Who to call after your discharge if there is a problem
Call 000 if the problem is life threatening or urgent and you are unable to contact your surgeon or someone from his team.
Hospital - Contact the hospital in which you had your operation and ward nursing staff may be able to help otherwise they will contact your surgeon for further advice - The hospital contact details can be found under 'Links'.
If you have undergone an operation for haemorrhoids or another anorectal condition you will have likely been discharged on the same day of your procedure. It is important to;
1. Have someone responsible to observe you overnight given you had a general anaesthetic.
2. Stay hydrated and take the medication prescribed to you. This may include pain killers, stool softeners/fibre preparations and creams/ointments. It is usually a good idea to take simple pain killers such as Paracetamol and Ibuprofen (if suitable) on a regular basis to reduce the use of stronger medications and exacerbating constipation.
3. Sitz baths - These are salt baths that lightly clean the raw operative area. It is usually suggested to perform these three times a day for about a week.
4. Expect some bleeding and discomfort as there is no painless operation for anorectal conditions. However if bleeding and pain becomes worrying please contact your surgeon.
5. Follow up as suggested by your surgeon for review.
Preparing for surgery
Any surgery, but especially a bowel resection can have a significant impact on your body. Many aspects around preparing and recovering from such an operation have been studied. It is important that your health and medical conditions are optimised. Maintaining a healthy diet is vital and undergoing some exercise every day leading up to the operation can aid in your recovery. It is also important to avoid smoking and other tobacco products and to minimise alcohol.
Your surgeon may prescribe special drinks for you to take in the 5 days leading up to the operation. A final drink is usually given 2-3hrs prior to coming into the theatre. These can help reduce the risk of infections and help your body deal with the stress of an operation.
Enhanced Recovery After Surgery (ERAS)
Your surgeon will most likely use an enhanced recovery after surgery approach. This has been shown to improve both patient recovery while in hospital and returning to normal activities when at home. This approach may seem quite different from more traditional preparation and recovery methods so it is important that you are aware of what may be expected of you after your operation.
Bowel Preparation - It is unlikely that you will need to take a full bowel prep prior to your operation (except in special circumstances). You may need to be given an enema on the day of your operation to empty the rectum however your surgeon will inform you of this.
Diet - You will be encouraged to eat and drink what you wish immediately after your surgery (pending how you feel). You don't need to finish everything however as you recover so will your appetite.
Pain Control - Pain control is important to help with your recovery by allowing you to move around, deep breathe and cough. We use many different methods; tablets, catheters/tubes placed into wounds/abdomen, pumps controlled by yourself and occasionally spinals/epidurals (medication placed into your back).
Exercise - If you are well enough after your surgery we expect you to be able to get up out of bed and freely walk around. The nurses and physiotherapists will help you with this. Moving around is extremely important for your recovery.
Your hospital admission can vary anywhere from 2 days after your resection but would usually be around 3-4. This will be determined by how well you are tolerating a diet and mobilising around the ward. It would also be reliant on normal observations, minimal pain and reassuring blood tests. Your bowels working would be reassuring but not essential. Any little hiccup or complication can add a day here or there.
It is still best to rest at home following discharge. This doesn't mean lying in bed or day which would be detrimental to your recovery. It means don't expect to be doing all the 'normal' things you were doing prior to the operation. You may find you fatigue easily so gradually increase the amount you do each day until you return to normal function.
It is important to establish good eating, drinking and exercise habits early after bowel surgery to maintain a healthy lifestyle. It is also recommended that you avoid smoking and tobacco related products.
What is a Stoma?
A stoma or bag is the general term given to an opening of the bowel onto the surface of the skin. Stomas can be made from small (ileostomy) or large (colostomy) bowel and they can be temporary or permanent. Patients may require one of these as part of their treatment depending on the section of bowel which needs to be removed, the immediate health of the patient or the physical inability to connect the two ends of bowel. They can act to help defunction an anastomosis (join in the bowel) which is downstream or be an end opening. Your surgeon will inform you of the likelihood or not of a stoma during your treatment and answer any other questions you have regarding them.
What is a stomal Therapist?
A stomal therapist is a specially trained and qualified nurse who will help patients with stomas. For a planned operation you will generally meet the therapist prior to your operation for further education and marking of the 'best' stoma location on your abdomen. Stomal therapists will then see you again after the operation to help you with learning to manage the bag, deal with problems which arise and answer any questions you may have. They will also arrange all the supplies you require for going home.
Stomal Therapy Contacts
Can I be cured from bowel cancer?
Yes, there will be a good chance of cure from the cancer if it is detected at an early stage. Overall 69% of patients are cured with treatment. Some patients will be advised that they need extra treatment in addition to surgery if the cancer has extended beyond the confines of the bowel wall.
Will I develop another cancer?
Experience and studies have shown that a patient who has been treated for one bowel cancer is at a slightly greater risk than the rest of the community of developing a second cancer and for that reason your surgeon will recommend a programme of "follow-up" and "surveillance".
How often should I see my surgeon?
An early post-operative review will be arranged for you from the hospital. This is usually within 2-4 weeks of leaving hospital. Your surgeon will assess your immediate recovery and wounds. They will also discuss further the results of any pathology and the possible need for further treatments.
From then on your surgeon will recommend a set programme of reviews. This may be individualised based on your current fitness or risk of further disease. These recommendations involve:
For how long should I continue to be checked?
It is recommended that a patient is "followed up" by their surgeon for as long as he/she remains fit to undergo further treatment should a new cancer develop. Below is a PDF print out of your likely schedule. You can bring this to each follow up appointment and it will be a good guide for you to follow. This schedule may vary with individual patient pathology, surgeon preference and treatment type.