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Definition

You had surgery to remove all or part of your small intestine (small bowel). You may also have had an ileostomy.

When You're in the Hospital

During and after surgery, you received intravenous (IV) fluids. You also may have had a tube placed through your nose and into your stomach. You may have received antibiotics.

What to Expect at Home

You may have these problems after you return home from the hospital:

• Pain when you cough, sneeze, and make sudden movements. This may last up to several weeks.
• You may have problems with greasy or bad smelling stools or diarrhea if a large section of your small intestine was taken out.
• You may have problems with your ileostomy.

Self-care

Follow your health care provider's instructions for how to take care of yourself at home.

Activity:

• It may take several weeks for you to get back to your normal activities. Ask your provider if there are activities you should not do.
• Start by taking short walks.
• Increase your activity slowly. Do not push yourself too hard.

Your provider will prescribe pain medicines for you to take at home.

• If you are taking pain medicines 3 or 4 times a day, take them at the same times each day for 3 to 4 days. They control pain better this way. Ask your provider if you can take acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) to help with pain and to avoid taking narcotic pain medicine.
• Do not drive or use other heavy machines if you are taking narcotic pain medicines. These medicines may make you drowsy and slow your reaction time.

Press a pillow over your incision when you need to cough or sneeze. This helps ease the pain.

Ask your surgeon when you should begin taking your regular medicines again after surgery.

Wound Care

If your staples have been removed, you will probably have small pieces of tape placed across your incision. These pieces of tape will fall off on their own. If your incision was closed with a dissolving suture, you may have had glue covering the incision. This glue will loosen and will come off on its own. Or, it can be peeled off after a few weeks.

Ask your provider when you can shower or soak in a bathtub.

• It is OK if the tapes get wet. Do not soak or scrub them.
• Keep your wound dry at all other times.
• The tapes will fall off on their own after a week or two.

If you have a dressing, your provider will tell you how often to change it and when you can stop using it.

• Follow instructions for cleaning your wound daily with soap and water. Look carefully for any changes to the wound as you do this.
• Pat your wound dry. Do not rub it dry.
• Ask your provider before putting any lotion, cream, or herbal remedy on your wound.

Do not wear tight clothing that rubs against your wound while it is healing. Use a thin gauze pad over it to protect it if needed.

If you have an ileostomy, follow care instructions from your provider.

Diet

Eat small amounts of food several times a day. Avoid eating 3 big meals. You should:

• Space out your small meals.
• Add new foods back into your diet slowly.
• Try to eat protein every day.

Some foods may cause gas, loose stools, or constipation as you recover. Avoid foods that cause problems.

If you become sick to your stomach or have diarrhea, call your provider.

If you have hard stools:

• Try to get up and walk around more. Being more active can help.
• If you can, take less of the pain medicines your doctor gave you. They can make you constipated.
• You may use stool softeners if your provider tells you it is ok.
• Ask your provider if you can take milk of magnesia or magnesium citrate. Do not take any laxatives without asking your provider first.
• Ask your provider if it is ok to eat foods that contain a lot of fiber or take an over-the-counter fiber product such as psyllium (Metamucil).

Talk to your provider if you have questions about ileostomy and your diet.

Returning to Work

Return to work only when you feel ready to. These tips may help:

• You may be ready when you can be active around the house for 8 hours and still feel ok when you wake up the next morning.
• You may want to start back part-time and on light duty at first.
• Your provider can write a letter to limit your work activities if you do heavy labor.

When to Call the Doctor

Contact your provider if you have any of the following:

• Fever of 101°F (38.3°C) or higher, or fever that does not go away with acetaminophen (Tylenol)
• Swollen belly
• Feel sick to your stomach or you are throwing up a lot
• Not had a bowel movement 4 days after leaving the hospital
• Have been having bowel movements and they suddenly stop
• Black or tarry stools, or there is blood in your stools
• Belly pain that is getting worse, and pain medicines do not help
• Your ileostomy has stopped working for a day or two
• Changes in your incision, such as the edges are pulling apart, drainage or bleeding coming from it, redness, warmth, swelling, or worsening pain
• Shortness of breath or chest pain
• Swollen legs or pain in your calves

References

Elmously A, Yeo HL. Management of small bowel obstruction. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:129-132.

Gan T, Evers BM. Small intestine. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 50.

Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Perioperative care. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 26.

Yeo HL, Michelassi F. Management of Crohn's disease of the small bowel. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:129-132.

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