Total colectomy or proctocolectomy - discharge
Definition
You had surgery to remove your large intestine. Your anus and rectum also may have been removed. You also may have had an ileostomy.
This article describes what to expect after surgery and how to take care of yourself at home.
Alternative Names
End ileostomy - colectomy or proctocolectomy - discharge; Continent ileostomy - discharge; Ostomy - colectomy or proctocolectomy - 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
When You're in the Hospital
During and after surgery, you received intravenous (IV) fluids. You also may have had a tube placed through your nose and into your stomach. You may have received antibiotics.
What to Expect at Home
Follow your surgeon's instructions for how to take care of yourself 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 or mucus 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, or make sudden movements. This may last for several weeks but will improve over time.
Self-care
Activity:
- It may take several weeks for you to get back to your normal activities. Ask your surgeon if there are activities you should not do.
- Start by taking short walks.
- Increase your exercise slowly. Do not push yourself too hard.
Your surgeon will prescribe pain medicines for you to take at home.
- If you are taking pain medicines 3 or 4 times a day, take them at the same times each day for 3 to 4 days. They regulate 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.
- Press a pillow over your incision when you need to cough or sneeze. This helps ease pain.
Ask your surgeon when you should begin taking your regular medicines again after surgery.
Wound Care
If your staples have been removed, you will probably have Steri-Strips (small pieces of tape) placed across your incision. These pieces of tape will fall off on their own. If your incision was closed with dissolving sutures, you may have glue covering the incision. This glue will loosen and come off on its own. Or, it can be peeled off after a few weeks.
Ask your surgeon when you can shower or soak in a bathtub.
- It is OK if the tapes get wet. Do not soak or scrub them.
- Keep your wound dry at all other times.
- The tapes will fall off on their own after a week or two.
If you have a dressing, your surgeon will tell you how often to change it and when you can stop using it.
- Follow instructions for cleaning your wound daily with soap and water. Look carefully for any changes to the wound as you do this.
- Pat your wound dry. Do not rub it dry.
- Ask your surgeon before putting any lotion, cream, or herbal remedy on your wound.
Do not wear tight clothing that rubs against your wound while it is healing. Use a thin gauze pad over it to protect it if needed.
If you have an ileostomy, follow care instructions from your surgeon.
Diet
Eat small amounts of food several times a day. Avoid eating 3 big meals. You should:
- Space out your small meals.
- Add new foods back into your diet slowly.
- Try to eat protein every day.
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, contact your surgeon.
Ask your surgeon how much fluid you should drink each day to prevent getting dehydrated.
Returning to Work
Return to work only when you feel ready. These tips may help:
- You may be ready when you can be active around the house for 8 hours and still feel OK when you wake up the next morning.
- You may want to start back part-time and on light duty at first.
- Your surgeon can write a letter to limit your work activities if you do heavy labor.
When to Call the Doctor
Contact your surgeon if you have any of the following:
- Fever of 101°F (38.3°C) or higher, or fever that does not go away with acetaminophen (Tylenol)
- Swollen belly
- Feel sick to your stomach or throwing up a lot and cannot keep food down
- Not had a bowel movement 4 days after leaving the hospital
- Have been having bowel movements, and they suddenly stop
- Black or tarry stools, or there is blood in your stools
- Belly pain that is getting worse, and pain medicines are not helping
- Your colostomy has stopped putting out any water or stools for a day or two
- Changes in your incision such as the edges are pulling apart, drainage or bleeding coming from it, redness, warmth, swelling, or worsening pain
- Shortness of breath or chest pain
- Swollen legs or pain in your calves
- Increased drainage from your rectum
- Feeling of heaviness in your rectal area
References
Galandiuk S, Netz U, Morpurgo E, Tosato SM, Abu-Freha N, Ellis CT. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 52.
Lee H, Fichera A, Fleshman JW. Surgical management of Crohn's colitis. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:194-199.
Reviewed By: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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