A delicate matter of flatus...
NOTE: This post was written before this one where I explain about being discharged early. All of the things in this post refer to things that happened before that one though. You don't need to read this one first and it will still make sense if you read it after my other one, but it's important to recognize the context between these posts as you read them.
Enjoy
~~~~~
Flatus. It preoccupies me.
Passing gas. Wind. Air biscuits. Tooting. Cutting the cheese.
Farting.
That's what today's blog is about, because that's what postop day 1 and 2 have been about.
Whenever a surgeon manipulates the intestines, our bowels tend to lose their rhythm. Quite literally, in fact. As smooth muscle, intestines have a slow, continuous wave-like contraction called peristalsis that happens automatically. Peristalsis helps move the food from our mouth to our stomach, from our stomach through our small intenstine, then from our intestines through our colon to our rectum. The rectum is a little smarter than the rest of the intestines, able to sense stretch better and regulate its contraction so that we can store feces and release it when it's convenient (or at least not wildly inconvenient).
Yeah. I don't have very much of that smart bowel segment left.
I never really thought about my rectum that much before my diagnosis. I doubt most people have - after all, it's literally out of sight and therefore soomewhat out of mind as it does its job. It doesn't beat like our heart or move when we ask it to like our legs or arms or fingers or give us information like our eyes or ears or noses, it just holds poop and releases it when we have the time to deal with our biological needs. But when my surgeon cut a big segment of my rectum out and stitched my sigmoid colon to what was left, all of my intestines decided to go on strike for a bit.
Left unchecked, the paralysis of the intestines - or ileus - could be painful and even life-threatening. That's why my nurses and my surgeon paid such close attention to my bowel sounds, those funny little gurgles that we get embarrassed by in polite company. We can't help them any more than we can keep our blood from pumping through our arteries and into our veins, yet we seem to carry a lot of stigma and even taboo about the fact that we all fart.
Yes. Even you. And we all know that you do.
Trust me - if you ever have abdominal or pelvic surgery, your medical and surgical team will be very interested in your bowel sounds. And they will be inordinately excited when you do, finally, fart. That fart, that release of gas from your intestines, signals that everything is back to normal and yu are on the road to recovery.
"Passing any gas yet?"
I was first asked that on postop day zero - the day I had my surgery. My answer was a definite no.
I was asked again as soon as I woke up on postop day one. The answer was the same. It seemed like every half hour my nurse would ask if I was passing gas yet, but the answer was always no.
It was only postop day one. It's not out of the ordinary to not pass gas yet, but I was creating bowel sounds a few hours after surgery. The sooner I farted, the sooner I could switch from my full fluid diet - liquids with yogurt and pudding and creamed or pureed soups - to a general diet.
Like normal people who haven't had their colon stitched together eat.
I did everything I could to help the process along. I chewed gum to help kick-start peristalsis. I drank frequent sips of water to start the peristalsis in my esophagus. I drank coffee - a more controversial kick-starter but let's just say that I know caffeine works for me. You probably already know if it works for you, too. I walked - just a few loops of my ward the first time but more and more as postop day 1 went on. Walking made me feel better, but it didn't really seem to do anything to help me pass gas.
"Keep working at it," my night nurse said. "It'll happen."
I wanted to believe him. I really wanted to fart. I felt bloated, I could hear and feel the gas moving around my tummy, and I knew that if I could just get it out I would feel so much better. But by the time I went to bed on postop day 1 nothing had happened.
Honestly, I felt defeated. It's such a simple thing, something I've probably done every single day of my life until now. Why was it so hard?
I didn't want to force it to happen because of my laparoscopy sites and laparotomy incision as well as my anastomosis. If I bore down, I was afraid I would rupture something and that would be so much worse. I even wanted to lie to my nurse, to tell them that I had farted when in fact I hadn't.
I've always been a high achiever; I really didn't want to underperform at anything related to my surgery, let alone passing gas.
No matter how much I wanted it though, the elusive release of gas just wouldn't happen. I went to sleep wondering what would happen to me if I couldn't pass gas.
And then it happened.
I woke up at 05:00h and felt my abdomen. This is another part of my new normal - a quick tactile survey of my tummy to make sure everything is still there and as it should be whenever I wake up. But at 05:00h my belly felt... different.
It was soft. It wasn't distended any more - at least, not as distended as it had been.
I had laid on my left side as I so often do when I sleep and I felt and heard gas gurgling down the left side of my colon. I felt a slight sharp pain - more of a spasm than anything else - as the gas reached the last stop before escaping, and then it just... slipped out.
No loud trumpet blast. No explosive escape. I farted like a little girl I guess - just a gentle little passage of gas that relieved the internal pressure and made me feel better. But the weird thing was that I still wasn't sure. I caught up with my nurse in the hallway after walking around the unit for about twenty minutes.
"I have a sort of silly question for you," I said. I explained what happened and asked him if that qualified as passing gas.
"Yeah," he said with a quirky smile. "Yeah, that's the sort of thing we are hoping for. At first at least."
So I'm passing gas now. Yay!
There are still a bunch of milestones for me to reach before I can be discharged, but it's good to know that I have re-trained my intestines to work again.
Enjoy
~~~~~
Flatus. It preoccupies me.
Passing gas. Wind. Air biscuits. Tooting. Cutting the cheese.
Farting.
That's what today's blog is about, because that's what postop day 1 and 2 have been about.
Whenever a surgeon manipulates the intestines, our bowels tend to lose their rhythm. Quite literally, in fact. As smooth muscle, intestines have a slow, continuous wave-like contraction called peristalsis that happens automatically. Peristalsis helps move the food from our mouth to our stomach, from our stomach through our small intenstine, then from our intestines through our colon to our rectum. The rectum is a little smarter than the rest of the intestines, able to sense stretch better and regulate its contraction so that we can store feces and release it when it's convenient (or at least not wildly inconvenient).
Yeah. I don't have very much of that smart bowel segment left.
I never really thought about my rectum that much before my diagnosis. I doubt most people have - after all, it's literally out of sight and therefore soomewhat out of mind as it does its job. It doesn't beat like our heart or move when we ask it to like our legs or arms or fingers or give us information like our eyes or ears or noses, it just holds poop and releases it when we have the time to deal with our biological needs. But when my surgeon cut a big segment of my rectum out and stitched my sigmoid colon to what was left, all of my intestines decided to go on strike for a bit.
Left unchecked, the paralysis of the intestines - or ileus - could be painful and even life-threatening. That's why my nurses and my surgeon paid such close attention to my bowel sounds, those funny little gurgles that we get embarrassed by in polite company. We can't help them any more than we can keep our blood from pumping through our arteries and into our veins, yet we seem to carry a lot of stigma and even taboo about the fact that we all fart.
Yes. Even you. And we all know that you do.
Trust me - if you ever have abdominal or pelvic surgery, your medical and surgical team will be very interested in your bowel sounds. And they will be inordinately excited when you do, finally, fart. That fart, that release of gas from your intestines, signals that everything is back to normal and yu are on the road to recovery.
"Passing any gas yet?"
I was first asked that on postop day zero - the day I had my surgery. My answer was a definite no.
I was asked again as soon as I woke up on postop day one. The answer was the same. It seemed like every half hour my nurse would ask if I was passing gas yet, but the answer was always no.
It was only postop day one. It's not out of the ordinary to not pass gas yet, but I was creating bowel sounds a few hours after surgery. The sooner I farted, the sooner I could switch from my full fluid diet - liquids with yogurt and pudding and creamed or pureed soups - to a general diet.
Like normal people who haven't had their colon stitched together eat.
I did everything I could to help the process along. I chewed gum to help kick-start peristalsis. I drank frequent sips of water to start the peristalsis in my esophagus. I drank coffee - a more controversial kick-starter but let's just say that I know caffeine works for me. You probably already know if it works for you, too. I walked - just a few loops of my ward the first time but more and more as postop day 1 went on. Walking made me feel better, but it didn't really seem to do anything to help me pass gas.
"Keep working at it," my night nurse said. "It'll happen."
I wanted to believe him. I really wanted to fart. I felt bloated, I could hear and feel the gas moving around my tummy, and I knew that if I could just get it out I would feel so much better. But by the time I went to bed on postop day 1 nothing had happened.
Honestly, I felt defeated. It's such a simple thing, something I've probably done every single day of my life until now. Why was it so hard?
I didn't want to force it to happen because of my laparoscopy sites and laparotomy incision as well as my anastomosis. If I bore down, I was afraid I would rupture something and that would be so much worse. I even wanted to lie to my nurse, to tell them that I had farted when in fact I hadn't.
I've always been a high achiever; I really didn't want to underperform at anything related to my surgery, let alone passing gas.
No matter how much I wanted it though, the elusive release of gas just wouldn't happen. I went to sleep wondering what would happen to me if I couldn't pass gas.
And then it happened.
I woke up at 05:00h and felt my abdomen. This is another part of my new normal - a quick tactile survey of my tummy to make sure everything is still there and as it should be whenever I wake up. But at 05:00h my belly felt... different.
It was soft. It wasn't distended any more - at least, not as distended as it had been.
I had laid on my left side as I so often do when I sleep and I felt and heard gas gurgling down the left side of my colon. I felt a slight sharp pain - more of a spasm than anything else - as the gas reached the last stop before escaping, and then it just... slipped out.
No loud trumpet blast. No explosive escape. I farted like a little girl I guess - just a gentle little passage of gas that relieved the internal pressure and made me feel better. But the weird thing was that I still wasn't sure. I caught up with my nurse in the hallway after walking around the unit for about twenty minutes.
"I have a sort of silly question for you," I said. I explained what happened and asked him if that qualified as passing gas.
"Yeah," he said with a quirky smile. "Yeah, that's the sort of thing we are hoping for. At first at least."
So I'm passing gas now. Yay!
There are still a bunch of milestones for me to reach before I can be discharged, but it's good to know that I have re-trained my intestines to work again.
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