Concerns After Discharge

Staple Removal

If you have staples in your wound, these will probably be removed before you leave the hospital. If not, you will need to make sure arrangements have been made for them to be removed. Staples that are left in after discharge from the hospital are generally removed one week after surgery, unless you have been instructed otherwise by your surgeon. Staples are usually removed by a home care nurse but you may be requested to come back to the outpatient office. This is not something that your family doctor will generally do.

Readmission to Hospital

Approximately 10 percent of patients will need to be readmitted to the hospital after major abdominal surgery. Research suggests that patients who are well enough to be discharged early are less likely to need to be readmitted.

About half of the patients who are readmitted to the hospital return because of symptoms of nausea, vomiting or bloating. Associated with this, you will often stop passing flatus or stool. When these symptoms develop, stop eating and drinking and wait one or two hours. In most cases these symptoms resolve and you can gradually start to eat and drink again. If not, please call your surgeon’s office.

The other patients who need readmission return to the hospital because of new or more unusual pain, fever or other symptoms. Some of these problems can be caused by abscesses or infections in the abdominal cavity or by a leak from the anastomosis (or joining) made after removal of a piece of bowel. These may occur in approximately 1 to 10 percent of patients, depending on the operation performed and the reason for surgery. Again, if in doubt, please call your surgeon’s office.

Problems with your Wound

If you develop new pain, redness or drainage from your wound, please call your surgeon’s office for advice. Your surgeon will be able to advise you what to do.

Recovery of Bowel Function

For the initial few weeks after surgery, your bowel habits may be quite changeable, varying between diarrhea and constipation. It is not uncommon to notice some blood or mucus being passed from your rectum, even if you have an ileostomy. Similarly, some patients notice the passage of staples used for the anastomosis. This is not a problem if you are otherwise well.

Nausea, Vomiting or Dehydration

Nausea and vomiting are symptoms that frequently occur in the first few weeks after abdominal surgery. If you do not feel like eating solid food, remember that it is important to keep drinking plenty of liquids so as not to get dehydrated. Drinks like chicken broth and Gatorade® are good as they replace salts as well as liquid. It is useful to keep a drink near you, so that you can sip on it frequently, as you may not be able to tolerate drinking a lot of liquid in a short period.

If you develop vomiting, stop drinking and eating for an hour or so then gradually try to start sipping on liquids. If the vomiting is still too severe, call the office and a prescription to help the nausea can be called in. If you keep vomiting, you may need to come to the clinic or emergency room for assessment and possibly for intravenous fluids for rehydration.

For nutrition, a useful and economical dietary supplement is to make milkshakes by blending Carnation Instant Breakfast® with ice cream, which can be taken between meals.

High Ileostomy Output

Dehydration can frequently happen in patients with a new ileostomy. If your ileostomy bag gets full more than six times per day, or if the fluid is very watery or profuse, you may be at risk for dehydration. Remember that it is important to keep drinking plenty of liquids so as not to get dehydrated. Drinks like chicken broth and Gatorade are good as they replace salts as well as liquid. It is useful to keep a drink near you, so that you can sip on it frequently, as you may not be able to tolerate drinking a lot of liquid in a short period.

If you have a prescription for Imodium® or Lomotil®, then take the pills or syrup as directed, as they slow down the fluid coming out of the ileostomy. These medications are best taken about half an hour before meals and half an hour before bed. One to two pills may be taken up to a maximum of eight pills per day. If in doubt, or if you don’t have a prescription, please call the office and a prescription can be called in for you. If these medications are not working, an alternative prescription may be called in.

If you are feeling weak and tired, and the amount coming out of your stoma appliance is still a lot, you may need to come to the clinic or emergency room for assessment and possibly for intravenous fluids for rehydration.

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