I often get asked about bowel movements after colon or abdominal surgery, so I decided to address the issue on my blog. In any surgery that involves making an incision in the abdomen, the bowels need to be moved or packed out of the way to get to the organ of interest. The small bowels are free-floating in the abdomen and are generally the first structure to be encountered in abdominal surgery. Once the bowel is manipulated during surgery,  its normal migratory pattern also known as peristalsis is temporarily altered. The movement of the bowels become dyscoordinated and ineffective. What this means to you is that the bowel does not move gas or liquid through and bowel contents can accumulate in the stomach. Air and fluid in the stomach can cause hiccups, nauseau, and sometimes vomiting. In anywhere from two to seven days, the bowel regain their normal motility pattern and begin to move things through and produce a bowel movement.

Some things that your surgeon may do while your "stunned" bowels are recovering is to  place a nasogastric or NG tube. This tube which goes from your nose to your stomach suctions out the accumulated fluid out of your stomach. Keeping your stomach empty and preventing its overdistention can alleviate the nauseau and hiccuping that can occur. You will often be maintained on IV fluids to keep you hydrated. And most importantly, but often the most discomforting for patients is that you will be kept NPO (nothing per os) meaning you will not be allowed to eat or drink anything except for maybe an ice chip or two and perhaps a sip of water. Bowel rest is needed to allow your intestines to recover. In addition, if you attempt to eat or drink anything, you will often vomit because the bowels are not moving things through. Patients will often ask where does this fluid and air come from when you are fasting. Believe it or not, even during fasting the bowels produce approximately one to two liters of fluid a day.  Also, we swallow air regularly while talking, swallowing saliva, etc. Air is often the way your surgeon knows that your bowels have recovered and it is safe for you to start eating. As mentioned earlier, air is swallowed on a regular basis often while talking. That air enters your stomach and works its way through the small and eventually large bowel. It emerges as a "fart" once your bowels have regained their full function after colon surgery. Air will usually precede a bowel movement and signals to your surgeon that you can start oral intake, usually in the form of clear liquids: soup, jello, etc, followed by solid food. Patients often view fasting as a bigger insult to them than the incision they have on their belly, but most Americans can generally tolerate not eating for up to a week. Bowels generally "wake up" between two to seven days, but can in certain situations take longer. Delayed return of bowel function can occur due to a history of multiple surgeries, Inflammatory bowel disease, i.e. Crohn's Disease and Ulcerative Colitis, a large hematoma, abscess,  or scar tissue. A computed tomography (CT) scan of the abdomen can often help elucidate the problem. TPN (total parenteral nutrition) is an intravenous (IV) solution of nutrients and minerals that can be given during periods of prolonged bowel rest, usually greater than one week.

Nothing has been proven definitively to stimulate the bowels to wake up faster, however some studies have suggested that early ambulation (getting up and wlking around) and chewing gum or hard candies helps stimulate the return of bowel function after surgery.