Information for patients undergoing bowel surgery

This is a care programme that will help you to recover from your bowel operation and regain your independence as quickly as possible. There is good evidence that early mobilisation (moving about), eating, drinking, exercise, and good pain control results in a quicker recovery. Therefore, the programme emphasises these aspects of your recovery and focuses on how you can help yourself after your recovery. It aims to help you leave hospital and return to your normal activities sooner, which is why we would like you to take part in this programme.

If you smoke or vape, we strongly suggest you stop before your surgery. This reduces the risk of lung problems whilst you are in hospital and after you go home. Your GP or Clinical Nurse Specialist can provide support to help you stop smoking. Can also contact tobacco dependency service on Uclh.tobaccodependency@nhs.net 

We recommend that you take regular exercise such as a 30 minute walk every other day, prior to your surgery.

Before your operation it is important for you to try and get yourself as fit as possible. Good nutrition before your surgery can help your recovery after surgery. 

You should continue to follow the diet sheet that you have been given. Five days before your operation please start drinking one bottle of Ensure® Plus milkshake or juice each day. The day before your operation, please slowly sip three bottles of Ensure® Plus milkshake or five bottles of Ensure® Plus juice. It is important that you take your nutrition drinks as this is vital to your recovery. 

Day before your surgery, stop eating at 2am and continue drinking clear fluids up to 05:30. Please take the two pre-op carbohydrate drinks two to three hours before the operation. Please do not have pre-op carbohydrate drinks if you are taking insulin for your diabetes or suffer from delayed gastric emptying (gastroparesis). 

Please do not drink any alcohol from two days prior to your surgery.

If you are having a left-sided resection (such as anterior resection or left hemicolectomy) and some colostomy reversals you will have bowel preparation medication the day before surgery or you will have two enemas, one the night before the operation at 20:00 and the second between 05:00 and 07:00 on the day of your surgery. You will also be given two different types of antibiotics (Neomycin and Metronidazole) to be taken the day before surgery if you are having bowel preparation. Recent research has found taking both bowel preparation and antibiotics is more effective than having bowel preparation alone in preventing complications such as infection after bowel surgery. This will be confirmed in the outpatient clinic by the Enhanced Recovery Nurse.

If you need a stoma (ileostomy / colostomy) or we think you might need a stoma, you will see the Stoma Care Nurse before your surgery. They will give you information and support and mark a suitable site on the skin for the stoma. This stoma may be temporary or permanent. Whilst you are in hospital you will see the Stoma Care Nurses. You can contact the Stoma Care Nurses if you have any problems or questions after you go home (see Contact details section). 

On the day before your surgery take a shower or bath before going to bed to remove oil from the skin. Wear freshly washed clothes to bed. Do not apply any cream to the skin. 

You will be admitted on the morning of your surgery. You will receive a phone call or a text message the day before surgery to confirm the time of arrival to the hospital. 

You will be admitted to the Surgical Reception on the first floor of University College Hospital. From there you will go to theatre for your operation. After the operation you will be transferred to T7 the surgical ward, Intensive care or the High Dependency Care Unit (PACU) (this depends on a number of factors including your medical history, the type of surgery you are having and what happens during your operation).  

You may wish to bring in some personal items with you: 

• wash bag 
• dressing gown and pyjamas or night dresses 
• comfortable clothes to wear in hospital like tracksuit bottoms, T-shirts and slippers
• coat and clothes to go home in 
• a small amount of money to purchase a TV card or a few items from the shop.

Please do not bring any valuables or large amounts of money into hospital as we cannot accept responsibility for any loss or damage. 

Note: If you require social care when you go home, please inform the Enhanced Recovery Nurse in the clinic, or inform the ward nurses on admission. You should also make sure you have made arrangements for getting home once you are ready to be discharged. This will avoid delays to your discharge.

On admission your named nurse will guide you through your individual preparation for theatre. We will ask you to put on some tight-fitting anti-thrombus stockings. These help to prevent clots from forming in your legs (deep vein thrombosis) while you are less active than normal after surgery. Please continue wearing the stockings for six weeks after your surgery. You can ask a nurse for a second pair before you go home.

As part of the recovery programme, we will ask you to keep a daily activity diary. We will give this to you in the pre- assessment clinic. 

Please ask staff in the Recovery Area for a glass of water and continue drinking fluids if you are able. This is to help the activity of your bowel. 

Sickness

Sometimes after an operation, a person may feel sick or may be sick. This is usually caused by the anaesthetic gases or drugs we use. You will be given medication during surgery to reduce these symptoms, but if you feel sick following surgery, tell the staff, who can give you other anti-sickness medications. It is important to relieve sickness to allow you to feel better so that you can eat and drink normally, as this will aid your recovery.  

Pain control

We will do all that we can to make sure you are not in pain. It is important that your pain is controlled so that you can walk about, breathe deeply, eat and drink, feel relaxed and sleep well. 

You may have an injection in your back (epidural), which allows a continuous supply of pain-relieving medicine to be given, or Patient Controlled Analgesia (PCA) pump. If you have a PCA please press the button whenever you have pain, the dose is set and you cannot overdose yourself. It is common for patients to experience pain in the morning, especially if they have not used the pain relief at all during the night. Please use the pain relief when you wake in the night if possible. Also always use the pain relief before movement or mobilising.  

The doctors will also prescribe other types of pain-relieving medicines which work in different ways. If you have pain relief tablets regularly (three or four times per day), this should help you feel more comfortable. If you are uncomfortable, please tell the staff immediately and they will help you. The epidural will usually be removed three days after your operation, but you will continue with the pain-relieving tablets. 

If you are having a reversal of ileostomy or colostomy, you may not require a pump for pain. You may start taking oral pain relief. Please tell the nurses if the pain relief is not effective. 

Tubes and drips

During your operation a tube (catheter) will be put into your bladder. This is done so that we can check that your kidneys are working well and producing urine. This will be removed as soon as possible, usually on the morning after your operation. 

You will have a fluid drip put in your arm during your operation to make sure you get enough fluid. We aim to remove this tube between the first and third day after your surgery. You will also have a nasogastric (NG) tube inserted through the nose to the stomach, but this is usually removed before you wake up after the operation.

Urinary catheter

Many things will be monitored during your admission, including how much food and liquid you consume, how much urine you pass, when your bowel first starts working, assessment of your pain, the number of walks you take and the time you spend out of bed. Please remember to tell us everything that you eat and drink and what you pass. We will ask you to record this information in your diary. 

Start drinking liquids and the protein drink. Start chewing gum for 30 minutes to stimulate your bowel. You are allowed to eat solid food. 

Staying out of bed and walking

We want to encourage you to regain your independence as quickly as possible and will give you whatever help we can to do this. After you wake up from your operation, it is important that you start deep breathing and coughing exercises. The exercises should reduce the risk of a chest infection or pneumonia. 

1. Support your abdomen (tummy) with a towel. 
2. Breathe in through your nose and out through your mouth slowly. 
3. Do this three times, followed by a cough. 
4. The whole process should be repeated each hour. 

You should also point your feet up and down and circle your ankles. Ask your nurse to show you these exercises. These exercises lower the risk of developing blood clots in your legs. We will also give you daily injections of blood thinning medication to help prevent blood clots.

The staff will help you out of bed about six hours after your operation. You will spend two hours out of bed on the day of surgery. Do not get out of bed on your own. Please wait for staff to help you.

On the day after your surgery, you can have a shower (you must keep your wound dry) or you will be given a wash bowl. You should change into day clothes. 

You should aim to spend at least eight hours out of bed each day from the day after your surgery until you go home. You will be encouraged to walk about 60 metres, or the length of the hallway, four to six times a day. You should drink two bottles of Ensure® Plus milkshake or juice each day. We will encourage you to use the walking time to go to the fridge and help yourself to these drinks. You should also walk to the bathroom if you need to use the toilet and use the bathroom to brush your teeth twice each day.

By being out of bed in a more upright position and by walking regularly, your lung function will improve and there is less chance of a chest infection. You should continue to do the breathing exercise.

Complications do happen after major surgery. It is important that you know what to look out for. During the first two weeks after surgery, if you are worried about any of the following, please phone your GP or phone the telephone numbers in this leaflet. 

Your wound

It is not unusual for your wound to be slightly red and uncomfortable during the first one to two weeks. Please contact the Enhanced Recovery Nurse or the ward if your wound is: 

• becoming progressively inflamed, painful or swollen 
• starting to discharge fluid 
• beginning to open.

Your bowels

Your bowel habit may change after part of your bowel is removed. Your motions may become loose, or you may become constipated. Make sure you eat regular meals three or more times a day and take regular walks during the first two weeks after your operation. If you require a specific diet, we will give you an information sheet. 

If you are constipated or have loose stools for more than four days, contact the Enhanced Recovery Nurse, the ward or your GP for advice.

Passing urine

Sometimes after bowel surgery, you may experience a feeling that your bladder is not emptying fully. This usually resolves within a week. If it does not, or if you have excessive stinging when passing urine, please contact us as you may have an infection. 

Abdominal pain

You will probably suffer griping pains during the first week following surgery. This pain usually lasts for up to a few minutes and will go away completely in between spasms. 

Anastomotic leak and postoperative ileus

Severe pain that lasts for several hours may indicate leakage of fluid from the area where the bowel has been joined together. This can be a serious complication which, fortunately, happens only rarely. Should this occur, it may be accompanied by a fever. On occasion though, leakage may occur which makes you feel generally unwell, causes fever but is without any pain. If you develop a fever or severe abdominal pain, please go to your local Emergency Department. 

An ileus is when your bowel goes to sleep or is inactive. This can be improved with regular exercise. 

Deep vein thrombosis (DVT) and pulmonary embolus

All surgery carries risks of clots in the deep veins of your leg. Sometimes a clot in the leg can break off and travel to the lung (pulmonary embolism). This can make it very hard to breathe. Please contact us or visit your local Emergency Department if you become short of breath or if you develop redness and swelling in your leg. 

Exercise

As we have already said, you should take regular exercise several times a day. Gradually increase your exercise during the four weeks following your operation until you are back to your normal level of activity. Do not undertake heavy lifting until eight weeks following your surgery. If you are planning to jog or swim, wait until twelve weeks after your surgery if you have a stoma, or eight weeks if you do not, and then start gradually. Common sense will guide your exercise and rehabilitation. If your wound is uncomfortable go easy with your exercise. Once your wound is pain free you can undertake most activities. 

Work

Normally people are able to return to work within four to six weeks following their surgery, but this may depend if you require further treatment or not. If your work involves heavy, manual labour, do not return to work until you have had your follow up with the surgical team. 

If you need a fitness to work certificate, please ask us for one before you go home. We can only give a fitness to work certificate for two weeks. You will need to go your GP after that. 

Driving

Do not drive until you are confident that you can drive safely. This should be at least four weeks after your surgery. It is best to check with your insurance company before you start driving again. 

Hobbies and activities

In general, you can take up your hobbies and activities as soon as possible after your surgery. This will benefit your recovery. However, do not do anything that causes significant pain or involves heavy lifting for eight weeks following your surgery. 

Sex

Sexual relationships can resume as soon as you feel physically comfortable. 

Discharge

The medical team will confirm your discharge date a day in advance, so you can make transport arrangements. This will include getting a few things ready. You will need to take a copy of your discharge summary home, a clip or stitch remover (if needed), dressing packs, gauze, normal saline to clean the wound and some dressings. Most patients will have clips or stitches removed at their GP surgery. You may also need some other items to take home for other needs. 

You will be required to leave the ward before 11:00. The hospital has a discharge lounge where you may wait for your medication or transport. Hot meals are available in the discharge lounge. 

A district or practice nurse referral will be made to follow you up at home if this is needed. Please ask the nurse discharging you to confirm this arrangement. 

Follow-up

You will be contacted by telephone within 24 to 48 hours by the Enhanced Recovery Nurse following your discharge home. 

We will arrange a follow-up appointment for you when you will be checked by a member of the surgical team. This will take place six to eight weeks after you go home. 

If you get numb or feel heavy from the waist downwards, please call the Enhanced Recovery Nurse on the number 07852 905 980 or via the switchboard on 0845 155 5000, bleep 6152 between 08:00 to 17:00 or go to your local Emergency Department out of hours. Inform the staff that you have had an epidural. This is a very rare but serious complication, and you must seek help immediately. 

Data collection

We plan to use anonymised data from the programme for audit purposes.  

If you have any problems after discharge, please contact one of the numbers below. The first point of contact should be your GP or Enhanced Recovery Nurse. If you experience severe pain, vomiting and high temperature or you are acutely unwell, please go to the nearest Emergency Department.

Enhanced Recovery Nurse (Tuesday  to Friday 08:00-17:00)

Mobile: 07852 905 980 

Switchboard: 08451 555 000 / 020 3456 7890 ex 70910 

Stoma Care Nurses (Monday to Friday 08:00-16:00)

Direct line: 020 3447 9182 

Switchboard: 08451 555 000 / 020 3456 7890 bleep 5816 

Mobile: 07961 959 505 

Colorectal Cancer Nurses (Monday to Friday 08:00-16:00)

Direct line: 020 3447 9188 

Switchboard: 08451 555 000 / 020 3456 7890 ext. 79188 

T7 North ward (Nurse Co-ordinator) 

Mobile: 07929 792 696 

T7 Central ward (Nurse Co-ordinator) 

Mobile: 07939 486 390 

Address: Enhanced Recovery Programme, University College Hospital, 235 Euston Road, London, NW1 2BU

The Enhanced Recovery Team is based on the seventh floor (T7) of University College Hospital.