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June 2008 Back Issue Table of Contents |
What is the Right Activity After Ostomy Surgery?
By Ann Page RN, BA, CWOCN with Patti Haberer RN, CWOCN
Now that the weather has turned warmer, it’Äôs time to get outdoors and start enjoying the great weather and longer days. For most of us, getting out into the fresh air goes hand in hand with adding more physical activities. This could be working in the yard, playing a round of golf or even beginning to train for a marathon.
Whether your ostomy surgery was weeks, months or years ago, you’Äôve probably been told that you can do anything after surgery that you did before surgery. That is true; however, before returning to physical activities, it is important to understand what happens to your body after ostomy surgery.
Most of us associate healing and recovery with an improved sense of well-being and exercise plays an important part. Exercise provides an increase in oxygen and nutrients to the body that can assist with healing. It can lift our mood and improve stamina. But when it comes to recovering from ostomy surgery, how much exercise and what type is right?
The medical profession agrees on general post-operative guidelines for those recovering from abdominal surgery. Wound, Ostomy, Continence (WOC) nurses should focus on hernia prevention as one of the areas of education for a person undergoing ostomy surgery. WOC nurses offer suggestions based on their knowledge of the healing process, type of surgery performed and any research supporting post-operative recovery guidelines.
Learning how a stoma is created, how surgical wounds heal and how certain activities affect healing will help you understand why these precautions are used. An abdominal stoma, whether a urostomy (ileal conduit), colostomy or ileostomy, is created by advancing the end of the intestine through a hole cut into the abdominal wall. The layers of the abdominal wall are the fascia, muscle, subcutaneous (fatty) layer and skin. The intestine is brought above skin level, cuffed over like a sock and stitched to the skin.
We know that uncomplicated surgical incisions begin to strengthen (called tensile strength) about 3-4 weeks after surgery and continue to strengthen for up to a year and beyond. The first 6-8 weeks after surgery is generally the time frame given for physical recovery of a non-complicated surgery. However, in some populations, it can be anywhere from 3-6 months. Surgical incisions heal to about 80% tensile strength of non-wounded tissue.1
Peristomal hernias are a risk of ostomy surgery. There is no one reason for a peristomal hernia to occur. Many risk factors have been stated, including but not limited to:
’Ä¢ Infection at the time of surgery
’Ä¢ Relative health at the time of surgery
’Ä¢ Weak abdominal muscles
During the healing process, the fascia layer forms a ring around the intestine. If the ring widens, loops of intestine can pass into the fatty layer to form a hernia. A hernia may occur at any weak spot in the fascia. This may be observed as a bulge next to the stoma.
Most hernias occur within the first two years of stoma creation.2 One frequent observation is that a permanent colostomy develops a hernia (0-58%) more commonly than a permanent ileostomy or urostomy (0-28%). One theory behind this is that the more formed stool of the colostomy will expand the fascial ring as it passes out of the stoma, unlike urine or ileostomy stool that is mostly liquid. Increased abdominal pressure can further enlarge a weak spot.3
So, now that you are armed with the knowledge of stoma construction and a time frame for wound healing, let’Äôs return to those lifting restrictions and low impact exercises. When lifting any weight, it’Äôs not just your arms that are used; you also use your abdominal muscles or ’Äúcore’Äù muscles. By tightening your abdominal muscles you protect your back from strain during lifting.
This action can increase abdominal pressure. When pressure increases, any weak points, like the stoma, may be strained. Think of a balloon. As you squeeze one end of the balloon, the pressure makes the other side of the balloon bulge. This is basically what happens with increased abdominal pressure.
Lifting laundry baskets and grocery bags is not the same as working out at the gym, but these actions can cause an increase in abdominal pressure. Vacuuming is a push/pull motion that may also increase abdominal pressure. Therefore, guidelines recommend that these and similar activities should be avoided during the acute healing phase.
Again, these are guidelines for the early recovery stage after surgery while incisions are knitting together and gaining tensile strength. We believe that protecting the healing incision is one of the many factors in gaining optimal tensile strength.
Nutrition, hydration, medications, and smoking are also items on a very long list of factors that affect healing. This article focuses on only one of the factors; how exercise or physical activity may affect recovery from ostomy surgery and what guidelines can be given to prevent complications.
Most of the information found on physical recovery after ostomy surgery is antidotal. For example, we understand that when returning back to an old activity or starting a new activity, we must remember to start out slowly to determine how our body responds.
We also know that what works for one person may not be appropriate for the next. Therefore, it is difficult to make specific recommendations for exercise programs. Once you are ready to increase your activity level, contact your physician, WOC nurse, physical therapist or qualified health professional to create a personal exercise program. With their help, you may have to make some modifications on how you perform certain activities, but don’Äôt let that stop you from doing the things that you enjoy!
Bibliography
1. Doughty, DB; Sparks-Defriese, B. Wound Healing Physiology. In Bryant RA, Nix DP. Acute and Chronic Wounds: Current Management Concepts. St. Louis: Mosby:2007: 56-79.
2. Colwell, JC. Stomal and Peristomal Complications. In Goldberg MT, Colwell JC, Carmel JE. Fecal & Urinary Diversions: Management Principles. St. Louis: Mosby: 2004: 308-10
3. Rubin, MS. Parastomal Hernias. In Cataldo PA, MacKeigan JM. Intestinal Stomas. Principles, techniques and management. Second edition, revised and expanded. New York: Marcel Dekker: 2004: 277-306
4. Gray M, Colwell JC, Goldberg MT. What treatments are effective for the Management of Peristomal Hernia? Journal of Wound, Ostomy & Continence Nursing. 32(2):87-92, March/April 2005.