Rebuilding and strengthening your abdominal muscles following stoma surgery is a hugely important part of the healing process. Being active helps speeds up your recovery and exercise is encouraged as it helps you get back to normal. It also has some great health benefits, people who exercise tend to sleep better, have stronger bones and experience lower levels of stress and depression.
It’s hard to know how much you should exercise following surgery but starting slowly with gentle exercising is better than doing nothing. Exercising whilst you are recovering from surgery might be the last thing on your mind, as you’re more likely to feel like resting with your feet up and reflecting on what you have just been through. Be kind to yourself, recuperating slowly is so important on the road to recovery. Those first few weeks after surgery are about taking things slowly, however you do not need to be bed bound, it is good to keep moving and slowly/gently walking around your home.
For others, who are keen to get back to their usual activity after stoma surgery, it’s important to recognise that you need to heal first. Don’t try any traditional abdominal exercise immediately after surgery. Attempting sit ups or crunches for your abdominal muscles after surgery may pull apart the stitches or staples holding the incision/wound together, requiring more surgery and hindering your process.
What are core muscles?
The abdominal area, together with the spine, is often considered the core of the body. The abdominal (stomach) muscles through which the stoma protrudes, are part of this core. Strengthening the core of the body through exercise can lead to better posture and increased body awareness. Core exercises may also help you reduce the risk of developing a hernia around the stoma (parastomal hernia).
Pelvic floor muscles form the base of the core, these muscles work with the deep abdominal muscles and the diaphragm to support the spine and control the pressure inside the abdomen (tummy). Following stoma surgery these muscles can also be affected, which may then lead to issues with urinary or faecal incontinence, back pain, and sexual issues.
Why strengthening your core muscles is important?
During stoma surgery an incision (cut) is made through your abdominal wall and muscles, to allow the bowel to be brought to the surface of the abdomen to create a stoma. This incision therefore weakens the muscle in this area. If the surrounding muscles are not strengthened and supported, a loop of bowel may protrude through the muscles and form a bulge under the skin. If this happens, it is known as a parastomal hernia. Parastomal hernias are quite common for ostomates and often cause discomfort and inconvenience.
When to start exercising?
Knowing when to exercise after surgery is a key to recovery and is also dependent on the type of surgery you have had (eg: keyhole versus open). It is important to check with your surgeon following your surgery as to when it is safe to start exercising. It is wise to avoid any heavy lifting/pulling/pushing or strenuous activities or exercise during the first 12 weeks after surgery. If you are not sure what you can do, discuss with your Stoma Care Nurse who will provide guidance.
Straight after surgery: Mobilising is a huge step in recovery and will be expected of you in the first few days following surgery. You will be expected to walk regularly, slowly increasing the distance you can go. Remembering to do a few gentle exercises can have huge health benefits and can help prevent post operative complications.
Deep breathing exercises can help increase the blood and oxygen flow to your lungs to prevent chest infections. Gently mobilising and flexing your ankles and feet whilst you are sat in a chair can help with your circulation, which helps prevent any DVT’s (Deep Vein Thrombosis/clots in the legs). Light exercises can aid in the recovery of your bowel function and can also increase blood flow to your wound, helping with healing. Other important benefits are the feel-good factors of exercising which can help you to feel focused whilst having a positive effect on your well-being.
Many hospitals have ward-based physiotherapists who can guide you on simple strengthening exercises that can be started immediately post-operatively.
After 2-3 weeks – Slowly build on the amount of walking you are doing. Remember wherever you walk to, you have to get back…. don’t do too much, too soon! Try to go up and down the stairs.
4-6 weeks – Your abdominal/tummy muscles will gradually strengthen over this time. Aim to be walking for 30-45 minutes per day by 6 weeks after surgery. Some people find starting with a gentle Pilates class with an experienced instructor helpful. They can guide you to focus on engaging your core muscles and slowly building on the exercises, post operatively. You’ll be shown gentle core tightening exercises such as pelvic tilts and knee rolls.
6-12 weeks – By this stage, you will usually have seen your surgeon for your post-operative follow up appointment, so it’s a good time to ask how much exercise is now safe to introduce. At the 6-8 week stage all your stitches will have been removed or dissolved and people often introduce swimming which is a good exercise for toning and strengthening. Having a stoma shouldn’t stop you from enjoying a swim…however it is not a good idea to swim if you still have any open wounds or wounds covered with dressings.
When you get the go ahead and are starting to exercise, here are some tips which you may find useful:
- Wear comfortable clothing and footwear
- Empty your stoma pouch before you start exercising
- Try to exercise at the same time and day of the week, so that it becomes part of your routine
- Drink plenty of water before, during and after each session
- Be aware of your physical restrictions, such as avoiding contact sports too soon after surgery
- Consider getting a support belt or stoma shield from your Stoma Care Nurse, to protect your stoma
- Don’t push yourself
- Stop if you experience any pain
- Maintain a healthy diet
There are a few things you can try that will help reduce your risk of developing a hernia, or prevent a current hernia increasing in size. Make sure the muscles are fully supported when they are being used and avoid any unnecessary strain. Support your wound and stoma when coughing, laughing or sneezing. Lifting, pulling or pushing heavy objects should be avoided, especially during the first 12 weeks after your surgery.
Support garments can also help hold the abdominal muscles in place. It is a good idea to wear a support garment when you are exercising or doing something strenuous such as carrying shopping, doing household chores or gardening. Light support garments can be purchased on the high street or from specialist ostomy wear manufacturers. If you require a firmer support garment – available on NHS prescription, speak with your Stoma Care Nurse and they will be able to measure and fit you with one of these.