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Colorectal Surgery Instructions

Your surgeon has determined that you are a good candidate for our Enhanced Recovery after Surgery (ERAS) Program. This program uses the best practices in surgical care.  It will help you recover and get home as quickly and as safely as possible after your surgery.  Please read this handout carefully to get the most out of the ERAS program.

The Colorectal Surgery office phone number is 415-885-3606.

Our Approach to Recovery

Your surgical team will: 

  • Use the most modern anesthesia methods
  • Promote return of bowel function as quickly as possible
  • Use best practices for diet, bowel preparation, antibiotics and hydration.
  • Encourage YOU to ambulate (walk and move around) soon after surgery
  • Provide non-narcotic alternative medications effectively treat pain.
  • Help you start drinking and eating soon after surgery with easy-to-digest liquids and foods 

Why Is This Important?

  • Simple things matter !!
  • Common yet serious complications can be prevented by simply getting out of bed, sitting in a chair and walking
  • Following these simple steps can help prevent:
    • Pneumonia
    • Blood clots
    • Bed sores
    • Prolonged “sleeping bowels” or ileus 

At Home Before Your Surgery

  • Continue regular exercise up until the date of your surgery. This is discussed in the next section.
  • If you smoke, quit today. Quitting smoking is the best way to avoid breathing problems! Quitting smoking will help you heal!
  • UCSF MyChart is web portal that provides an easy, confidential way to stay in touch with UCSF Medical Center providers. This is a secure online resource to communicate with your providers. You can sign up for the service at UCSF MyChart.
  • A week before surgery you will receive a phone call from the PREPARE clinic to set up either a phone consult or in-person pre-operative clinic appointment. The number for the PREPARE clinic is 415-885-7670 in the event you need to schedule a visit.
  • Call your surgeon's office to confirm where your operation will take place: 1) Moore/Bakar Hospitals at UCSF Mission Bay OR 2) Moffitt-Long Hospital at UCSF Parnassus?
  • Purchase Boost Breeze or Ensure Clear (a nutritional drink) as you have it to drink before you come to the hospital. (See "The Day of Surgery" below).
  • Purchase sugarless gum or hard candy for use after your surgery.
  • Arrange to have someone take you home after you are discharged. This its typically two to three days after surgery. 

Exercises Before Surgery that Aid in Recovery

Please click here for a printable version of these exercises.

Walking

  • At least 20 minutes, 5 times a week                      
  • This should be in addition to normal activity 
Running


Mini squats

  • Stand at counter, using fingers for balance as needed
  • Place feet hip width apart
  • Sit down and back as if you are sitting in a chair
  • Do not let your hips drop below your knees
  • Repeat 10 times, 2 times/day 
Min Squats


Heel Raises

  • Stand at a counter, use fingers for balance as needed   
  • Raise up on your toes, lifting heels off the ground
  • Stay for 1-2 seconds and SLOWLY lower your heels
  • Repeat 15 times, 2 times/day
Heel Raises


Single Leg Stance

  • Stand at counter, using fingers for balance as needed
  • Lift LEFT leg and hold for 30 seconds
  • Lower and repeat with RIGHT leg
  • If that becomes too easy, try holding your balance
    without using your hands, or close your eyes
  • Perform 2 times/day for 30 seconds on each leg 
Single Leg Stance



The Day before Surgery

  • Do one of the following as previously instructed:
    • Bowel prep with Golytely or equivalent
    • Bowel prep with Fleet’s enema
    • No need to do any bowel prep
  • If you have any questions about this, promptly call your surgeon's office.
  • Shower the evening before or morning of surgery with either Dial Antibacterial or chlorhexidine soap (Hibiclens). Wash your entire body.
  • Do not use chlorhexidine (Hibiclens) on your face because it can damage your eyes. These soaps are available at most drug stores (for example Walgreens, Target, Wal-Mart, CVS, or Rite Aid).
  • The day before your surgery you should have no solid food, and have only clear liquids, which you may drink up until 2 hours before you arrive at the hospital.
  • Clear Liquids are limited to the following:
    • Clear Broth
    • Clear juices such as apple, cranberry and grape. (No orange juice)
    • Jell-O
    • Popsicles
    • Coffee/tea (with no milk or cream)
  • Wear comfortable clothing
  • Leave all valuables at home.
  • Wear your eyeglasses and bring a case. (no contact lenses)
  • If you become sick before  surgery (fever, cough, sore throat, cold, flu, infection), please call your surgeon and the Mount Zion Adult Prepare Clinic at 415-885-7670.
  • You may bring toiletries if desired; otherwise the hospital will provide them.
  • DO NOT bring your medications to the hospital unless specifically instructed to do so.
  • BRING a list of your medications including dose(s) and times you take them.
  • BRING TWO forms of ID - including one ID with a photo. 

Activities and Exercises After Surgery

Patient ERAS Program Visual 11 2014

The Day of Surgery

Surgery at Mission Bay (Moore/Bakar Hospitals)

  • Arrive at 1855 Fourth Street, San Francisco. Check in on the 2nd floor at the adult surgical waiting (Room A 2460) at the assigned ARRIVAL time (two hours before the scheduled surgery). Admitting will direct you to the Pre-Op Nursing Station. Phone # (415) 476-0989. 
  • Check in at Admitting, Room #A108 at assigned ARRIVAL time (two hours before the scheduled surgery).
  • Staff at admitting will direct you to the Pre-Op Nursing Station on the third floor. Phone: (415) 885-7363

Surgery at Parnassus (Moffitt-Long Hospital)

  • Arrive at first floor of Moffitt-Long Hospital, 505 Parnassus Avenue and check in at the admissions office. From there, you will be instructed to got to Pre-Op area on the fourth floor. 

What to Eat and Drink

  • Drink 1 container (8 ounces) Boost Breeze or Ensure Clear 2 HOURS BEFORE ARRIVAL at the hospital. For example, if arrival time at hospital is 6 a.m., drink the Boost Breeze at 4 a.m.
  • If you have diabetes, drink only half the container (4 ounces).
  • Boost Breeze is also available available at most Bay Area pharmacies. It comes in 8-ounce containers and costs approximately $2.50 each for each flavor: wild berry, orange and peach. Alternatively, you may purchase Ensure Clear which is more widely available. These special drinks provides your body with energy during the operation. .
  • If you have been instructed to take any medications the morning of surgery, take them with a small sip of water. 
  • You should have nothing else to drink after the Boost Breeze/Ensure Clear liquids. If you eat or drink after that time, your surgery may be canceled or delayed 

After You Arrive for Surgery

  • You will receive IV fluids
  • A warming blanket will keep you warm to help prevent infection after surgery.
  • You will learn to use incentive Spirometer, a breathing exerciser.  This can help prevent pneumonia. It is important to use it on your own to help with your recovery.
  • You will sign a consent form for surgery and the possibility of a blood transfusion.
  • If you think you might be pregnant, tell your surgeon or nurse.
  • You may have an epidural placed before the surgery to reduce postoperative pain.
  • You may have an anti-nausea patch placed behind your ear.
  • You will receive two or three pain medications to help with pain control.  These pills include:
    • - Gabapentin: Blocks nerve related pain
    • - Acetaminophen (Tylenol)
    • - Diclofenac:  Anti-inflammatory pain medicine 

Post-Operative Period

Post-Op Day 0 (The Day of Surgery)

  • You will get out of bed with assistance on the day of surgery itself. Getting out of bed can reduce complications.
  • Staying active is the most important thing you can do to facilitate your recovery
  • You will most likely be provided with a PCA (Patient Controlled Analgesia) pump to help with pain control, which. your nurse will show you how to use.
  • A urinary catheter (which was put in while you were asleep) will be removed the day after surgery.
  • Unless instructed otherwise, it is fine for you to take clear liquids and chew gum or hard candy including:
    • Clear Broth
    • Clear juices such as apple, cranberry and grape.
    • Jell-O
    • Popsicles
    • Coffee/tea (no milk/cream)
  • You may drink liquids as you like, but do not push yourself to drink.  If you become nauseated, stop drinking and inform your nurse. 

Post-Op Day 1 (First Day After Surgery)

  • GET UP AND GET MOVING!  This is extremely important after surgery.
  • You will be provided with a "Postoperative Activity Record" to track of your progress. Please use it. Click here for a printable version.
  • Plan on walking at least five times a day and sit in a chair for at least six hours.The first time you walk will be with your nurse.  Your nurse will tell you when you are safe to walk by yourself.
  • Getting out of bed, sitting, and walking will help with breathing, circulation, bowel functioning and your overall well being.  It may even REDUCE PAIN!
  • Activity will not damage the surgical area.
  • Staying active is the single most important thing you can do to aid in your recovery and prevent complications.
  • Use the incentive spirometer 10 times every hour you are awake. 
  • The urinary catheter will be removed in the morning. If the catheter has not been removed by noon (and you have not been given a reason), please inform a member of your healthcare team.
  • Unless your surgeon tells you otherwise, it is OK for you to eat soft foods the day after your surgery.
  • Initially, small frequent meals are usually best after abdominal surgery, but don’t force yourself to eat.
  • Inform your nurse if you have nausea.
  • Once you have begun to drink liquids, you will be given medication for pain. The pills work best when taken regularly, so request another dose to avoid the pain worsening.
  • We try to keep you comfortable after your surgery, but expect some discomfort as you move about. We try to balance minimizing pain and avoiding the side effects of the pain medication. Expect soreness after surgery, but let your healthcare team know if you need more help to control your pain.
  • Assist your nurse in recording how much you eat and drink and how much you urinate.
  • You will be provided with an activity journal.  Fill it out with pride! 

Post-Op Day 2 (Second Day After Surgery) 

  • Your epidural catheter will probably be removed this morning. Pain should be well controlled with pain pills. Soreness is to be expected but it should not limit your ability to be active.
  • Write down questions to discuss with your team. Your nurse will go over instructions with you.
  • Continue to walk at least five times daily and have a family member help you if needed. 
  • Remember: Even when at home, you are only phone call away from your care providers at UCSF. 

At Home After Discharge

  • Make an appointment to see your surgeon 2-4 weeks after surgery by calling (415) 885-3606 or scheduling one through MyChart.
  • If you develop any of these symptoms, please call our office at (415) 885-3606:
    • Fever of greater than 101.5°F
    • Nausea or vomiting (especially if you are unable to keep liquids down)
    • Severe pain at the incision
    • Pus or foul smelling drainage from the incision (thick, dark yellow drainage)
    • Persistent diarrhea or more than 10 bowel movements in 24 hours
    • Inability to urinate after 8 hours
    • Experience dizziness, lightheadedness, or extreme fatigue
    • Bright red blood from the incision, rectum or ostomy (greater than 1 cup).  (A small amount of bleeding may be normal, depending on your surgery.) 

Call 911 Immediately If You Develop Any of the Following:

  • Chest Pain
  • Sudden Shortness Of Breath
  • Fainting and/or Loss Of Consciousness.

Physical Activity (unless otherwise instructed)

  • No lifting greater than 10 pounds for 4 weeks to avoid developing a hernia at the incision.
  • No driving while on narcotic pain medication.  Avoid driving for at least the first week after surgery.
  • It is normal to feel tired; you may need to take naps or rest during the day.
  • You may walk flights of stairs, perform non-strenuous activities, ride in a car and shower
  • Continue to walk frequently and increase you stamina! 

Diet

  • Small frequent meals may be more easily tolerated after abdominal surgery.   Avoid large meals.
  • Drink plenty of fluids. Avoid caffeine, alcohol and fluids with high sugar content because they can cause increased urination, diarrhea, and dehydration. Water, Crystal Light and/or sports drinks (Gatorade) are good choices. Sugar free or low sugar sports drinks are better. 

Pain Control

  • Pain from the incision is normal. The pain will vary with activity, but should decrease over time.
  • Mild crampy abdominal pain and bloating are normal. This should improve slowly. Eating several small meals instead of a few larger meals will help prevent bloating.  Walking before and after meals will also help.
  • Pain medication can sometimes cause constipation.  Drink plenty of fluids and take stool softeners and/or laxatives as instructed. Stop taking stool softener if you develop loose stools.
  • Take your pain medication only as prescribed.
  • Narcotic pain medications are best for major pain. Narcotic pain medication can affect your ability to think clearly, drive or operate machinery. Do not drive if you are taking narcotic pain medication. Do not take with alcohol.
  • Non-steroidal anti-inflammatory medications (NSAID’s), such as ibuprofen, may be prescribed and are good for minor pain and will not alter your ability to think clearly. Common brands are Advil®, Motrin® and Aleve®.
  • Acetaminophen - Tylenol® is also an excellent pain reliever for minor pain.  Do not take Acetaminophen while taking Percocet® or Norco® or other medications that contain Acetaminophen.  Taking more than 4,000mg of Acetaminophen in 24 hours can cause severe liver damage.
  • If your pain becomes progressively worse, or if you develop nausea and vomiting call your surgeon’s office. 415-885-3606

Bowel Movements 

  • After abdominal surgery your bowel movements (BMs) may not be regular.  You may have loose stools or constipation.  Your surgeon may send you home with medication or recommendations to help with these problems. 

Urination

  • You may experience some mild burning with urination, which will improve in time.  If the burning persists, you have difficulty urinating, or you urinate small amounts often, call your surgeon’s office.  If you went home with a urinary catheter, please make sure that you have a follow up appointment for the catheter to be removed. 

Sleep

  • You may find you don’t sleep as well after surgery and being in the hospital. This will get better with time. We do not usually recommend sleeping pills unless you were taking them before surgery.

 Incision Care

  • Unless told otherwise, you may shower. However you may not take baths, sit in a Jacuzzi or hot tub or swim until your surgeon gives the OK.
  • The incision does not need to be covered.  If there is a small amount of drainage, cover the area with gauze to protect your clothing and prevent rubbing.
  • A small amount of yellow/red/clear drainage from the incision is normal.  If you notice thick, dark yellow drainage or, foul smelling drainage or redness at or around the incision (like a spreading sunburn), please call the surgeon’s office as this may indicate infection, especially if you have a fever over 101°F.
  • Most healing takes place by 6 weeks after surgery. The scar  will continue to soften, and the skin will become lighter in color over the next year. Keep your incision covered from sunlight for the first few months, or use sunscreen to protect your newly healed skin from sunburn.

Drain Care

  • If you have have been sent home with a drain, your nurse will teach you how to care for it.
  • After the drain has been in place for three days you may shower, and change the dressing. Do not take a tub bath or swim.
  • Please check the skin around the tube. If the skin becomes red, tender or you notice foul smelling thick drainage from the skin, please call your surgeon.  A little redness and a small amount of clear to pink drainage are normal.
  • You will be sent home with instructions, a medication list and prescriptions.  

Required Activities After Surgery

  1. Use your incentive spirometer (ICS) once per hour while you are awake to prevent pneumonia
  2. Sit up in the chair every 2 hours that you’re awake to prevent pneumonia and pressure ulcers
  3. Walk 5 times per day to prevent pneumonia and to get your bowels moving
  4. Chew gum 4 times per day to help get your bowels moving

Activity Record - Celebrate Progress!

Please click here for a printable version of the activity record.


Today's 
Date: ___________________________________


Date of Surgery:  ________________________________

What time did you take your first walk? ___________ a.m.____  p.m.____


Did you require help to take your first walk?  Yes _____ No ______

Place an "x" in the applicable box each time an activity is completed.

Activity Record - Celebrate Progress!

If you have questions please call your surgeon at (415) 885-3606.
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