Postoperative Advice

You’ll find the advice I usually give to the patients for the period immediately after the surgery here. This is what we normally discuss on the day, right before discharge. There may be times when I will not be able to be there in person because of prolonged subsequent surgeries. These are general recommendations. There may be individual variations. If you are worried or increasingly feeling worse, please do not hesitate to contact me or A&E. We usually meet for a review roughly 3 weeks after the surgery. Natalie will arrange it.

Please select the type of procedure you had

Can eat and drink as normal. Avoid heavy lifting or any other strenuous activity that increases the abdominal pressure for 3 weeks. But stay active with light exercises, like walking. The rule of thumb is that anything that comes with straining that makes the face go red, don’t do it. You can gradually resume activities to reach full speed by the end of the next 3 weeks. Bruising is possible. As long as there is no major pain or increasing lump, all acceptable. Take the dressing off (if there is any) after a few days. If the wound is clear and dry no further dressing is necessary. If in doubt, contact me or A&E

Gradually go back to normal diet. Gradually introduce food in your diet that you weren’t able to eat before. Be active. Normal exercise will not hurt the insides. Minor pains, nausea are acceptable initially. As long as the symptoms keep improving, all good. If you keep feeling worse for whatever reason, contact me or A&E

Normal diet and activities can be immediately resumed. The dressing (if there is any) can be removed a day or two after the procedure. If the wound is dry, no further dressing is necessary.

Hernia and general surgery

Proctology

Any surgery that we do on the anus, haemorrhoid (piles), fistula or fissure treatment, that leaves an open wound on the anus, will come with increased pain after surgery. That usually lasts for 7-10 days. It is most intense after opening your bowel. For the same reason it is advised you take your painkillers half an hour before planning to go to the toilet.

There is usually a haemostatic sponge left in the Anus that will fall out either spontaneously or with the first bowel movement. It is not painful when it happens.

It is also best if you keep cleaning the Anus with water at least 3 times a day, including after every bowel movement. Use minimal amount of toilet paper. The most ideal tool is a bidet but in the lack of that (not many houses have one) you can use sitz bath, or the shower either in the shower cabin or by sitting on the edge of the bath tub. A few days later you can start using gentle soap or shower gel.

Keep taking the painkillers as needed, the Antibiotics (Metronidazole) and the laxatives (Lactulose or Movicol) to avoid constipation that can happen simply because of the fear of pain during defecation. Constipation will lead to a larger, harder stool eventually that will hurt more.

You do not need to use any special dressing. You can keep a simple pad in the underwear for protection. Not protecting the wound, but the underwear. The initially blood stained mucusy discharge will clear up slow down significantly in the first week.

This should be a relatively painless procedure, unless part of the fistula was laid open, in which case please see the above section. You can resume all normal activities immediately.

You will be given advice at discharge regarding the management of the wound. There may be two possibilities
1. You only have small wounds that only need you to keep it clean with regular washes with water and soap or shower gel. twice daily recommended.
2. You have a larger, open wound that requires regular dressing initially. Usually the Family Nursing service will come and see you for that. The ward nurses will arrange that for you before discharge.

Normal activities and diet can be resumed immediately, except if you had sedation. In that case driving and legal decision making is not recommended for 24 hours.

Colonoscopy or Gastroscopy

Colorectal surgery

After discharge from the hospital keep a light diet and just gradually build up to full. Possibly over the course of a week or 10 days. Drink plenty of fluids, preferably water, but tea and coffee are fine. It is possible to drink alcoholic drinks too in moderation. Stay active. Do light, 20 minutes exercises like walking at least twice a day. You will be advised and taught how to use the injections daily to prevent Deep Vein Thrombosis (DVT). Please do not forget to do it for 28 days after discharge. The Colorectal Nurses will be in touch regularly, but if there is any worsening in your general condition (tummy pain, spasms, vomiting, fever, significant bleeding from the back passage) please contact me, the colorectal nurses or A&E!

The Colorectal Nurses should have taught you how to manage the bag and the stoma. Accidents unfortunately can happen, please be patient with yourself. You will get better at it very quickly.

It is important to remember that you loose salt with your ileostomy that you need to replace, otherwise you will be dehydrated even if it looks like you drink enough water. You will loose most of it if there is not enough salt in your system. It is therefore best if you take a flat teaspoonful of table salt with your diet every day. The way you take it doesn’t matter. You can spread it out throughout the day. This has to be extra, above the amount that you usually take to season your food.

The Colorectal Nurses should have taught you how to manage the bag and the stoma. Accidents unfortunately can happen, please be patient with yourself. You will get better at it very quickly.

Colostomy does not need any dietary modification. You can eat and drink as normal.