Total colectomy or proctocolectomy - discharge

What to Expect at Home

If your rectum or anus remains, you may still have the feeling that you need to move your bowels. You may also leak stool during the first few weeks.

If your rectum has been removed, you may feel the stitches in this area. It may feel tender when you sit.

You will probably have pain when you cough, sneeze, and make sudden movements. This will last for 1 to 5 days.

Self-care

Activity:

• Do not lift anything heavier than a gallon of milk (about 10 pounds) for the first 6 weeks.
• You may take short walks and going up and down stairs is okay. 
• Increase your exercise slowly. Don't push yourself too hard.

Your doctor will give you pain medicines to take at home.

• If you are taking pain pills 3 or 4 times a day, take them at the same times for 3 to 4 days. They may control pain better this way.
• Do not drive or use other heavy machines if you are taking narcotic pain medicines. These medicines may make you drowsy and slow your reaction time.
• Try getting up and moving around if you are having some pain in your belly.

Press a pillow over your incision when you need to cough or sneeze. This may ease pain. Ask your doctor when you should begin taking your regular medicines again after surgery.

Wound Care

You may have Steri-Strips (small pieces of tape) placed across your surgical incision after your staples are taken out.

Take sponge baths for the first 2 days after your staples are removed. You may shower after that. Ask your doctor or nurse when you can soak in a bathtub.

• It is okay if the Steri-Strips get wet. But do not soak or scrub them or let the shower spray land directly on them.
• Keep your wound dry at all other times.
• The Steri-Strips will curl up and fall off on their own after a week.

Your doctor will tell you how often to change your dressing.

• Your doctor will tell you when to start cleaning your wound with soap and water every day. When you do this, look carefully for any changes to the wound.
• Pat your wound dry. Do not rub it dry.
• Do not put any lotion, cream, or herbal remedy on your wound before asking your doctor if is okay.

Do not wear tight clothing that rubs against the site of the surgery while it is healing. Use thin gauze over the wound to protect it, if needed.

If you have a colostomy, follow your doctor’s care instructions.

Sitting on a pillow may help with pain if the surgery was in your rectum.

Diet

Eat small amounts of food 5 to 8 times a day. Do not eat 3 big meals.

• Space out your small meals. Wait the same amount of time between each one.
• Add new foods back into your diet slowly--one or two at a time.
• Try to eat plenty of protein.

Some foods may cause gas, loose stools, or constipation as you recover. Avoid foods that cause problems.

If you become sick to your stomach or have diarrhea, avoid solid foods and drinking only clear fluids and for a little while. Call your doctor.

Call your doctor if you have severe diarrhea.

Drink plenty of water or fruit juice to keep enough fluid in your body.

Returning to Work

Return to work only when you feel ready to. These tips may help:

• You may be ready when you can be active around the house for 8 hours and still feel okay when you wake up the next morning.
• You may want to start back part-time and on light duty at first.
• Your doctor can write a letter to limit your work activities if you do heavy labor.

When to Call the Doctor

Call your doctor if:

• You have a fever over 101 °F, or a fever that does not go away with acetaminophen(Tylenol).
• Your belly is swollen.
• You feel sick to your stomach. Or, you are throwing up a lot and cannot keep food down.
• You have not had a bowel movement 4 days after leaving the hospital.
• You have been having bowel movements, and they suddenly stop.
• You have black or tarry stools, or there is blood in your stools.
• You are having belly pain that is getting worse, and pain medicines are not helping.
• Your colostomy has stopped putting out any water or stools for a few days.
• Your abdomen gets swollen and you are throwing up.
• There are changes in your surgery:
  • The edges are pulling apart
  • Green or yellow drainage is coming from it.
  • It is redder, warm, swelling, or more painful.
  • Your bandage is soaked with blood.
• You are short of breath or are having chest pain.
• Your legs are swelling.
• You have pain in your calves.
• You have increased drainage from your rectum.
• You have a feeling of heaviness in your rectal area.

Alternate Names

End ileostomy - colectomy or proctolectomy - discharge; Continent ileostomy - discharge; Ostomy - colectomy or proctolectomy - discharge; Restorative proctocolectomy - discharge; Ileal-anal resection - discharge; Ileal-anal pouch - discharge; J-pouch - discharge; S-pouch - discharge; Pelvic pouch - discharge; Ileal-anal anastomosis - discharge; Ileal-anal pouch - discharge; Ileal pouch - anal anastomosis - discharge; IPAA- discharge; Ileal-anal reservoir surgery - discharge

References

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Coln and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 52.

Update Date: 12/10/2012

Updated by: Robert A. Cowles, MD, Associate Professor of Surgery, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.