About the Author

Charlotte Foley, MS OTR/L, CBIS, received her Occupational Therapy degree at Boston University and began her career in the adult Inpatient Rehabilitation setting. She now works in the adult Acute Care setting at Providence Alaska Medical Center in Anchorage, Alaska. Because of her own personal and professional experience, Charlotte founded and runs her own education and consulting business, Restorative Ostomy Solutions, to empower a better physical recovery for individuals following ostomy surgery.

Charlotte has received compensation from Coloplast to provide this information.
 

Physical recovery from ostomy surgery is multifaceted. It involves the innate ability of the body to heal, and active participation of the individual recovering from surgery to engage and participate in the process. The greater the structures in place to support physical recovery from ostomy surgery, the better quality of life that an individual will have. In addition to the wound and structural healing required following surgery, there are four categories of physical rehabilitation that should not be overlooked:

• Breathwork
• Early Mobilization
• Core Rehabilitation
• Lifestyle Management

Proper breathing is vital in physical recovery, not only at the cellular level for the delivery of oxygen rich blood to the healing surgical site, but also because of the functional implications on the body. The goals of breathwork following surgery include: decreasing intra-abdominal pressure (IAP), coordinating the inner core, and improving cardio-pulmonary function. Breathwork training such as diaphragmatic breathing, coughing techniques, and breath coordination during functional movement can assist with ensuring the surgical site remains intact. It can also decrease risk for parastomal hernia, musculoskeletal issues, pelvic floor dysfunction, and post-operative pulmonary complications.

If possible, a walking program should be initiated the day of surgery. Walking after surgery is important for the heart, lungs, and digestion. It is also an excellent place to begin strengthening the core following surgery, if performed in a skilled manner. Walking should be initiated on flat ground so as not to increase IAP and strain the surgical site. Incorporation of hiking poles can improve muscular endurance, neuromuscular connections of the core, and overall individual confidence (Hanuszkiewicz, 2020). Walking program progression can be evaluated on an individual basis, and in cases where walking is not an option, alternative early mobilization is advised to ensure similar positive outcomes to those who are more mobile.

Current guidelines recommend to “commence gentle abominable exercise 3-4 days after surgery” (ACSN clinical guidelines). Despite this recommendation, research shows that “87% of patients did not do any core/abdominal exercises at all and 83% were not advised to by their nurse or surgeon” (Russell, 2017). This discrepancy between what is being advised and what is being practiced is notable, but not all that surprising due to the complexity of ostomy surgery and the fear of increasing complications following surgery. However, despite this fear, the benefits of strengthening the core are undeniable. Exercises can specifically target the core, such as pelvic tilts and knee rolls, but they can also include manual techniques such as scar mobilization, myofascial work and visceral manipulation.

In addition to targeted exercises, physical rehabilitation can be viewed in the context of daily tasks, such as transitioning in and out of bed, standing and sitting, and physically being able to manage the ostomy. Implications on sexual and pelvic health should also be considered because of the connection of the abdomen to the pelvic floor. Finally, the impact of coping with such a significant life event should be taken into account in regard to impact on physical recovery from surgery.

Overall, impacts of surgery on quality of life are numerous, and physical recovery can impact an individual’s ability to engage in daily activities in the home, community, work environment, and leisure settings. However, significant abdominal surgery post-op complications can be mitigated by an interdisciplinary approach to care that involves Occupational Therapy (OT) and Physical Therapy (PT). If you are looking for more information on the topics outlined above, don’t hesitate to reach out to your local OTs and PTs, as they are trained in the pertinent skills to support physical recovery and quality of life following surgery. ●

References

Association of Stoma Care Nurses (2016). ASCN stoma care national clinical guidelines. Retrieved from https://ascnuk.com/_userfiles/pages/files/national_guidelines.pdf

Hanuszkiewics, J., WoZZniewski, M., & Malicka, I. (2020). The influence of nordic walking on isokinetic muscle endurance and sagittal spinal curvatures in women after breast cancer treatment. Acta of Bioengineering and Biomechanchics, 22(2), 47-54. DOI: 10.37190/ABB-01545-2020-02

Russell, Sarah (2017). Parastomal hernia and physical activity. Are patients getting the right advice? British Journal of Nursing, 26(17), S12-S18.