative. If you do feel like you need a laxative after having colon surgery, you should call your doctor before taking any over the counter medications. If your doctor says it is OK to take a laxative, over the counter medications can treat this well. Senna, Miralax, or dulcolax are some of the most common and are available at most drug stores or grocery stores. Take as directed.
If you are having trouble having a bowel movement AND have abdominal bloating, nausea
or vomiting, and not passing gas, you should call your doctor.
You may notice blood in your stool during the first few bowel movements following
colon surgery. This usually is caused by small amount of bleeding at any site where
your intestine had to be divided and put back together (called an anastomosis). It
usually looks like thick clots or blood mixed in with the stool. This will often look
like bright red blood once in the toilet bowl. If there is a large amount of blood,
if the bleeding persists, or if you have any light-headedness or dizziness, you should
call your doctor.
Follow Up
You will be given a date and time to see your surgeon following surgery, usually in
10 days to 3 weeks. If you are discharged late in the day or over the weekend, you
will be given a number to call the following business day for an appointment. If you
are having trouble making an appointment, you should call your doctors' office directly
for assistance.
If your colon operation was for cancer, you will likely need to see other doctors for continued care. Oncologists are medical doctors who specialize in the non-surgical treatment of cancer. If you need chemotherapy or radiation therapy before or after surgery, they will be the team that coordinates and administers that care. Ask your surgeon or Oncologists about clinical trials that you may qualify for in the treatment of your cancer.
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Contact Information
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After hours and weekends: Call 706-721-8400