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Physiotherapy advice for abdominal surgery

https://kingstonhospital.nhs.uk/information/physiotherapy-advice-following-abdominal-surgery

This is an exercise guide for people who are having abdominal surgery. It will help you to:

  • prepare for your surgery before you come to hospital
  • prevent chest or circulatory (heart and blood) problems
  • move more easily
  • be more comfortable after surgery
  • regain your previous fitness levels.

Before surgery: preparing for surgery before you come to hospital

Improving your fitness before you have surgery has been shown to result in a quicker recovery. It can help you avoid post-operative complications.

  • If you can, try to increase the amount of exercise that you take.
  • Exercise can be broken down into 10 minute sessions which you can spread across the week. Or you can exercise for 30 minutes on 5 days of the week.
  • Do whatever suits your lifestyle and current levels of fitness.

To prepare for surgery, practise deep breathing and circulatory exercises

Immediately after you have your surgery in hospital, it will be important that you take some deep breaths. Taking these deep breaths will help in the following ways:

  • It will reduce your risk of getting a chest infection or other lung complications.
  • It will help to maintain good circulation (blood flow in your veins) and prevent the formation of blood clots.

Practise the following breathing and circulation exercises now. If you practise them now, you will be familiar with the exercises when you come to hospital for your surgery.

Deep breathing
Deep breathing image
  • Sit comfortably, as upright as you can.
  • Place your hands on the sides of your ribcage if you can.
  • Take a deep breath in. Feel your rib cage expand under your hands.
  • Hold your breath for 2 to 4 seconds if you can.
  • Slowly breathe out.
  • Repeat this 3 times.

Practise this breathing exercise frequently throughout the day. You can do it when you wake up, after breakfast, at mid morning, after lunch, at mid afternoon and before you go to bed.

Ankle pumps image
Ankle pumps (to boost circulation)
  • Sit or lie down.
  • Bend your feet and ankles up and down quickly for 1 minute.

Practise this exercise whenever you are sitting down or when you are lying in bed before you fall asleep.

 

Immediately after surgery, while you are in hospital: help your lungs to recover

After your operation, a physiotherapist may come and see you. It will depend on the type of incision (surgical cut) you have had or whether you normally suffer from breathing problems.

Pain can slow down your recovery. Discuss any pain with your nurse, doctor or physiotherapist so that they give you enough pain relief.

It is important to take deep breaths immediately after surgery. You also need to cough up any phlegm (or mucus) in your lungs. This will help to prevent chest infections such as pneumonia.

If it is painful to take deep breaths or cough, tell your nurse so they can adjust your pain medication.

Start doing these breathing exercises as soon as you wake from your operation.

Deep breathing
Deep breathing image

Immediately after your operation, do this exercise every half hour. Keep doing it until you can take several short walks a day on the ward.

  • Sit comfortably as upright as you can.
  • Place your hands on the sides of your ribcage if you can.
  • Take a deep breath in and feel your rib cage expand under your hands.
  • Hold your breath for 2 to 4 seconds if you can.
  • Slowly breathe out.
  • Repeat this 3 times.
Coughing
  • Do not worry about harming your stitches or scar when coughing.
  • It may feel more comfortable if you hold a pillow or a folded towel firmly over your stomach when coughing.
  • It is important to let the nurses, doctors or physiotherapists know if it is too painful to cough. They will be able to adjust your pain medication.

Start doing these circulation exercises as soon as you wake from your operation.

Keep doing them until you get back to your normal level of activity.

Ankle pumps image

Ankle pumps (to boost circulation)

  • Before you had surgery, you may have been given TED (anti blood clot) stockings to wear to prevent the formation of blood clots in your legs.
  • It is important to keep wearing these.
  • It is also important to pump your ankles up and down briskly for 30 to 60 seconds every hour.

During your stay in hospital: getting moving

Getting up and moving regularly will help you to recover from your operation. It will also help to improve your breathing and circulation, and to relieve any discomfort you feel from spending time in bed.

Sitting out of bed

On the day of your surgery or the morning after your surgery, nurses or a physiotherapist will help you to get out of bed. They will move any drips or drains with you and these will not prevent you from getting out of bed.

  • When you are out of bed, try to sit out in a chair for at least 2 hours in the morning and 2 hours in the afternoon.
  • Try to gradually increase the time you spend out of bed, every day.
Getting out of bed
Getting out of bed image

Getting out of bed will be easiest if you roll onto your side first.

  • Bend your knees up and roll onto your side.
  • Let your legs slide off the bed first.
  • Push yourself up into a sitting position with your hands and forearm.
  • Sit for a minute.
  • When you are ready to stand, push up with your hands and your legs.
  • Try to keep your back straight.
Walking
  • If you feel well enough, try to walk on the day after your surgery. If you cannot walk on the first day, try to walk on the second day after your surgery.
  • Nurses or physiotherapists will help you to manage any drips or drains until you can walk safely by yourself.
  • When you can walk safely by yourself, you will need to walk regularly throughout the day.
  • Try to increase the distance that you walk every day.

Bed and chair exercises while you are in hospital

You can start these exercises the day after your surgery. They can help to do the following:

  • strengthen your abdominal muscles
  • relieve trapped wind
  • ease back pain
  • ensure your wound heals properly without any tightness.

Do these exercises slowly. Take the movement as far as you can without causing pain. It is normal to experience a stretching feeling.

Pelvic tilts
Pelvic tilts image
  • Pull the muscles of your abdomen (tummy) in and flatten your back against the bed.
  • You will probably feel your pubic bone tilting upwards. 
  • Hold this position for a few seconds, then release gently.
  • Repeat up to 5 times.
  • Do this 3 times a day.

Knee rolls image
Knee rolls
  • Draw in your lower abdomen (tummy).
  • Keep your shoulders flat on the bed or the ground.
  • Gently lower both knees to one side (as far as you can so that it is not too painful or uncomfortable).
  • Bring your knees back to the middle then lower them down to the other side. 
  • Repeat this exercise up to 5 times.
  • Do this 3 times a day.

Lower back stretch image
Lower back stretch
  • Stand up tall.
  • Place your hands in the small of your back.
  • Push your hips forwards until you feel a comfortable stretch.
  • Repeat this exercise 3 times, every time you stand up.

Rotations image
Rotations
  • Stand or sit up tall.
  • Place your arms across your chest.
  • Turn to the right and then to the left.
  • Do this 3 times a day.

When you are back at home: returning to everyday activities

If you have had laparoscopic surgery (keyhole surgery) ask your surgeon how long it will take you to get back to normal.

If you had a laparotomy (surgical incision) or open surgery, the information below can guide your recovery.

Pace yourself

  • You will be more tired when you return home so make sure to prioritise essential tasks.
  • Spread your tasks across the day.
  • Think about sitting down while you are preparing food. This will help you preserve your own energy.
  • Try to get help from friends and family, especially if you need to look after babies or young children.

Lifting

  • Avoid heavy lifting.
  • Avoid heavy housework until 6 weeks after surgery. Do not carry full laundry baskets or heavy shopping bags. Do not mow the lawn or vacuum your floors.
  • Only carry what you can comfortably manage with one hand, such as a full kettle.

When you start to lift things, do the following:

Image of correct way to lift a heavy load
  • gently tighten your stomach muscles
  • keep your feet apart
  • bend your knees
  • keep your back straight
  • hold the object close to your body
  • straighten your knees to stand up (let your legs do the work instead of your arms or back).

Exercise

Taking regular exercise will help you recover more quickly from your operation.

  • Be guided by common sense. Do not do something if it feels uncomfortable or painful.
  • Aim to be back to your normal level of activity by 6 to 12 weeks after your operation.
  • Continue the exercises you were doing while you were in hospital (see above). Gradually increase the stretches.

Walking

Walking is one of the best forms of exercise to help you recover from your surgery.

  • Take several walks a day.
  • Gradually increase the length and speed of your walks.

Low impact exercise

You can return to low impact exercise around 4 weeks after your operation. Low impact exercise includes:

  • hill-walking
  • static cycling
  • using a cross-trainer
  • swimming (if your wound has fully healed).

If you take part in an exercise class, let your instructor know what kind of surgery you have had.

More strenuous exercise

After 6 to 8 weeks you can return to more strenuous exercise. Make sure you gradually build up your activity and pay attention to the way your body reacts.

More strenuous exercise includes:

  • golf
  • squash
  • jogging
  • road cycling.

Return to work

Your doctor will be able to give you advice on when you can return to work. Their advice will depend on the type of surgery you have had and what kind of job you do.



Contacts

Kingston Hospital Physiotherapy Department, Monday to Friday 8am to 5pm 020 8546 2510
khft.physioop@nhs.net

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For information accessibility please visit Kingston Hospital AccessAble www.accessable.co.uk/kingston-hospital-nhs-foundation-trust
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For detailed information on accessibility at Kingston Hospital visit Kingston Hospital AccessAble (https://www.accessable.co.uk/kingston-hospital-nhs-foundation-trust).


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