Rehabilitation after colorectal surgery

Transcription

1 Rehabilitation after colorectal surgery Advice for your recovery Information for patients

2 Recovering after your operation The recovery period following your operation starts as soon as you get back to the ward and physiotherapy is an essential part of this recovery process. The main areas of physiotherapy involvement are: Chest care/ respiratory physiotherapy Mobility and exercise Rehabilitation Education The physiotherapist will visit you on the ward, usually on the first day after your operation. They will explain the processes and start your rehabilitation. Chest care / respiratory physiotherapy Chest problems and breathing difficulties after surgery are common. This could be because of a number of factors including: The anaesthetic process this can increase the amount of phlegm; make your phlegm sticky, thick and difficult to clear. It makes you sleepy after your operation, which makes you take smaller breaths and can make your cough less effective. Previous chest problems this can increase your risk of having increased phlegm production and problems with your chest. The operation during the operation your lungs are not inflated fully and you need to fully re-expand them after your surgery. The incision pain from the wound site can cause you to be reluctant to take deep breaths and cough. Posture - sitting or lying in a slumped position can affect your ability to take a deep breath. All these factors together put you at a higher risk of a chest infection, which could slow your recovery and may mean you need to spend more time in hospital. To speed up your recovery and prevent chest infections, it is vital that you practice breathing exercises and cough freely. Always ask for more painkillers if pain is stopping you from deep breathing or coughing. Don t suffer in silence! page 2 of 16

3 Breathing exercise cycle 1. Relaxed breathing control Relaxation and gentle breathing, swelling the stomach as you breathe in and letting it fall as you breathe out. Continue breathing in this way for 30 seconds (or 6-8 breaths) 2. Deep breathing Take a deep breath in until you cannot fit any more air in, hold for 3 seconds, and then gently breathe out. Repeat 3 times 3. Huffing Take a medium breath in and then force the air out through a wide-open mouth with the back of the throat open, as if you are misting up a pair of glasses to clean them. Repeat 3 times. 1. Breathing control 2. Deep breathing 6. Huff 5. Breathing control 3. Breathing control 4. Deep breathing Ideally you should perform a set of these breathing exercises every 30 minutes throughout the day. page 3 of 16

4 Coughing Effective coughing is very important to clear any phlegm. You may feel you need to do this more often after your operation, especially after your deep breathing exercises or walking. To help your cough be more effective: Sit upright Support your wound with your cough cushion (rolled up towel) Lean slightly forwards Cough strongly from your tummy not your throat. Posture Due to your wound you may feel that you tend to lean forwards as this is a more comfortable position. However it is important that you try to maintain an upright posture whilst sitting in bed or on a chair. This will help prevent any back or neck problems and will aid wound healing. This will also help with your chest care. page 4 of 16

5 Mobility and exercise It is important to become active as soon as possible. Ward staff, including nurses and physiotherapists, will encourage you to sit out and walk on the ward as soon as you can. Taking regular short walks during your stay will help aid your recovery. Make sure you keep a good upright posture whilst standing and walking. You may feel that you become short of breath for the first few times but this is normal after an operation. Why exercise? Helps to strengthen and rebuild muscle. Helps to clear your phlegm after an operation during times of decreased mobility. Improves joint movement and keeps bones strong. Aids with bowel movement and wind release. Helps to improve your confidence. Helps to return you to your everyday activities, work and hobbies. When to stop exercising Only do what you are comfortable doing. You do not have to do all exercises in one go, but it is important that you exercise regularly throughout the day. Stop when you feel you have done enough. After exercises are complete, any increase in discomfort should settle down again back to your previous level within 15 minutes. If not, then you are pushing too hard. Do a few repetitions of each exercise to start. Build up the number of repetitions gradually, once confident you are not experiencing too much discomfort. Remember you may not be able to do as much as the day before. If you have any questions, please speak to the physiotherapist. Immediately alert a health professional if you experience any persistent symptoms such as any dizziness, chest pains, chest tightness or ongoing breathlessness. Your exercise tolerance (amount of walking) will increase gradually over the following days. You should try to follow your personalised walking programme whilst on the ward and the physiotherapist will check with you that you can manage a flight of stairs, if appropriate, before you go home. When you are able to walk safely on your own, try to have a walk every hour. page 5 of 16

6 Recovery timeline Recovery following an operation normally follows a pattern similar to the outline below. Not everyone follows the same pattern of recovery and your treatment may differ depending on any complications or unexpected investigations, but don t worry your physiotherapist will tailor your recovery to your personal needs. Day 0 Day 1 Time line Day 0 to 1 Physiotherapy goals and expectations Day 0-1 we would expect you to do: Perform deep breathing exercises Sit out in your chair or upright in bed Walk short distances with the staff on the ward Day 2 Day 3 Day 2-4 Day 2-4 we would expect you to be able to: Walk independently / with the staff on the ward (with / without walking aid) Aim to walk 60 metres x 4 through the day Continue deep breathing exercises Perform exercises shown in the booklet Day 4 Day 5 Day 6 Day 7 Day 5-7 Day 5-7 we would expect you to be able to: Contiinue walking independantly on the ward 60 metres x 4 (more if you are able to) Manage all exercises independently Aim for home if all going to plan. Planning for home: Once you are fully independent on the ward, able walk and the doctors are happy with your progress then we can plan for you to go home. Following discharge: You should continue a steady gradual increase in your progress once home. (This is discussed further at the back of the booklet). page 6 of 16

7 Ratings of perceived exertion scale Using this scale we would like you to rate your perception of exertion, that is, how heavy and strenuous the physical task feels to you. 0 Nothing at all 1 Very easy 2 Easy 3 Moderate 4 5 Hard 6 7 Very hard Extremely hard Absolute maximum The perception of exertion depends mainly on: Strain and fatigue in your muscle Your feeling of breathlessness It should be the conscious sensation of how hard, heavy and strenuous the physical task is, measuring muscle fatigue and breathlessness. You should use the Perceived Exertion score to grade how hard you are working from You should aim to be working between 3 and 5 on the scale. This will ensure you are working hard enough to see a benefit from your exercise, but are not underdoing or overdoing it. When your physiotherapist sees you after the operation, they will use this scale to measure what your capability was before your operation. Remember that any increase in activity, however small, will be beneficial for you. page 7 of 16

8 Exercises Try to do the following exercises shown by the physiotherapist three times a day whilst you are in hospital, but also once you are discharged. These will help you increase your strength, flexibility and general fitness after your operation. Bed and chair exercises Lower limb exercise Description Repetitions Ankle pumps and circles Bend both your ankles up, pulling your toes toward you, and then bend both your ankles down, pointing your toes away from you. Heel slides (hip and knee flexion) Bend your hip and knee by sliding your heel up toward your buttocks while keeping your heel on the bed. Straight leg raises Straighten your knee, squeeze your thigh muscle and then lift slowly into the air, (keep your knee straight throughout). Slowly lower back to the bed. Sitting knee extensions Sitting in a chair. Lift your foot, straightening your knee as much as possible. Hold for 5 seconds. Slowly lower your leg down and relax. Repeat with opposite leg. Knee bending (sitting knee flexion) Sit on a chair. Bend your knee back as much as you can. Hold for 5 seconds. Return to the starting position and relax. page 8 of 16

9 Upper limb exercises Upper limb exercise Description Repetitions Elbow bends Bend your elbow through full range, and then straighten out. Repeat on the opposite arm. Arm lifts Lift your arm above your head, keeping your arm straight throughout. Be careful of any attachments like drips etc Side arm lifts Lift your arms out to the side, keeping your arms straight. page 9 of 16

10 Standing exercises Standing exercise Description Repetitions Marching on the spot Stand holding a firm surface. Take your weight onto one side and at the same time lift the opposite leg off the floor, then slowly lower. Repeat on the other side. You can continue into a march on the spot when you get better. Standing knee bends Bend your knee up, lifting your foot up behind you. Slowly lower and repeat on the opposite side. Squat Stand holding a firm surface. Slowly bend both your knees together, then straighten again. Sit to stand Sit with arms crossed. Slowly stand and then sit again. If you are struggling then you can use your arms to help you page 10 of 16

11 Incisional hernias Hernias are a common complication after surgery. Weakness in the abdominal muscles after surgery can cause some of the abdominal wall to protrude through the abdominal muscles. This results in a noticeable bulge in the abdomen, and can be quite tender to touch. It is therefore important to understand how we can help prevent them. You are more likely to develop an incisional hernia if: You gain significant weight after your operation You have had multiple abdominal surgeries You do heavy lifting You return to sports too quickly Hints and tips: Do not do any heavy lifting for the first 12 weeks after your surgery. Perform gentle pelvic floor and abdominal exercises as below. Remember Do the exercises slowly and in a controlled way. Do not rush the movement. You should feel comfortable at all times. Hernia prevention exercises Description Repetition s Pelvic tilting a) Lie on your back on a firm surface with knees bent and feet flat on the floor. b) Pull your tummy in, tilt your bottom upwards slightly while pressing the middle of your back into the floor and hold for 2 seconds. c) Let go slowly. Knee rolling a) Lie on your back on a firm surface with knees bent and feet flat on the floor. b) Pull your tummy in, and keeping your knees together, slowly roll them from side to side. page 11 of 16

12 Rehabilitation Diary Date Time Activity Duration / repetitions BORG score Comments page 12 of 16

13 Planning for home The decision that you are ready to leave hospital is based on a number of factors rather than being on a set day after your operation. The physiotherapy team will make sure you can safely manage the stairs before discharge if needed. If you are not able to complete the stairs safely, alternative arrangements will be discussed and arranged. The main points when considering going home are that you: are able to carry out your everyday personal tasks such as washing and dressing and using the toilet on your own. are able to get around your home safely. have an adequate support network around you for such things as cleaning, shopping and housework. If you are managing all of the above and the doctors are happy with your recovery then we can plan for going home The occupational therapists may assess you on the ward for any support you may need once you are at home. Planning for home (medically fit for discharge) Functionally independent enough to be discharged home? No Yes, fully independent at my previous functional level. Confident I have the appropriate support at home to support my discharge. Yes, but I am not as mobile and still tire easily. We would recommend allowing us to refer you to our community therapists, who can continue your rehabilitation process in your own home environment. Yes, but I require support with everyday living activities. We can support your everyday living needs at home with the possibility of a temporary or permanent care package. We have offsite rehabilitation facilities that can offer you futher time and therapy input to allow you to progress functionally, in preparation for your safe return home. page 13 of 16

14 Once you are home Expect to need to take things easy for a few weeks after your operation. The exact time that it will take for each step of the recovery will vary from patient to patient. Resting and progression back to normal function Upon discharge, try to do at least 10 minutes of functional exercise per day (if you could do this before your operation). Continue to complete the exercises shown in this booklet as these will continue to aid your recovery. It is quite normal at first to feel tired following exercise, but progression back to full function is a gradual process. Take regular rests between tasks, doing activity little and often. Housework Have a rest from heavy housework in the first two weeks that you are home. General everyday activities such as making a drink or light snack or easy household jobs are fine to complete. After the first two weeks it is quite safe to gradually increase your household jobs. You should be able to resume your normal routine by 6 weeks, with the exception of work involving heavy lifting or prolonged standing. Vacuuming should be avoided until 4 to 6 weeks after the operation. Lifting After your operation try to limit your lifting to approx. 2kg (a full kettle) and always lift correctly. Bend your knees, keep your back straight, pull in abdominal muscles and hold any object close to your body. You should avoid heavy lifting for at least 3 months after any abdominal surgery due to the increased risk of a hernia. Walking Besides your exercise programme, you must leave time for walking. Walking helps build your strength and endurance. Walk around your home 3 to 5 times each day. Trips to the bathroom or kitchen are not enough. Progress to walking outside and in the community if able. Important: talk with your therapist about how far you should walk each day so you don't overdo it and you can progress from your walking programme safely. Driving You must be able to perform an emergency stop and have full lower limb movement and power. When you feel able to drive, obtain permission from your doctor and inform your insurance company. If you have had an epidural, it is usually advisable to wait 3 to 4 weeks before driving. page 14 of 16

15 Activity and exercise: You want to be able to return to your hobbies and sports as quickly as possible. Due to the nature of your operation, this may take 1-2 months until you can begin participating in sports and activities. Depending on your sport / activity it may be longer due to the stresses on your wound. Light walking and low impact sports may include: Walking / hiking Swimming Cycling Contact and high impact sports should be avoided until 8-12 weeks, then gradually build back to training slowly, until you feel ready and fit for full competiveness. These include: Football Rugby Gymnastics / dancing Golf Gym You can begin light, low impact steady cardiovascular work such as swimming, walking, cross-trainer and cycling at approximately 4 weeks after your operation. This will help build up your exercise tolerance. Make sure your wound is fully healed prior to swimming. For weightlifting exercises, it is advised to wait until 8 weeks after your operation so as to avoid any post-operative complications (hernia, pain and wound problems). If you would like to start becoming more physically active to increase your fitness after your surgery, there are programmes in the community around Sheffield to support you. For more information please visit: or ask your physiotherapist who can give you more information about the scheme and the referral process. Work Returning to work will depend on the type of work that you do. People with jobs that involve a lot of heavy manual work may need to take more time than those with less active jobs. It may also be advised to consider a phased return to work if this is possible. Please speak to your doctor, nurse or physiotherapist if you have any concerns about returning to work. page 15 of 16

16 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Sheffield Teaching Hospitals NHS Foundation Trust 2017 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD8880-PIL3781 v1 Issue Date: August Review Date: August 2019