Post operative care, concerns, cautions and core exercises after surgery for abdominal cancers
Exercises are required for following reasons:
- Avoid deep vein thrombosis
- Improves circulation to muscles
- Light exercises improve healing and prevent hernias.
- Exercises to pelvic floor
- Deep breathing exercises helps in lung expansion, better oxygenation and early recovery
- Ambulation and exercises makes early return to intestinal motility
Recovery time after the abdominal surgery is approximately one month.
During this time you have to avoid lifting and carrying heavy loads (maximum 1-2kg).
Abdominal binder/ belt:
During the recovery time, use the elastic abdominal support belt. You get the belt from the hospital as a loan. If you get any other advice on how to use the support belt, follow it. Before you sit up, put the support belt on and use it when you walk around.
During the recovery time turn to your side before you sit up and avoid straining your abdominal muscles.
It’s most appropriate to start using an APPROPRIATE size belt from early post operative period.
Walking is the best exercise after surgery. It helps you recover from surgery and regain your previous condition. Make sure that your shoulders are relaxed and try to maintain good posture even if the wound might feel tight. It’s highly recommended to walk daily, extend the walking distance gradually.
Kegels pelvic floor exercises:
Your pelvic floor may be weakened after a hysterectomy, which can cause temporary loss of bladder control, shifting of pelvic organs and other problems. Kegel exercises are quick contractions designed to strengthen the pelvic muscles. Simply squeeze the muscles you would normally use to stop the flow of urine, release and repeat.
- Contract your pelvic floor muscles for 3-10 seconds at a time;
- Repeat these contractions for up to 8-12 repetitions in a row for one full set of exercises;
- Perform 3 sets of exercises throughout the day i.e. approximately 20-30 exercises in total;
- Aim to do your kegel exercises every day; and
- Try to make your kegel progressively stronger as your strength improves.
Deep breathing exercises:
Many people feel weak and sore after surgery and taking big breaths can be uncomfortable. Your provider may recommend that you use a device called an incentive spirometer. If you do not have this device, you can still practice deep breathing on your own.
The following measures may be taken:
- Sit upright. It may help to sit at the edge of the bed with your feet hanging over the side. If you cannot sit like this, raise the head of your bed as high as you can.
- If your surgical cut (incision) is on your chest or belly, you may need to hold a pillow tightly over your incision. This helps with some of the discomfort.
- Take a few normal breaths, then take a slow, deep breath in.
- Hold your breath for about 2 to 5 seconds.
- Gently and slowly breathe out through your mouth. Make an “O” shape with your lips as you blow out, like blowing out birthday candles.
- Repeat 10 to 15 times,
Circulation exercises
These help to maintain the blood circulation in your legs whilst you are not so active. This reduces the risk of getting a blood clot (DVT).
• Keep your legs and ankles uncrossed at all times
• With your legs stretched out, briskly circle your feet and bend them up and down.
Do these every hour while you are awake. You can do these when lying down or sitting in a chair
Basic exercises
Start with exercises sat in a chair:
• March your knees alternately for 30 seconds.
• Bend and straighten your knees.
Hold your knee straight for 10 seconds, keeping your toes pulled up. Repeat 5 times with each leg as you are able.
• Lift your heels and toes alternately for 30 seconds
Once you can do these exercises comfortably, progress to exercises in a standing position. Place your hands on a supportive surface like a kitchen worktop or back of a chair. Make sure your shoulders are not hunched and that you’re standing tall:
March for 30 seconds.
Small squats. Aim to repeat 10 times keeping the movement slow and controlled.
Push up onto your toes 10 times
After 2 weeks post surgery:
you can start exercises for the internal abdominal muscles. The purpose of this exercise is to regain the function of abdominal muscles and to prevent wound hernia.
You should do this exercise 5 – 6 days a week.
Take supine position with knees flexed and arms on your sides. Lift your head during exhale and lay it back during inhale. Repeat exercise at the pace of your normal breathing 3 x 5 – 15 times.
you can also start light stretching for the abdominal muscles. The purpose of this exercise is to restore the elasticity of the abdominal muscles and prevent tension of scar tissue. Stretches should be done after the abdominal muscle exercise (5 – 6 days a week).
Take supine position with arms on your sides. Lift arms over your head during inhale and move them back to starting position during exhale. Repeat exercise at the pace of your normal breathing 3 x 2 – 5 times.
After 6 weeks of surgery
you can start exercises for the external abdominal muscles. The purpose of this exercise is to strengthen your abdominal muscles.
| Take supine position with knees flexed and arms crossed over your chest. Arch your upper back during exhale. Your head, shoulders and upper back should rise up from the surface. Relax your muscles and return back to starting position during inhale. Repeat exercise at the pace of your normal breathing 3 x 5 – 15 times. Core Stability Exercises Having major abdominal surgery will affect your abdominal muscles and hence your core stability. To improve your core stability, please do the exercises outlined in the following pages. The best position to do these exercises is lying on the floor. However, if you are unable to do so, you could do them lying on a bed. Aim to do them three times a day. 1. Deep Abdominals• Lie on your back, knees bent, at hip width apart, feet flat • Put one pillow under your head • Breathe in, gently letting your tummy rise • As you breathe out, gently draw your tummy button towards your spine• Hold for a few seconds, then relax • Rest for a few seconds • Repeat 3-5 times 2. Pelvic Tilting Lie in the same position as shown. • As you breathe out and draw your tummy in, gently tilt your pelvis and flatten the small of your back into the bed. • Hold for a few seconds, and then relax• Repeat 3-5 times and gradually build up to 10 times 3. Knee Rolling |
Walking & Yoga:
Aim to walk every day gradually increasing the distance. You should aim to be able to walk 30 minutes daily by one to two months after your operation. Start walking on level ground and gradually build up to inclines and uneven ground such as cobble paths. Walking on uneven surfaces requires small changes of direction which can cause some discomfort in the healing abdominal muscles. After two to three months you could consider moderate exercise like swimming or cycling. To progress your core stability exercises you could attend a Yoga or Pilates group. However, seek advice from the group’s instructor about an appropriate level of exercise. If you wish to return to a specific sporting activity please discuss this with your consultant.
You can return to your previous activities after 1 – 2 months.
Exercise summary
Exercises before your operation:
• General exercise
• Deep breathing exercise
• Core stability exercises
Exercises after your operation:
• Getting in and out of bed and walking
• Deep breathing exercises
• Exercises for clearing secretions
• Circulation exercises
• Core stability exercises
Exercises after you have returned home:
• Core stability exercises
• Exercises sat in a chair
• Once comfortable, exercises in standing
• General exercise
Common concerns
1] Urinary issues:
In post operative period urinary catheter is kept for almost 3-5 days. This is useful to reduce efforts of the urinary bladder for voiding as the pelvic nerves are handled during the surgeries. However, patients are advised to performs Kiegel’s exercises regularly after 2nd day.
It strengthens the muscles that support the bladder. Strong pelvic floor muscles can go a long way toward warding off incontinence.
- Pretend you are trying to avoid passing gas.
- Pretend to tighten your vagina around a tampon.
Choose your position. Start by lying on your back until you get the feel of contracting the pelvic floor muscles. When you have the hang of it, practice while sitting and standing.
Contract and relax
- Contract your pelvic floor muscles for 3 to 5 seconds.
- Relax for 3 to 5 seconds.
- Repeat the contract/relax cycle 10 times.
Keep other muscles relaxed. Don’t contract your abdominal, leg, or buttock muscles, or lift your pelvis. Place a hand gently on your belly to detect unwanted abdominal action.
Extend the time. Gradually increase the length of contractions and relaxations. Work your way up to 10-second contractions and relaxations
Aim high. Try to do at least 30 to 40 Kegel exercises every day. Spreading them throughout the day is better than doing them all at once. Since these are stealth exercises that no one notices but you, try to sneak in a few when waiting at a stoplight, riding an elevator, or standing in a grocery line.
Diversify. Practice short, 2 to 3 second contractions and releases (sometimes called “quick flicks”) as well as longer ones.
2] sexual dysfunction:
The surgery affects the sexual function in 2 ways. One being removal of ovaries surgically or damage to ovaries by chemotherapy or radiation and thus the production of estrogen and progesterone are halted. Another way is changes in female reproductive system post surgery leading to shortening of vagina, loss of uterus etc. however, the painful sensation wanes completely in 3-4 weeks and thereafter dyspareunia i.e. pain during intercorse goes off.
3] Stress urinary incontinence:
The injuries to autonomic nerves during surgery or advanced cancers involving these nerves can lead to post op leaking of few drops of urine during vigorous activities like jumping or coughing etc. the only good known remedy for it is to do kiegel’s exercise as described above.
4] Bedsore:
Elderly patients need to be nursed with frequent change of positions as the same position puts pressure at bony prominences in contact with mattress. Due to poor blood supply and skin quality, bedsores may crop up as no surprise. Skin care with appropriate moisturisers, powders, prevention of maceration due to sweat are of utmost importance. At times water or air beds need to be used.
5] Vaginal hygiene:
Post surgery there could be thin discharge from healing tissues. It needs to be cleaned with clean water and soap and maintain local hygiene. Commercially available neutral pH soap solutions are good and gentle on this body part. If the discharge is smelly or white curdy colour then please consult doctor as it needs Rx
6] Suture care:
The healing scar needs to be kept clean and tidy. Our preferred way is to keep it open and dry to air. Patient needs to inspect the wound twice a day and look for any redness or discharge from the wound. patients should take wash or bathe over the wound and even apply soap and water on it. Please make sure to dab the scar to dry and apply alcohol based sanitizers or chlorhexidine based sanitizer to skin around the scar. Sutures are usually removed after 2 weeks i.e. 14 days post surgery. In case any issue is noted at scar, click a photo and send to clinic number 9819073781 or e-mail on oncosurgeon.hp@gmail.com.
Don’t forget to ask Dr at postoperative follow up:
1] condition of surgical site
2] histopath report
3] stage
4] further treatment ie chemotherapy, radiotherapy etc
5] prognosis
6] follow up plan and investigations at follow up