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 proctolectomy - discharge; Continent ileostomy - discharge; Ostomy - colectomy or proctolectomy - 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 health care provider'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, and 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 doctor if there are activities you should not do.
      • Start by taking short walks.
      • Increase your exercise slowly. DO NOT push yourself too hard.

      Your doctor will give you pain medicines to take at home.

      • If you are taking pain medicine 3 or 4 times a day, take them at the same times each day for 3 to 4 days. They control 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.
      • Try getting up and moving around if you are having pain in your belly.

      Press a pillow over your incision when you need to cough or sneeze. This helps ease pain.

      Ask your doctor when you should begin taking your regular medicines again after surgery.

  • Wound Care
    • If your staples have been removed, you will probably have small pieces of tape placed across your incision. These pieces of tape will fall off on their own. If your incision was closed with a dissolving suture, you may have had a liquid glue covering the incision. This glue will loosen and can be peeled off after a few weeks.

      Ask your provider 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 doctor 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 doctor 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 provider.

  • Diet
    • Eat small amounts of food several times a day. DO NOT eat 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, call your doctor.

      Ask your provider 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 doctor can write a letter to limit your work activities if you do heavy labor.
  • When to Call the Doctor
    • Call your doctor if you have any of the following:

      • Fever of 101°F (38.3°C) or higher, or you have a fever that does not go away with acetaminophen (Tylenol)
      • Swollen belly
      • Feel sick to your stomach or you are 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, incision is red, warm, swollen, or more painful
      • Short of breath or chest pain
      • Swollen legs
      • Pain in your calves
      • Increased drainage from your rectum
      • Feeling of heaviness in your rectal area
  • References
    • Mahmoud NN, Bleier JIS, Aarons CB, Paulson EC, Shanmugen S, Fry RD. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 51.

      Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Perioperative care. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2016:chap 26.