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These notes give an overall guide to your stay in hospital. You may see some differences in the details of your treatment, since it is tailored to suit your own condition.
WHAT IS THE PROBLEM?
As you know, you have a colostomy. This is an opening of the bowel draining waste out onto the skin instead of down the normal way into the back passage. It has been decided that it is time to close off the colostomy so that the waste will again run into the back passage.
What does the operation consist of?
A cut is made around the colostomy to free the bowel from the skin and the body wall. The bowel is then joined up again inside the tummy or sealed off so that the waste will drain the normal way to the back passage. The wound where the colostomy once was is then closed off. Sometimes the main wound in your tummy has to be reopened to join the bowel up properly. It is stitched up again at the end of the operation.
WHAT HAPPENS BEFORE THE OPERATION?
Reception
When registering at reception your medical aid details will be required. Your medical aid may require that you obtain an authority number from them for the hospital. Please check this. If you are not on a member of a medical aid you will be required to pay a deposit or to sign an indemnity form. As far as possible we will try to advise you about hospital costs before your admission.
Welcome to the ward
You will be welcomed to the ward by the nurses or the receptionist and will have your details checked. Some basic tests will be done such as pulse, temperature, blood pressure and urine examination. You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings. The surgeon will have explained the operation and you will be asked to sign your consent for the operation. If you are not clear about any part of the operation, then read this again and then ask for more details from the surgeon or from the nurses.
Visit by the anaesthetist
If you are having a general anaesthetic, the anaesthetist who will be giving your anaesthetic will interview and examine you. He will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had.
Bowel preparation
It is important that the bowel is as clean as possible before the operation. You will have your usual diet until the day before the operation. Thereafter you will take only clear fluids until 8 hours before the operation. On the evening before the operation you will have to drink a quantity of fluid laxative which will completely cleanse the inside of the bowel. This is important in order for the bowel to be empty and clean and therefore safe for the operation.
Shaving
The operation area will be shaved to remove excess hair.
Timing of the operation
The timing of your operation is usually arranged the day before so that the nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing.
Transfer to theatre
You will be taken on a trolley to the operating suite by the staff. You will be wearing a cotton gown, wedding rings will be fastened with tape and removable dentures will be left on the ward. There will be several checks on your details on the way to the operating theatre where your anaesthetic will begin.
The operation is then performed
WHAT HAPPENS AFTER THE OPERATION?
Coming round after the anaesthetic
Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back on your bed in the ward. Some patients feel a bit sick for up to 24 hours after the operation but this passes off. You will be given some treatment for sickness if necessary. You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. You will be given salt solutions or blood down a plastic tube into an arm vein until you are drinking normally. You may have a fine plastic tube down the back of your nose to drain your stomach for a day or two. Occasionally a tube (catheter) is put into your bladder to drain urine until you are more mobile.
Will it hurt?
The wound is painful and there is discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant. You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm and the exercise is very helpful for you. The third day after operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor. By the end of one week the wound should be virtually painfree.
Drinking and eating
The operation causes the bowel to stop working for a day or two. Until the bowel starts up again you will be given water, salts and sugar solutions into your arm vein. The tube in your nose will be used to draw off any build-up of stomach juices. The first signs of returning bowel activity are noises in your tummy and passing wind out of your back passage. Once these have happened you will be able to start drinking - a little at a time.
When you are able to drink freely the arm drip tubing is removed. You should be eating normally after 4 or 5 days. You should be on a full diet within a week.
Opening bowels
It is quite normal for the bowels not to open for 3 or 4 days after the operation. Often there is diarrhoea but this settles down by itself.
Passing urine
If there is a drainage tube (catheter) in the bladder, passing urine is not a problem. Sometimes there is a feeling that there is a leakage all the time but this is just an irritation by the tubing and it passes off. Once you can walk about in reasonable comfort the catheter is taken out.
If you have not had a catheter it is important that you pass urine and empty your bladder within 6-12 hours of the operation. If you find using a bed pan or a bottle difficult, the nurses will assist you on to a commode or the toilet. If you still cannot pass urine let the nurses know and steps will be taken to correct the problem. If you have had a catheter in the bladder you must pass urine after the catheter is taken out. If you cannot, ask the nurses for advice.
Sleeping
You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know.
Physiotherapy
The physiotherapist will check that you are clearing your lungs of phlegm by coughing and that you are helping your circulation by movement of your arms and legs. Coughing, although uncomfortable, will not harm your wound.
The wound
The wound has a dressing which may show some staining with blood in the first 24 hours. The wound is held together by stitches which are removed after 8-10 days. The dressing is usually removed after 1-3 days and replaced. This dressing is usually waterproof, allowing you to shower. Sometimes a plastic drain is used to drain excessive secretions from the wound. It may cause slight discomfort and is removed after a few days.
There may be some purple bruising around the wound which spreads downward by gravity and fades to a yellow colour after 2 to 3 days. It is not important. There may be some swelling of the surrounding skin which also improves in 2 to 3 days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor sized blebs form on the wound line but these settle down after discharging a blob of yellow fluid for a day or so.
Washing
You can wash the wound area as soon as the dressing has been removed, or earlier with a waterproof dressing. Soap and tap water are entirely adequate. Salt water is not necessary.
How long in hospital?
Usually you will feel fit enough to leave hospital after 7 to 10 days. You will be given an appointment for a check up about a 1 to 2 weeks after your operation.
Sick notes
Please ask your surgeon for any sick notes or certificates that you may require.
After you leave hospital
You are likely to feel a bit tired and need rests 2 or 3 times a day for 2 weeks or more. You will usually be back to your normal activities in 4 to 6 weeks.
Lifting
At first discomfort in the wound will prevent you from harming yourself by too heavy lifting. After 2 months you can lift whatever you like. There is no value in attempting to speed the recovery of the wound by special exercises before the month is out.
Driving
You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 3 weeks.
What about sex?
You can start sexual relations within 2 to 3 weeks, when the wound is comfortable enough.
Work
You should be able to return to a light job after 3 to 4 weeks and a heavy job within 4 to 6 weeks.
Complications
Complications are rare and seldom serious. The most important are infection in the wound and a leak from the bowel where it has been joined together. Very occasionally this can lead to severe problems with infection and very rarely it may be necessary to re-fashion the colostomy. If you think that all is not well, please ask the nurses or doctors.or you to leave hospital can be arranged.
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