Going Home (Inpatient Discharge)
Leaving the Hospital after Major Surgery
Leaving the hospital after major surgery is a natural source of anxiety both for patients who have had surgery, as well as for their families who will need to provide additional support during the remainder of the recovery period.
At the time of hospital discharge, most people are able to walk without assistance, eat a normal diet, and have normal bowel and bladder function. There is usually some pain from the surgical incision, and pain medication will be provided to you to make you more comfortable as this pain subsides.
The only restriction on activity after leaving the hospital is to avoid lifting objects weighing more than 10 pounds, or straining the abdominal muscles an equivalent amount, for a total of six weeks following your operation. This is to allow the abdominal wall to regain sufficient strength so as not to form a weak area, or hernia, in the deep layers of the incision when normal activities are finally resumed. Climbing stairs, riding in a car, walking up and down hills and other activities are to be encouraged, not avoided.
Take pain medication as prescribed. There is no virtue in trying to "tough it out" without medication. It is most helpful to take TWO kinds of pain medicine:
- First, a "non-steroidal anti-inflammatory agent" such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) to minimize inflammation and pain. We recommend ibuprofen 3 tablets (a total of 600 mg) every 6 hours, whether or not you have pain, for a week or two, until your pain is minimal. The object of this is to keep the pain away, rather than waiting for the pain to build up and then try to make it go away. These medications do not require a prescription, and should be purchased in any drug store or supermarket.
- Second, you will receive a prescription for a narcotic pain medication. This should be taken every 3-4 hours as needed for pain. Narcotic medication can cause constipation and other side effects. Taking a "non-steroidal" medication, as recommended above, will likely decrease the amount and length of time you require narcotic pain medicine, and reduce the side effects of these medications.
At the time of discharge, your incision will usually be held together with surgical staples, or if these have been removed, little white strips of paper tape will be present. If staples are present, these will be removed in your doctor's office several days after your discharge. Both the staples and the tape are waterproof and showering or bathing can be performed as usual; there is no need to vigorously clean the incision or tape area. The tapes will fall off with time, and there is no harm in this. The incision seals itself against infection within 24 hours of surgery, so there is no need to cover it with a dressing unless the rubbing of your clothes on it is uncomfortable. In that case, a light piece of gauze held in place with paper tape is all that is necessary.
Bowel movements usually will return to normal within a few weeks after surgery. Prior to that time, it is common to have stools slightly looser and more frequent than normal. Pain medications which contain codeine or similar narcotic drugs tend to slow down the intestine and cause constipation, but generally they provide more pain relief than pain medicines not containing these drugs. If constipation is a problem, Milk of Magnesia is a gentle, safe laxative which can be taken; it comes as pills or liquid, and the proper dose is 2-3 tablespoons of the liquid or 2 tablets, as needed.
A "bulk laxative" containing a bran or psyllium seed preparation is often helpful in making the bowel movements more normal during the month or two following surgery. Such "bulk laxatives", such as Konsyl, Metamucil, Citrucel, Hydrocil, Fibercon and the like, are available at any drug store and most grocery stores, without a prescription, and should be taken once a day. They may cause some bloating initially, but this will improve after a few days.
Many people mention that their energy level is low after surgery, and this is perfectly normal. After all, with several days not eating food and lying in bed, this is not uncommon even without the stress of surgery. A nap or two during the day, for the first few weeks after surgery, is often helpful. Energy will gradually return to its presurgical level or higher, usually after one to two months, depending on the individual. Despite one's natural impatience, there is no medication or activity which will hurry this process; nature simply will take its own sweet time in getting you better.
Eating a balanced diet and avoiding becoming overly tired will allow this process to proceed normally.
Getting back to work
How soon a person can go back to work depends in part on the kind of job a person has and how quickly one feels up to returning. When a person works at a job requiring minimal physical exertion, sometimes work can be resumed in 3-4 weeks, again depending on how fast the energy level returns to normal. Obviously, if a job involves heavy lifting or long hours of exertion, one should wait a minimum of six weeks (or sometimes longer, depending on the return of energy) before beginning to work again. Returning to work part time for a week or two, when possible, can provide a good transition to a full time job.
Intercourse can be resumed as soon as a person feels up to it. Some discomfort in the incision is usually felt, but this is not harmful. Sometimes a soft article of clothing over the incision improves comfort until complete healing occurs.
While most complications of surgery occur in the hospital, occasionally some develop after a patient is discharged. Signs to watch for are fever (more than 100 degrees F), nausea, vomiting, diarrhea, constipation for more than two days, burning on urination and increasing pain in the incision or abdomen. If you believe you have one or more of these signs, or simply have a question for the medical assistant or the doctor, please do not hesitate to call our office at 206-386-6600. There is always a doctor on call for emergencies after office hours and on weekends and holidays.
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