Bowel activity how soon after resection?

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June1956

Joined
Feb 22, 2015
Messages
15
Location
Bristol, Vermont
Three days ago I had a laparoscopic erection, terminal ileum, valve and cecum. They took about 8" total. Now I just have a little gas at the third day, feeling a little bloated. How long might be before I start to see BM's? I feel pretty good, however am concerned about lack of activity and do not know what to expect. I went about 22 years with Crohn's before surgery, so feel quite lucky overall. Am now worried that I'm minimizing bloating because of course I'll be fine, just need to wait. Had surgery without catheter and was catheterised twice, second time nurse said she got 800 ml, which shocked me and proved how talented I am at ignoring symptoms. Now taking Flowmax and doing great with peeing. Any thoughts?
 
I had small bowel resection in two areas when I was younger and had bowel activity on the third day after surgery. Mine was an open procedure and surgery was more than 7 hours long. I state that because sometimes it takes longer for bowels to wake up when it is a longer surgery or there has been more insult to the bowel (more handling of it) during the surgery. With my colectomy, however, the surgery didn't take as long, but my bowels didn't start moving for 5 days.

Another cause for delay of activity is the pain relievers after surgery. Morphine and codeine will significantly slow down bowel activity. Walking is your best bet to get things moving. You might also ask if you are allowed to chew gum. This can aid in waking up a sleepy gut, though many doctors/nurses don't allow it.
 
Are you eating solid food yet? Generally, once you pass gas you will start being allowed soft food, then gradually a normal diet. You need food in the gut before it comes out the other end.
 
I'm eating some food. Had a turkey sandwich, jello and broth day after surgery, then yogurt and banana smoothie and chicken broth with tiny pasta yesterday. More chicken broth today and in a fit if not thinking (2 oxycodone), a banana muffin with chocolate chips and walnuts at 2:00am last night while my wife was asleep. She is sure the chocolate and walnuts were a bad idea. Compared to my intake before surgery, not even ten percent of the food volume and still feeling bloated.
 
Sounds good! Walk as much as you can. If everything is going as it should (and I suspect it is), you'll most likely fart the bloating away. If you have ileus somewhere along the GI tract, your food will eventually come back up. Any nausea? If no nausea, most likely no ileus or obstruction considering all you have been eating.

I mention ileus, as I went through that myself. I had bowel sounds, so the surgeon approved a liquid diet. Once I started a soft diet, I had bloating and severe nausea. This in turn lead to vomiting and dehydration. It just took a little longer for my guts to fully wake up and get moving.

Don't worry too much about the bloating just yet; it's still very early in recovery. However, continue to let your nurses and doctors know what you are experiencing and se what they recommend.
 
Thank you for the feedback, it's very reassuring to hear from someone who has been there.

I have no nausea, thankfully. Had a talk with the nurse today and she reinforced what you said. The general message was if passing some gas and no nausea, keep getting exercise, be brave enough to eat a little more and things will get better. I'm going with that for now. Took a 25 minute walk today, then passed more gas. Was taking oxycodone but was able to skip the dose this morning and after lunch, nurse said if could go without would help my gut.
 
I had ileus after my stoma surgery. I didn't vomit at all. The nurses could tell what was wrong by the size of my stomach, it was bloated with bile that couldn't go down or come up - have you had an abdominal examination? Though I'm very underweight, so my bloated stomach was very prominent. I think the ileus resolved after several days, I know I was in hospital ten days, and they'd made sure my stoma was working for a few days before discharging me, so I guess it was about a week before I passed anything, but that was with the ileus (and a different surgery from yours).
 
I'm grateful for the feedback from forum members. It has provided some useful perspective on where I am in the process. Once again I'm feeling very fortunate, both to have found this forum as a resource and for the soft but relatively normal bowel movement this morning after a 20 minute walk. That is a few hours short of four days after surgery. Still a lot of healing to do, but good progress along that path.
 
Update: Tonight is 16 days after surgery and feeling physically quite good, except no bowel movements for 5 days. Did fine for a few days, after waiting four days, then nothing. Have been taking MiraLax once per day for the last two days and will again tomorrow morning. On advice of surgeon, gave Fleet enemas a try last night and this morning with no results at all. Fortunately, no nausea, generally feeling well and have good energy. Some bowel cramping, usually fairly moderate in intensity, that is hopefully the sign of everything moving toward the exit... Still feeling quite positive about the whole surgery process, since I feel good, but a bit frustrated with the lack of BM's.

Was talking today with our elderly safety consultant (92 and going strong!!) who comes to do safety committee and large group meetings every month. He told me he once went 10 days after surgery before getting things moving again. Not interested in waiting that long now...
 
Update: In two days it will be a month since my surgery. From Saturday through Thursday of last week I was in the hospital after vomiting up dinner on Last Friday, then not being interested in eating or drinking on Saturday. After a day and a half on IV fluids finally started to pee again. Was discharged from the hospital because was passing gas and having a little diarrhea. Now three days after discharge and passing some gas but little or no diarrhea and no other sort of bowel movement. Been doing quite a bit of walking and eating I think moderately with a fairly soft and easily digested diet. Now starting to get worried again, would prefer to stay out of the hospital. Not having any luck getting bowels to resume pushing food through normally.... It's almost a month now!!
 
Fortunately, my one month follow up from surgery is tomorrow afternoon. I know there are no magic bullets, but hope he has at least a silver one!! Heading out now for another long walk, since that is what helps me feel best and the nurses and doctors both said exercise was critical to recovery.
 
Do you have prostate problems?

What were your bowel movements like prior to surgery?

Dusty. xxx
 
Enlarged prostate, like many men who are close to 60. Just discovered Flowmax after surgery, when was having difficulty urinating and had to admit was struggling some with that before surgery. My father carried the radioactive implants for at least fifteen years to deal with his prostate cancer, I get the finger test every year.

Normal bowel activity was a large, well-formed stool every day, with occasional light bouts with constipation, was eating a few prunes every day to keep myself on track. I was pretty happy with bowel function overall for years. Except, for two months prior to surgery was having a rough time and eating a pound of cheddar cheese every few days to keep the very loose stools at bay.
 
So not enlarged enough to be placing pressure on the rectum and hence constipation?
I don’t imagine the constipation is a side effect of the Flowmaxtra as your GI issues seem too complex for that.

Your immediate post op period has been interesting in the sense of when food was re introduced. Of course surgeons differ in their opinions but I will admit that I am surprised that you were commenced on solid foods so soon post op and without first having a bowel movement. Regardless of the access (open or laparoscopic) your bowel will go into post operative ileus mode with the ‘wake up’ time generally varying between 2-6 days.

It is good that you will you be seeing the surgeon tomorrow and not before time by the sound of things. Good luck! Please keep us posted with how you get on.

Dusty. xxx
 
I was a little surprised too. When I left the hospital the day after surgery, the orders said regular diet! I had instructions to not eat nuts, or raw fruits or vegetables, generally eat food that is well cooked and easy to chew. Well, we did that and more. When I called the surgeon's office after the first 5 days of no bowel movements, about a week and a half after surgery, she asked about diet and then told me not to eat bananas after I told her I was eating two every morning. She said bananas tend to bind people up. I'm sure another nurse told me bananas were ok to eat(but of course, looking back, raw fruit!). Regardless, that's all in the past now and hope the surgeon has some great advice. Lots of rumbling this morning but no gas or output of any type, very frustrating. On the plus side, the surgery itself really helped me feel better, just one more goal to meet...
 
A side note: Last time I was in the hospital for 8 days with an obstruction that was not dissolving. Since I was not eating I was not brushing my teeth (my mouth felt fine).

Well, a month later I went for a teeth cleaning and had this massive tartar build up in all my teeth. The saliva itself, inactive because of digestion, created this tartar.

Next time I am in the hospital I will brush my teeth three times a day !
 
A great point about teeth, I was in the hospital for five days and only thought about my teeth on the fourth day, then started brushing. Would take floss next time. Best not to lose ground on good tooth care...

Saw the surgeon today along with his understudy(?). They both felt that I was one of the small percentage of people that the sewn together section stays more swollen and causes problems with passage of fecal material. They felt my gut was less hard than previously and said drink lots of water, eat easily digested, well chewed food and drink Ensure or something similar for calories and energy. A fleet saline enema would be ok to try if I feel it is needed. Call them if still no bowel activity in 2 to 3 days. I have another Dr appointment on Friday and the following Friday, so they are doing well at keeping track of me. Still rather nervous, however will forge ahead on their vote of confidence.
 
Getting the bowel restarted is quite a physiological challenge.
they cut the whole section of the bowel, saw the pieces together, the bowel is now physically together but the nerve endings are not connected, they need to find their way to reconnect.

Lots of walking around the hospital floor is what got me restarted along with lots of broth. Took 4 days for me.
 
DustyKat said:
Your immediate post op period has been interesting in the sense of when food was re introduced. Of course surgeons differ in their opinions but I will admit that I am surprised that you were commenced on solid foods so soon post op and without first having a bowel movement. Regardless of the access (open or laparoscopic) your bowel will go into post operative ileus mode with the ‘wake up’ time generally varying between 2-6 days.
Click to expand...

I've had about ten bowel surgeries, and after all but one I was told to eat solid food either in the evening of the surgery day itself or the day after. This was both before and after I got a stoma. The only time I've been told not to eat was after my emergency surgery, which was the only one done by a different surgeon, but it was also my most major surgery and my only open surgery. My usual surgeon says eating helps get the bowel moving (he also forbids opiates after surgery, as they're constipating), and it doesn't seem to have hindered my recoveries, though it didn't stop me getting ileus. I wake up and the first thing that happens is a nurse puts a sandwich and ice cream in front of me.
 
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Your situation is unusual, June1956. From what I've read it seems most people struggle with diarrhoea after surgery, either because of the missing bowel that was taken out during surgery, or because the digestive system is still recovering. It does sound like your doctors aren't concerned that something very serious is wrong, so that's reassuring.

When I called the surgeon's office after the first 5 days of no bowel movements, about a week and a half after surgery, she asked about diet and then told me not to eat bananas after I told her I was eating two every morning. She said bananas tend to bind people up. I'm sure another nurse told me bananas were ok to eat(but of course, looking back, raw fruit!).
Click to expand...

Bananas are an exception, they don't have the same problems as other raw fruits; they're constipating for one thing. Unlike most fruits, they can be eaten on a soft or low fibre diet, which is why someone would tell you they're ok after surgery. But like I said, usually people have the opposite problem after surgery. However, I don't think you should start eating too much fibre (fruits besides bananas, etc.) as a soft/low fibre diet doesn't just counter post-surgery diarrhoea, it reduces irritation to your intestine while it's healing.

I hope the enemas and other measures work and you can get things going again. Is the constipation causing you pain, either stomach pain from not being able to go, or pain passing stool?
 
Sandwich and ice cream, sign me up!

Well, constipation is thankfully not the problem, from what I can tell. They believe it is that the food/fecal matter is not passing easily by the sutured site where the bowel was joined back together. The doctor said my belly felt less hard and looked a little less bloated than the last time I was seen, so I'm taking their optimism as a good sign and moving forward on that basis.

I have a lot of cramping, rolling pain, not very intense, which I associate with the normal movement of the bowel, just not having much luck moving things along. I've been taking docusate sodium stool softener since my surgery and now they have me taking it twice per day, which should result in quite loose stools. My first stools after surgery were all quite soft, firm enough to hold it together rather than be diarrhea. a few days ago there were some flakes or small clumps, then when I tried an enema last night, diarrhea again and some gas. Today just gas so far, every 4 hours or so. Hopefully a good sign.

Doing a fair amount of walking and eating soft, easily digested food and as of today drinking Ensure to get some more calories. I've lost 10 lbs. since the surgery a month ago, certainly could stand to lose just a little weight, but preferably not much more. I believe much of the weight loss happened a week ago when I went 3+ days with IV's and drinking only juice and water.
 
I just wanted to second what UnXmas said about the new norm of starting solid foods early after surgery

Your immediate post op period has been interesting in the sense of when food was re introduced. Of course surgeons differ in their opinions but I will admit that I am surprised that you were commenced on solid foods so soon post op and without first having a bowel movement. Regardless of the access (open or laparoscopic) your bowel will go into post operative ileus mode with the ‘wake up’ time generally varying between 2-6 days.
Click to expand...

The older style protocol, described above, of waiting until you pass gas or have a bowel movement and then allowing liquids and soft foods is considered to be unnecessary by a lot of surgeons these days and unhelpful for resuming peristalsis. Like everything, different surgeons will have different opinions and there will be situations in which any surgeon might favor the more conservative approach. Overall though it seems that the early reintroduction of normal foods is a newer approach that is filtering down to more and more surgeons.

That has been my experience. For my first bowel resection in 2001 (open procedure) I was not even allowed sips of water for two days. At that point I had my first bowel sounds and was then allowed to drink sips progressing within a day or so to a whole cup. I had to wait at least until I passed gas before I could start having a little solid food and we started slowly.

By contrast after my second (open) resection in 2005 with the same surgeon, he allowed fluids straight away (which was such a relief since I always struggle with dry mouth after surgery - another reason to brush teeth!). And that was even with an NG drainage tube to relieve the excess bile in my stomach. After a couple of days he even allowed me to eat a little soft food...although unfortunately I gradually became nauseous and had increasing pain, which was later discovered to be caused by a twisted loop of bowel causing a temporary blockage. I think the lesson there is that while starting foods early may not put you at any greater risk of complications (leaks at the bowel joins and sutures, for strictureplasties) it's important to listen to your body and respond to what your body tells you.

Of course you also need your doctors to respond and in my case they didn't - everyone insisted that I keep eating and walking - only deciding to investigate further when I was (at their insistence) up and walking past the nurses' station hunched over with tears streaming down my face. I'm not saying that to frighten anyone but because I want to convey how important it is to insist that your doctors and nurses listen to you and the symptoms that only you can tell them about.

For my third and fourth bowel resections my new surgeon was happy for me to eat straight away or alternatively wait if that's what I felt like doing. Knowing my history with complications and also that he was doing "a lot of stitching" he was equally happy for me to take the conservative route. From my point of view it was partly caution and also that I hadn't been eating much before surgery so couldn't suddenly have normal food afterwards and needed them to understand that I wouldn't miraculously be able to consume (to me) large quantities of normal food straight away.

Sorry I hijacked your thread a little June1956! Sorry to hear that your bowel is having a hiccuping stop-start post-operative function - I guess we are all very different int he ways our bodies recover - but I'm very glad to hear that your surgeons are keeping a close eye on you so that they will be ready to act if needed.

The supplement drinks sound like a sensible idea at this stage. I do think that it is easy to lose weight quickly in the post-operative period when you are not eating normally and (especially since you have continuing issues) it's better to address that sooner to prevent more weight loss.

My gastro team now advise calorie loading before surgery to counteract that effect and to give your body the energy and nutrition it needs to heal effectively in that time. My fourth surgery, last August, was the first time I did that, drinking about 3000 calories (which is a big increase for me) of Fortisip drinks for 2-3 weeks before surgery. It was the first time I didn't have TPN after surgery so it felt important to do that and I certainly think it helped me recover and minimize weight loss due to the surgery and recovery.

Good luck June1956, keep updating us!
 
I was drinking Gatorade before surgery, the day before and the day of. The nurse and doctor both said they found that people did noticeably better after surgery when they had some fuel stored up to help the body start to recover. I believe it helped quite a bit, since my general sense of well being after surgery was quite good. I still feel quite good post surgery, just kind of sluggish on the output end.
 
Yes, things have changed a lot regarding optimal preoperative preparation for elective colorectal surgery too! There's often less fasting done before surgery so that your body has more recent fuel stores - with some even saying that solid food can be eaten up to six hours before surgery! (source) And carbohydrate drinks given two hours before surgery - to reduce the time to return of bowel function and minimize loss of muscle mass. There are mixed results in these studies though (another paper here shows no risks but less benefits). As a patient, I felt that having the carbohydrate drinks before surgery was at least psychologically beneficial - it felt good to know that I was doing something that might help and alleviated some of my concerns about going without much intake for a while after surgery. They may be of no more help than a placebo though :), but I definitely believe in optimizing nutrition before surgery and calorie loading in the immediate pre-operative period when possible/appropriate.
 
I should have been a bit clearer in that my instructions were to not eat anything after midnight on the day before surgery. We ate normally for dinner, not a heavy meal, and I also drank a 32 oz bottle of regular Gatorade 2 hours later, about 8:00. There was a type of Gatorade that was not desirable, don't remember what that was. Then between 5 and 6 hours before surgery, I drank another 32 oz. The instructions said 20 oz, I had a 32 oz bottle and it was not struggle to drink it. Just a bit extra to drain off before surgery. I agree that it felt good to be doing something to assist in my recovery in the day before the surgery.
 

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