What to expect from bowel resection surgery: before, during, and after
Having gone through an ileocecal resection myself, I know the unknowns can feel overwhelming. If you are facing this surgery, you probably have a range of questions: will it be painful? Will I suffer any long term effects from the surgery? Will I still be able to go to the toilet normally? What kind of recovery time can I expect?
These are all normal questions. Preparing for surgery can be a stressful time, and sometimes it's hard to absorb all of the information in your allotted appointment time.
From someone who has been through a gut resection before, I'm here to help. No two bowel resection surgeries are the same, but there are commonalities and it can be helpful to understand the physical, mental, and emotional challenges that may come with it.
Before we proceed, a little disclaimer: This is not medical advice, nor is it a substitute for professional medical support. I am simply aiming to help arm you with some additional guidance, from one bowel resection patient to another.
What is bowel resection surgery?
Bowel resection surgery is a surgical procedure to remove part of all of the small or large intestine. It is usually performed to treat a range of conditions – such as cancer, diverticulitis, Crohn's disease, ulcerative colitis – and aims to remove the damaged or diseased portion of the bowel and rejoin the remaining gut.
Depending on your circumstances, the surgery may be performed using laparoscopic (keyhole) surgery or, if that's not possible, open surgery.
Before surgery: how to prepare for a bowel resection
At this point you already know that you'll be having a bowel resection, and you've probably already had initial appointments with your doctor or surgeon. This period is all about knowledge: understanding why you need the surgery, exactly what they are planning to do, getting any tests you need to support the surgery, and perhaps following a particular diet to prepare for the big day.
Understanding why the surgery is needed
You will likely already know what condition is causing the need for bowel resection surgery. You have probably been suffering pain and discomfort from a condition like Crohn's disease, ulcerative colitis, diverticulitis, or perhaps have discovered cancer or other bowel injury that requires a resection to treat. Your surgeon will explain exactly which section of bowel will be removed and why. Gaining a better understanding of the reasons behind your surgery will help you prepare for the changes that follow, such as changes in digestion, absorption of nutrients, and bowel habits.
Tip: Write down any questions you have before your appointments so you can get clarity on the procedure and any long-term impacts on your gut health and digestion. I carried a notebook to all of my appointments, and I'd jot down and questions or concerns I had whenever they popped into my head so I could easily reference them when it came time for my appointment.
Pre-surgery tests and assessments
You may need to undergo blood tests, imaging scans (such as CTI, MRI or a colonoscopy), or general health checks. All of these are important and should be treated as such; they will help your doctor understand your current state of health and the best treatment path. If you have inflammatory bowel disease, your doctor may also discuss how to manage inflammation before the operation.
Nutritional preparation and adjustments in medication
Malnutrition is common in people needing bowel surgery, especially if symptoms have been ongoing. Your care team may recommend a specific diet in the lead up to your surgery – perhaps a low-residue or low-fibre diet, or specific supplements to help your individual circumstances.
Tip: If you already have food intolerances, make a note of these so the hospital dietician can help with meal planning during recovery.
Preparing mentally and emotionally
There is a lot to take in with an upcoming surgery, and it can be daunting. If you know of anyone who has had a resection, see if they will speak to you about it and share their experience. This will help put your mind at ease and help manage anxiety.
If either of them are your thing, practice mindfulness or meditation, and write in a journal. Meditation and mindfulness can help you feel present, even when things are hard. Writing in a journal helps collect your thoughts and notice what feelings come up throughout your experience.
Search online for support groups. These are filled with people who have been through bowel resection surgery and can offer useful tips and support. Some examples
There are also likely in-person groups in your local area.
Packing list – items to make your hospital stay comfortable
The length of your hospital stay will depend on your surgical plan, medical insurance, or the hospital system where you live. These are all items that I found useful during my hospital stay. I would recommend gathering all of these as a hospital kit you can have beside you when you wake up.
- Loose-fitting pyjamas: Your abdominal section is likely to be quite sore or even extremely painful. It feels good to have some comfy pyjamas, but avoid anything with a tight elastic or waistband. Find something loose-fitting that won't put pressure on your surgical wounds.
- Power bank and phone charger: A power bank will make keeping your devices charged more convenient, since you may not be able to easily reach the power socket yourself. Using my phone to keep in touch with friends and support was key for me, especially since I was in the hospital during Covid times, when I could only designate one single visitor who was allowed to visit for the duration of my stay.
- Eye mask and earplugs: Hospitals are noisy places, and it's not always easy to rest there. There are machines beeping, nurses busy around the ward, patients needing support, and quite likely other people in the same room as you that will have consultations and medical support. The fluorescent lighting is bright and intense, too. A good eye mask and some decent earplugs will help you disconnect and enable better rest during your stay.
- Books, magazines, or other entertainment: Nobody needs daytime TV during a recovery. Bring your own entertainment so you can keep your mind blissfully occupied.
- Headphones: Listen to music or watch your favourite show on your phone or tablet. Bonus points for noise-cancelling or isolating headphones that do a better job of blocking out external noise.
- Comfort items: Especially if you know you will be in the hospital for more than a day or two, having a "feel good" item that gives you a sense of comfort and normalcy can be a blessing. It might be a favourite plush friend, or a small plant – whatever it is, if it brings you some joy and comfort, it may be worth bringing along. I was lucky enough to have some native flowers, which reminds me of the Australian bush and nature outside the clinical walls of a hospital room.
Pre-op diet restrictions
Your surgeon and medical team will give you specific instructions on what to eat in the days leading up to your surgery. It is important to eat a healthy diet in the lead up to keep your body humming along, and keep moving – exercise is important to help reduce your recovery time. It is also likely your body will lose some weight and muscle during recovery when you are not eating much or at all, so a good level of activity and even resistance training – as long as your surgeon has not said to avoid it – will help.
You may be required to go on a liquid-only diet and take some form of bowel preparation that will empty your bowel. This kind of preparation is also common if you are having a colonoscopy, but the version for surgery can be less intense. Be prepared to be nearby a toilet in the day or so leading up to your surgery. You will also likely be fasting on the morning of your operation.
Be sure to ask questions and get as much clarity as you need to feel comfortable with the instructions.
How long will I be in hospital?
As with many aspects of bowel resection surgery, the answer is 'it depends'. If your surgery is relatively straightforward and done laparoscopically, you may only be in hospital for a 3–7 days. If you had open surgery or a more complicated procedure, it may be up to a few weeks.
I was in hospital for a total of twelve days, but I had a few things that made this necessary: open surgery, which meant my wound was bigger and required more management; and an ileus (a blockage in the digestive system), that meant I was not able to digest food for days longer than expected.
In general the medical team will want to make sure that you can walk around independently, that your pain can be managed with painkiller tablets, you have experienced a bowel movement post-surgery, and your food and liquid intake is sufficient before they discharge you.
During surgery
On the day of your surgery, you will likely be nervous – and that's completely understandable. I've found most nurses are good at helping you feel at ease, talking you through what will happen and offering gentle words of support. Don't be afraid to ask for reassurance if you need it.
In the theatre there will be the surgeon, nurses, and the anaesthetic team. They are all there to help look after you during the procedure.
If you have any special requests, you can ask the surgeon right before you go in. I had a desmoid tumour in my abdomen, which is why I needed a resection. I reminded the surgeon before I went in that I wanted a photo of it, to see for myself what had caused such a huge disruption in my life.
What happens in surgery
There will be some variables to this based on your individual circumstances, but at its core an intestinal resection will involve removing a part of your damaged or diseased bowel and reconnecting the two healthy sections. This will create a shorter bowel that will still be fully functional – though it will take some time to find a new normal in the months after surgery.
The surgical team will keep you under anaesthetic and you won't remember any of it. They will connect drips and tubes to assist with the procedure, some of which will still be there when you wake up, until such time as they are no longer required.
In many cases of gut resection surgery, there are some unknowns when you go in – the surgeon will not know fully what things look like until the surgery has commenced. This means there are likely some variables you won't know about until you wake up, and this discovery can only be done when you are on the operating table. When you see the surgeon after you wake up and are back in the ward, they will fill you in on everything they found and did to correct it.
Try to relax, you are in good hands
As you prepare and ultimately go into the operating theatre, remember to breathe. Slow, calm breaths will help relax you and slow your heartbeat. You won't remember much beyond this until you wake up.
I was scared when I went into the theatre, despite the staff all being super friendly and explaining things clearly to me. You can hear a lot of preparation noise as you lie on your back, and while I wasn't concerned with the risks of surgery, there's a sense of the unknown, and the hugeness of what I was about to go through. I took some breaths, reminded myself that it was all going to be OK – one way or another – and waited patiently to be put under.
While surgery does carry with it some risks, the chance is very low. Your surgeon and support team should already have gone through this with you. Unfortunately no surgery is completely risk-free: remember generally things go completely as expected and this surgery is happening to save your health, and possibly your life. Medical staff spend years training to care for people undergoing surgery just as you are, and they will look after you.
After surgery
Waking up from anaesthesia can be confusing and hazy. Remember that the medical team will be there in the recovery ward when you awake, so you're in good hands.
Waking up from surgery
You will slowly come to, and things may be confusing for a short while. Someone will be there with you as you wake up, to check in and see how you are feeling. There may be some pain, but they will also have options for you here. I had a button I could press to dispense pain killers, and to be honest I needed it. If your surgery couldn't be completed laparoscopically, this pain will be more intense.
You may have a combination of tubes, drains and IV fluids connected to you. These are to help with pain, hydration, and taking fluids away from the site of your wound. You may also wake up with a nasogastric tube – which will extract food and liquids from your stomach before they can enter your digestive system – and a catheter – to take your urine automatically so that you do not need to go to the toilet on your own.
All of these things can be quite uncomfortable, but are not uncommon discomforts. Tell a nurse if you are feeling discomfort or are unsure about something. They will be able to help reassure you or possibly adjust something to make you more comfortable. Over the coming days as you begin to recover, these will gradually come out one by one, and you will get your body back.
You will get visits from nurses, pain specialists, and your surgical team within the first day after surgery. Ask any questions you need, and again make sure to mention any particular discomfort you are noticing – some of it will be expected and may not be helped, but some can be addressed.
Your first fart – a key first sign of healing
That's right, passing wind is a sign that things have gone well. You will never have a more victorious fart in your life than the first fart after a bowel resection. This might sound like a ridiculous statement, but it's true. Why, you ask? A fart means that gas can pass through your resected and healing bowel, which means that the surgery was successful and a proper seal was created during your operation.
Go easy – don't force it out. But when it comes, stop and celebrate that victory, because passing wind is a notable step in the healing process.
First few days
At some point, and if all thing are going well, you will start reintroducing fluids, and then soft foods. If you had a nasogastric tube, this will be removed when they are satisfied things are healing well. Take note of how the food and fluids feel, and report any concerns to your medical team.
I was unlucky in my recovery and I developed an ileus – a blockage that prevents food from moving from moving through the digestive tract. They can be very painful, and in my case occurred because the tumour I had removed was connected to my duodenum, and its removal had caused inflammation around that area.
Your pain may be intense – particularly if you have open surgery – and some painkillers feel absolutely awful. There are usually alternatives, so be sure to mention how you are feeling to your pain specialist or nurse so they can suggest other options. I was on opioids at first and they make me feel terrible: I was itching all over and felt really gross. Thankfully they were able to change my medication to Fentanyl, which was much better.
Moving your body, and discharge criteria
Your nursing team should be encouraging you to get up and move as soon as you can after surgery. This is especially important with major abdominal surgery to keep blood flow to your legs. Take it slow and easy: try and do a lap around the ward when you can. The sooner you start moving, the better your body will heal.
In my own case, the first time I could get out of bed felt like a huge win – even though it was painful. Those first laps around the ward were slow and challenging. Each time got a little bit easier, and I took the opportunity to really feel that the movement I made was one small step in my road to recovery.
Being able to move about on your own – as well as having bowel movements, eating food and drinking fluids, and a pain management plan at home – will determine when you are ready to be discharged to continue your recovery at home.
Tip: Hospitals and their food are not necessarily geared towards supporting the recovery of your gut, which is going to be more sensitive for some time after your surgery. Take steps yourself to introduce foods that will help your healing digestive system.
Recovery at home
Whether you're in hospital for a few days or a few weeks, eventually you will get to return home. The comfort of your own bed, freedom from the incessant beeping of medical machines, and the peace of not being disturbed at 2am for another blood pressure check will kickstart your recovery with new found speed.
Emotional ups and downs
It is natural to feel a bit down and out after surgery like this. It will, after all, reshape your digestive life in ways that you won't fully come to know for months afterwards. What felt normal before might feel entirely different, and you may feel the loss of the digestive life you were able to live before. There may be a sense of loss or grief. That's OK, and perfectly normal. Go easy and be kind to yourself in the days ahead.
The physical side of things will take some getting used to also. The pain and discomfort may be a struggle. Right before my ileus finally cleared was one of the lowest points I have ever been through. I had suffered through days of intense pain (including vomiting with a huge abdominal wound), fighting to have enough fluid movement for tubes to come out, having a nasogastric tube reinserts when the blockage began,
Remember: it will pass. One bite, one sip, one fart, one breath at a time.
Physical recovery
Your medical team will instruct you on how to best care for your wounds. Make sure you keep them clean and follow all instructions they provide you. Keep an eye on redness or swelling that might indicate an infection. If you notice something strange, speak to your medical team early rather than letting it develop further.
Keep moving as you can. If you have a large surgical wound, be careful stretching or lifting above your head – again, your medical team will give you instructions on how best to support your healing wounds. Go for walks outside when and as you can, and take a support person if possible to help if you get tired. Walking was one of the best things I did during my convalescence. You get the sun on your face, see some trees and flowers, hear the birds singing, and bring some light movement to your body. Try and avoid just staying in bed or on the couch – your body (and mind) will thank you for it.
Digestive changes and nutrition adjustments
You will have already noticed the changes in your bowel movements during your hospital stay, and these will continue over the coming weeks and months until things gradually return to a new normal. Some things you can expect:
- Increased frequency of bowel movements: There is no sugar coating it: you will need to go more often. I remember having at least eight bowel movements a day in my first days at home. Don't forget that certain foods such as chilli or caffeine will exacerbate this, so be careful what you put into your gut at the beginning.
- Urgency in bowel movements: 'I need to go' might become 'I need to go now'. Experiencing increased urgency in needing to go to the toilet is normal. Having a toilet nearby and preferably one that you won't need to kick someone out of at a moments' notice will be a godsend.
- Pain or discomfort: This changed significantly for me post-surgery. The best I can describe it is that it feels like you're cramping around your rectum somewhere. This should improve in time, but things will feel uncomfortable for a while. You may also experience some grazing or pain from wiping your bum too often. You can get soft, flushable wipes to help with this.
- Loose or inconsistent stools: The consistency of your poo will likely be different. For me it was way more watery and mostly diarrhea, but depending on the surgery you had it may, err – return to form – sooner than later.
- Sensitivity to certain foods: Be careful of the kinds of things you eat in the first days of being home. I found that caffeine, chilli, or anything overly fatty or greasy caused huge issues and discomfort. Introduce foods slowly and carefully and monitor how you go.
It's worth carefully considering the foods you eat and looking to keep things simple for your healing gut. I focused on simple foods – fermented where possible – and starchy carbs that wouldn't irritate my gut. Avoid caffeine, excess sugar (though a little certainly feels like a nice treat), and chilli. Consider some gentle oats to help things move slowly and give you some slow-digesting carbs, fibre, and digestive support.
Building strength and the road to full recovery – how long will it take for me to fully recover from a gut resection?
When you reach your version of full recovery will vary greatly depending on the type of surgery you have had, and how you support yourself during recovery.
A friend who had a laparoscopic bowel resection of the large intestine was back to relative normal within a month, while I – sporting a 20cm abdominal wound from removing a large tumour, and having an ileocecal resection – had to recover for about 18 months to reach my new normal. Most people are reasonably recovered and driving within 6 to 8 weeks.
Keep moving your body, and reintroduce normal activity and the foods you enjoy gradually. Keep track of how you feel, and what things trigger digestive issues or irregular bowel movements for you. Nourish yourself, include good fibre, and look for nutritional tools and healthy foods to support your gut.
Long-term considerations
Some changes to your digestion will be permanent, such as increased urgency to poo or a higher frequency of bowel movements. This will be part of your new normal, and it is helpful to keep this frame of reference rather than hoping or expecting things will go back to how they were before.
Depending on how much gut you had resected, you may experience malabsorption issues or certain nutrient deficiencies. I myself ended up with Vitamin D, B12 and Iron deficiencies after losing 80cm of my small bowel. Speak with your doctor or surgeon about regular blood tests and work with them to develop a treatment plan to support you.
Make sure to attend follow up appointments and continue getting any tests or scans to ensure you don't experience a recurrence or worsening of your condition.
You will carry scars from this experience, both in the physical sense on your body, as well as mentally and emotionally. If you are experiencing grief at the loss of the life you had before, or any other struggles with your mental health, consider seeing a therapist for support.
You might feel a loss of confidence in your body image, which is completely normal. After all, what was once smooth skin is now marked with scars. It's natural to feel some insecurity around this, or even grief for the body that was.
I have found it helpful to reframe the scars I bear as a reminder that I have healed from a situation that could have even more adversely impacted my health. The scars help me to be grateful for the gut and health I do have, not the one I wish I had. If I didn't get my tumour removed when I did, I would likely have lost even more of my bowel and possibly had significantly worse health complications.
Personal tips, and what I learned
My surgery was a huge journey, and yours may be too. You will have your own experience, but these are a few things that I found help or that I learned through my process.
- Your medical team are there to support you. They are experts in their field, and they've got your back. Trust their expertise, but also ask as many questions as you need to feel comfortable.
- Keep a recovery journal or symptom log. This is helpful to reference when you see your surgeon or doctor, and helps you learn your new patterns and digestive triggers over time.
- Your gut is an unsung hero. Take the time to appreciate what it does for you, silently, every second of every day. I didn't stop enough to appreciate my gut for this, and now I do.
- There will be hard moments, but they will all pass. Yes, I know it's typical mindfulness talk, but it's also true. You will experience pain, discomfort, and frustration – and all of that will eventually pass. One day you'll look back on this and it will be a memory, not the immediate feeling you have right now.
Less gut, more understanding
Whether you've had a small bowel resection or large, a colectomy or colon surgery, I hope these insights and tips can help you navigate what can be a major transition in your life.
Remember that recovery is a process, not a race. Be patient. It takes time to heal from this significant surgery. Advocate for yourself with your medical team, and make sure to care for and nurture yourself as you would anyone else you love.
If your surgery is coming up, you're already doing the right thing in reading this: you are arming yourself with knowledge on what to expect and how to plan for your operation and recovery. Learn all you can, and seek answers to all of the questions you have to help yourself feel more comfortable.
If you have had this surgery and are now in the stages of recovery, you are doing great and I believe in you! Remember, one step at a time – slow and steady wins the race.
No matter what surgery you've had, remember this: the pain and discomfort of surgery will pass. You will find a new normal, and you will discover new ways to feel in tune and in harmony with your resected gut. You will find ways to nurture your body through nutrition and habits. You will come through this, and you will learn a few things about yourself along the way.
If you've been through this surgery, I'd love to hear from you. Share your experience and tips int he comments.
I'm cheering you on from the east coast of Australia, wishing you peaceful bowel movements and a harmonious microbiome.
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