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Patient Instructions

You had surgery to remove your large intestine. Your anus and rectum also may have been removed. You also may have had an ileostomy.

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.

Activity:

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

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

• If you are taking pain pills 3 or 4 times a day, try taking them at the same times for 3 to 4 days. They may be more effective this way.
• Do not drive or use other mechanical equipment 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. Ask your doctor when you should begin taking the medicines you stopped taking before surgery.

See also: Ileostomy - discharge

If your staples have been removed, you will probably have Steri-Strips (small pieces of tape) placed across your surgical incision.

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 beat 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 and when you may stop using one.

• 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.

See also: Surgical wound care

Do not wear tight clothing that rubs against the incision 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.

If you have a rectal incision, sitting on a pillow may help.

Eat small amounts of food 5 to 8 times a day, instead of 3 big meals.

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

Some foods may cause gas, loose stools, or constipation when you are recovering. Avoid the foods that cause these problems.

If you become sick to your stomach or have diarrhea, try only drinking clear fluids and not eating for a little while. Call your doctor.

To keep from getting dehydrated (not having enough fluid in your body), keep drinks such as sports drinks on hand.

If you have hard stools:

• Try to get up and walk around more. Being more active can help.
• If you can, take less of some of the pain relievers your doctor gave you. They can make you constipated.
• You may use stool softeners if your doctor tells you it is okay.
• Ask your doctor or nurse whether you can take milk of magnesia or magnesium citrate. Do not take other laxatives without asking your doctor first.
• Ask your doctor if it is okay to eat foods that contain a lot of fiber or take psyllium (Metamucil).

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

• You are probably 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 normally do heavy labor.

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. You 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 to ease your pain.
• There are changes in your incision:
  • 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 increased drainage from your rectum.
• You have a feeling of heaviness in your rectal area.

End ileostomy - discharge; Continental ileostomy - discharge; Ostomy – 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

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. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

Updated by: Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.