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Movement & recovery

Day one after surgery: breathing comes first

The very first exercises after surgery are done lying flat with knees bent — and the first of them is just breathing properly.

3 min read2 sources

Three rules come before any of the exercises. If uncomfortable — stop. If tired — rest or sit down. And: exhale when you need strength, power and steadiness, because it activates the deep abdominal muscles. That last one shapes every exercise that follows.

Everything on day one is done lying flat in bed with your knees bent, slowly and in a controlled way. Do not rush the movement.

1. Breathing

Breathe in through your nose with your mouth closed, inhaling all the way down into your abdomen — feel it bulge. Blow out through your mouth, emptying your abdomen so it goes flat. Throughout, be conscious of pressing your lower back down into the mattress.

Then the progression: breathe in, and lift your arms above your head while breathing out. Breathe in again, and lower your arms on the next exhalation. Only move your arms when you breathe out, and keep your lower back pressed into the mattress.

2. Pelvic floor lift

This eases strain in the pelvic floor and relieves the increased blood volume pressure there, which is a common problem after abdominal surgery. It also strengthens the pelvic muscles and increases blood circulation in the area, which promotes healing.

  1. Lift the pelvic floor, hold, and release down.
  2. Lift the pelvic floor, rock slowly from side to side, and release down.
  3. Repeat 5 times to start with, then regularly increase the repetitions.

Getting out of bed

Position yourself on your side, place both arms in front of your chest and push up. Keep your back straight, and try to control your abdominal and lower back area — think of holding your corset in place. Use your breathing, and get up while exhaling.

Once you are sitting on the bed: lean slightly forward with your back straight and swing your arms in turn, up and down and back and forth, exhaling when your arms are up or forward, concentrating on pulling your abdomen in towards the spine.

How much of this to do

  • Do the breathing exercise every day. It matters for your body system to function at its best.
  • Do the lying down exercises daily for the first 3–4 weeks.
  • Get up and move around as often as possible.
  • Start with 5 to 7 repetitions of each exercise, and gradually increase to 20–25 as you get stronger.

One movement can start even sooner. The pelvic floor exercise can be begun within three days after surgery, or at any time in the future — with one specific exclusion: internal pouch patients should avoid it unless their consultant recommends it.

Where this came from

  • If uncomfortable stop, if tired rest, exhale for strength; the day-one breathing exercise and arm progression; the pelvic floor lift and 5 repetitions; DVT risk and why walking matters; getting out of bed; the post-op sitting exercise; daily breathing, lying down exercises for 3-4 weeks, and 5-7 repetitions building to 20-25.

    Dansac A/S, “Getting fit after stoma surgery”, 2014

  • The pelvic floor exercise can be started within 3 days after surgery and should be avoided by internal pouch patients unless recommended by their consultant; the roll out of bed habit protects your back and tummy muscles.

    IA (Ileostomy & Internal Pouch Association), “Exercises for Ostomates”, 2018

Before you change anything

These posts are readings of published patient information, and every one links to the sources it came from. They are general information, not medical advice, and they cannot account for your own diagnosis, surgery or treatment. Anything you plan to change — what you eat, how you manage your bowel, your medication, your activity, your stoma or pouch care — is a conversation to have with your IBD team or stoma care nurse.