Recovery in the Hospital
Patients spend an average of two to five days in the hospital following bariatric surgery, or longer if complications develop. Patients who undergo laparoscopic bariatric surgery usually have a shorter hospital stay.
When you return to your hospital room after surgery, you will be closely monitored by your nurses. Along with periodic monitoring of your vital signs — blood pressure, pulse, temperature and respiration — your nurses will encourage and help you to perform deep breathing, coughing, leg movement exercises and to get out of bed. These activities can help prevent complications. Report any symptoms of nausea, anxiety, muscle spasms, increased pain or shortness of breath to your nurse.
To varying degrees, it is normal to experience fatigue, nausea and vomiting, sleeplessness, surgical pain, weakness, light-headedness, loss of appetite, gas pain, flatulence, loose stools and emotional ups and downs in the early days and weeks after surgery. Please discuss any concerns you have with your doctors and nurses.
You may feel pain at your incision site or from the position your body was in during surgery. Some patients also experience neck and shoulder pain after laparoscopic bariatric surgery.
Your comfort is very important to us. Although it is normal to experience some discomfort after surgery, keeping your pain under control is necessary for recovery. When you are comfortable, you are more able to walk, breathe deeply and cough, all of which are essential for recovering as quickly as possible.
If you are feeling pain after surgery, you will be able to push a button on a cord to administer pain medication to yourself. This is called "patient-controlled analgesia," or PCA. As soon as you are able to tolerate fluids, your medical team will add oral pain medication. Please know that you are not bothering the staff if you ask for pain medicine.
Your nurses and doctors will ask you to describe your pain. Two helpful ways to describe pain include the number scale (on a 0 to 10 scale, with 0 being no pain and 10 being the worst pain possible), or words to describe your pain as none, mild, moderate or severe.
No matter what form of pain control you receive, the following tips will help you stay comfortable:
- Tell your nurses and doctors if you are experiencing pain, particularly if it keeps you from moving, taking deep breaths and generally feeling comfortable. Everyone is different, so keeping your nurses informed about how you feel will help them help you.
- Plan ahead for pain; if you are comfortable lying down, you may still need pain medication to get up and walk around.
- Keep ahead of the pain — don't wait for the pain to be at its worst before you push the PCA button or ask for pain medicine. Pain medication works best when used to prevent pain.
The risk of becoming addicted to pain medicine is very low when it is used for a specific medical purpose, such as surgery.
Exercises to Speed Recovery
Activities such as walking and even changing positions in bed help promote circulation. Good blood flow discourages the formation of blood clots and enhances healing. Standing up, walking and doing your post-operative exercises may help speed up your recovery and minimize complications.
Repeat the following exercises at least once every hour after surgery. It's a good idea to practice them before surgery as well, to increase lung function and agility.
- The first night after surgery, with the help of your nurse or physical therapist, sit up and dangle your feet and stand at your bedside. This may hurt, but will get easier each time. Each day you will notice your strength returning and less pain.
- You will be asked to get out of bed and walk the first day after surgery. After that, you will need to walk at least three times per day and perform your leg and breathing exercises hourly. You may not feel well enough to go for a walk, but it is very important to try your best and do as much as possible.
- Your nurse will teach you how to cough and breathe deeply, and you will be shown how to use an "incentive spirometer" to help you expand your lungs. Coughing and deep breathing helps loosen any secretions that may be in your throat or lungs and helps prevent pneumonia. Deep breathing also increases circulation and helps to eliminate anesthesia.
How to breathe deeply:
- Inhale as deeply as you can.
- Hold the breath for two seconds.
- Exhale completely.
- Repeat three times.
How to cough:
- Inhale deeply.
- Cough. The cough should come from your abdomen, not from your throat. Hold a pillow on your abdomen for support.
How to exercise your feet and legs:
- Push your toes toward the end of the bed, as if you're pressing down on a gas pedal.
- Pull your toes toward the head of your bed, then relax.
- Circle each ankle to the right, then to the left.
- Repeat three times.
Recovery at Home
Your surgeon will decide when you are ready to leave the hospital, based on your progress. Prior to your discharge, you will be given specific dietary and activity instructions, along with information about certain precautions and when to notify your surgeon. If you have any concerns about returning home, discuss them with your nurse or discharge coordinator.
When you return home, plan on taking things easy for a while. Your body will be recovering from major surgery and weight loss during the recovery period.
Planning Your Recovery at Home
It is important to think about your living environment and how you will manage it after surgery. Are there many steps in your home? Is your bedroom upstairs? How accessible is your bathroom? Please tell the hospital staff about your living environment, as they can prepare your going home plan with your specific needs in mind. A rubber shower head with a detachable hose, long sponge stick or kitchen tongs, and toilet lift are all useful items.
We care about your progress. Keep in communication with us, and we will do our best to ensure your recovery is as smooth as possible.
Your first office visit with your surgeon will be scheduled for 10 days to three weeks after surgery. Your discharge instructions will tell you when to return to the office for follow-up.
You will continue to see your surgeon periodically after the initial follow-up visit — usually six weeks, three months, six months and nine months after surgery. Thereafter, you will have an annual appointment. Please call your surgeon's office with any surgical concerns between scheduled visits.
It is also important to keep your primary care doctor informed of your progress. Be sure to contact him or her with any medical concerns as well.
Activities to Avoid
Strenuous activity is prohibited for three to six weeks after surgery.
- Avoid lifting anything heavier than 20 to 30 pounds, or doing push or pull motions such as vacuuming, during the first six weeks after surgery.
- Avoid heavy work such as lifting, carrying or pushing heavy loads for the first three months after surgery.
- Avoid sitting and standing without moving for long periods. Change positions frequently while sitting, and walk around in lieu of standing still. These strategies may help prevent blood clots from forming in your legs. Climbing stairs is encouraged.
During the first several weeks after surgery, you may feel weak and tire easily after activity. However, light activity, such as frequent short walks, is recommended. Gradually increase the distance. The more physically active you are, the better. It will enhance your recovery and ultimately give you more energy.
Continue walking at least four times a day, so that you are walking 30 to 45 minutes per day by the sixth week. By your six-week office visit, you should be regularly walking two miles a day or more, unless you have specific problems with your weight-bearing joints. If so, water exercises are recommended. You can begin these about three weeks after surgery.
You may be tired, weak or nauseated or may experience vomiting the first few weeks after surgery. Keep up your fluid intake with small, frequent sips as necessary. We recommend drinking 1.5 to 2 liters of water each day.
You can resume traveling short distances as soon as you feel strong enough to make the trip. Do not drive a motor vehicle until you are no longer taking prescription pain medication, which is usually about one week after surgery.
Most patients like to have someone home with them the first few days after surgery for moral and physical support. Due to the nature of abdominal surgery, you may need some help using the toilet.
Flushable baby wipes, a peri-bottle or small sports top water bottle are gentler for personal hygiene. A long sponge stick can also be helpful.
Your wound should need minimal care. If sutures were used, they will most likely dissolve, so there is no need to remove any stitches.
You may notice some tape on your wound. This tape is called "steri-strips" and should fall off on its own.
If surgical staples were used, they will have to be removed, usually around the tenth day after surgery. This should not cause any pain.
No matter how your wound was closed, it is important to keep it clean and dry to promote faster healing. Unless otherwise prescribed, you should shower, wash with soap, rinse and dry thoroughly. If the wound is oozing or catching on clothing, you may cover it with a very light dressing, but otherwise leaving the wound open to air whenever possible may help prevent suture infection.
After about three weeks, it is usually safe for your incision to get completely wet. Ask your surgeon for the official "go ahead" before taking a bath. As you feel stronger, you may enjoy a swim or a soak in the tub.
Despite the greatest care, any wound can become infected. If your wound becomes reddened, swollen, leaks pus, has red streaks, has yellow/green purulent or odorous drainage, feels increasingly sore or you have a fever above 100.5˚F, you must notify your surgeon right away. These may be signs of an infection.
Do not use any antibiotic ointment or other occlusive ointment on your incision, unless your medical team has instructed you to do so.
Symptoms to Watch For
We do not expect you to have any serious problems after surgery. However, if you experience any of the symptoms below, you must contact your surgeon right away.
- Fever of 100.5˚F or above
- Redness, swelling, increased pain or pus-like drainage from your wound
- Chest pain or shortness of breath
- Nausea or vomiting that lasts more than 12 hours
- Pain, redness or swelling in your legs
- Urinating fewer than four times in 24 hours
- Pain that is unrelieved by pain medication
You may experience some of the symptoms below, which are considered normal.
- Moderate swelling and bruising. However, if you experience severe swelling and bruising, notify your surgeon, as it may indicate bleeding or infection.
- Mild to moderate discomfort or pain. However, if the pain becomes severe and is not relieved by pain medication, please contact your surgeon.
- When an incision is made during surgery, small sensory nerves to the skin are occasionally cut, which may cause temporary numbness. Sensation in those areas usually returns, typically within two to three months, as the nerve endings heal. However, it is important to be especially careful not to burn yourself when applying heating pads to areas that may have post-operative numbness.
- Itching and occasional small shooting electrical sensations within the skin frequently occur as the nerve endings heal. These symptoms are common during the recovery period. Ice, skin moisturizers, vitamin E oil and massage are often helpful.
- Initially, all scars are red, dark pink or purple in color. Scars take about one year to fade. It is very important to protect your scars from the sun for a year after your surgery. Even through a bathing suit, a good deal of sunlight can reach the skin and cause damage. Wear a sunscreen with a sun protection factor (SPF) of at least 15 when exposed to the sun.
Recommended Home Pharmacy Supplies
- Gauze pads
- Bandage tape
- Cotton balls
- Hydrogen peroxide
- Heating pad
Nausea may be related to insufficient chewing, fullness, sensitivity to odors, pain medication, not eating, post-nasal drip or dehydration. In the first days after surgery, nausea usually can be treated with medications called antiemetics. It is very important to take your nausea medication as prescribed by your surgeon.
Rarely, nausea can be so severe that it prevents patients from drinking adequate amounts of liquids. If this happens, you will need to come back to the hospital to receive intravenous (IV) fluids. Persistent vomiting may lead to dehydration and electrolyte imbalance, which may cause vitamin deficiencies.
Odors can sometimes be overwhelming after surgery. If you are dry heaving, try sniffing a few drops of peppermint essential oil on a handkerchief. Avoid perfumes and scented lotions. If food odors bother you, try having someone else prepare your meals or prepare bland foods.
Learn to recognize when you are full. This will not happen immediately, but by eating very slowly, it will become easier.
Should you have difficulty drinking due to nausea, try peppermint tea, fennel tea, decaffeinated green tea, or hot or cold water with lemon. Sucking on a cinnamon stick may sometimes help alleviate nausea.
If you believe your pain medication is causing nausea, call your surgeon's office to request a prescription change.
Remember to stay hydrated by sipping fluids all day long. You need to drink a minimum of 1.5 to 2 liters of fluids per day, or more if you are sweating.
Vomiting is often caused by eating inappropriately. Initially, it can be difficult to gauge how little food will satisfy your hunger — chances are, you will feel full with very little food. A couple of teaspoons may be all you can eat at one time.
Possible causes of vomiting include:
- Eating too fast
- Not chewing food properly
- Eating food that is too dry
- Eating too much food at once
- Eating solid foods too soon after surgery
- Drinking liquids with meals or right after meals
- Drinking with a straw
- Lying down after a meal
- Eating foods that do not agree with you
To prevent vomiting:
- Chew your food well.
- Keep your food moist.
- Eat only half of what you anticipate eating. If there is still space, and you still feel hungry, you can always eat more.
- Strictly follow your recommended post-surgery diet.
If you experience prolonged vomiting, stop eating solid foods and sip clear liquids such as clear and very diluted juice, broth and herbal tea. Should you have difficulty swallowing foods or keeping foods down, please call your surgeon.
Vomiting may indicate that your stomach pouch is blocked. If vomiting continues for more than 24 hours, contact your surgeon. Vomiting can lead to severe dehydration, a serious condition that needs medical attention. Contact your surgeon if you believe you may be dehydrated.
Dehydration will occur if you do not drink enough fluids. Symptoms include fatigue, dark colored urine, fainting, nausea, low back pain (a constant dull ache across the back) and a whitish coating on the tongue. If you experience these symptoms, you will need to have blood work done to establish the severity of dehydration. Dehydration may also lead to bladder and kidney infections.
Contact your surgeon if you believe you may be dehydrated. In some cases, you may be admitted to the hospital so we can administer fluids intravenously.
To prevent dehydration:
- Buy a sports bottle and take it with you everywhere so you can sip water all day.
- Drink at least 1.5 to 2 liters of fluids per day. Increase this amount if you are sweating.
- Avoid beverages that contain caffeine; they are diuretic and can dehydrate you. Unsweetened herbal iced tea is OK.
- If you have difficulties drinking due to nausea, suck on ice chips.
It is normal to have one to three bowel movements of soft stool per day. It may be foul smelling and associated with flatulence. Most of these changes resolve as your body heals and you adapt to changes. Please call your surgeon if you have persistent diarrhea.
After bariatric surgery, the amount of food you consume is greatly reduced, and the quantity of fiber or roughage you consume may be much smaller. As a result, the amount of bowel movements you have will be reduced, causing less frequent bowel activity and sometimes constipation. If this becomes a problem, you may want to try a stool softener to avoid rectal difficulties.
To keep your bowel movements regular:
- Remember that your stools will be soft until you eat more solid food.
- Lactose intolerance and high fat intake are generally the culprits of loose stool and diarrhea. Avoid all high-fat foods and cow's milk products, other than yogurt.
- Use your pocket journal to help recognize problem foods.
- If cramping and loose stools (more than three per day) or constipation persist for more than two days, please call your surgeon's office.
Everyone has gas in their digestive tract. Bariatric patients have a shortened bowel, which can cause gas to be more odorous and expelled more forcefully. Gas comes from two main sources: swallowed air and normal breakdown of certain foods by harmless bacteria that are naturally present in the large intestines.
Foods high in carbohydrates cause gas; those high in fat and protein cause very little.
The foods that are known to cause more gas are beans, vegetables, some fruits, soft drinks, whole grains, wheat, bran, cow's milk and cow's milk products, foods containing sorbitol and dietetic products.
To help prevent flatulence:
- Eat your meals more slowly, chewing food thoroughly.
- Lactose intolerance is generally the culprit of gas. Discontinue eating all cow's milk products. Yogurt is OK.
- Avoid chewing gum and hard candy.
- Avoid drinking with a straw.
- Eliminate carbonated beverages.
- Remedies for flatulence include Lactobacillus acidophilus (a probiotic or "good bacteria" that aids digestion), natural chlorophyll and simethicone.
To minimize the risk of developing a hernia, avoid heavy lifting for three months after surgery. You may notice a bulge under the skin of your abdomen. This is part of your bowels that are not being contained in the abdomen, due to a weakness in the abdominal wall at the site of your surgical incision. You may feel pain when you lift a heavy object, cough or strain during urination or bowel movements. The pain may be sharp and immediate. In some cases, the pain may be a dull ache that gets worse toward the end of the day or after standing for a long period of time. If you think you may have a hernia, please call your surgeon for a consultation.
Surgery is the only way to repair a hernia. If the hernia pops out and will not go back into place when you lie down, and is causing you pain and vomiting, it can result in an emergency. Call your surgeon's office or your primary care doctor immediately if this occurs.
Thrush and Yeast Infections
You may notice a white, cottage cheese-like coating on your tongue after surgery. Your tongue may also be very red and inflamed. Most likely you have thrush, which is a yeast overgrowth in the mouth. Often, this is due to large amounts of antibiotics taken before surgery. Call your primary care doctor if you have an oral infection or a rash on your skin.
Taking Lactobacillus acidophilus in addition to following the regimen prescribed to you after surgery may help prevent thrush.
Vaginal yeast infections are caused by yeast called Candida albicans. Yeast are tiny organisms that normally live in small numbers on the skin and inside the vagina. If the environment of the vagina becomes less acidic, too many yeast can grow and cause an infection.
Symptoms of a vaginal yeast infection include itching and burning of the vagina and around the outside of the vagina (vulva), a white vaginal discharge that may look like cottage cheese, and swelling. If you have symptoms of a yeast infection, call your primary care doctor or gynecologist.
You can help prevent yeast infections by avoiding tight-fitting or synthetic clothing, wearing cotton underwear, not wearing pantyhose every day, and not douching or using feminine sprays. You may also take Lactobacillus acidophilus in addition to the regimen prescribed to you after surgery.
All menstruating women should take an iron supplement to prevent anemia, or iron deficiency. Please contact your doctor to find out which iron supplement is best for you.
Signs of iron deficiency anemia include paleness, decreased work performance, weakness, difficulty maintaining body temperature, fatigue, dizziness and shortness of breath.
Iron deficiency may also be caused by low vitamin A levels. Vitamin A helps to mobilize iron from its storage sites, so a vitamin A deficiency limits the body's ability to use stored iron. This results in an "apparent" iron deficiency because hemoglobin levels are low, even though the body can maintain an adequate amount of stored iron.
Temporary Hair Loss and Skin Changes
Hair thinning or loss is expected after weight loss. It is temporary, but can still be disheartening for patients.
During the phase of rapid weight loss, calorie intake is much less than the body needs, and protein intake is marginal. Your body reacts to this deprivation in various ways, with a common side effect being hair thinning. This is a transient effect and resolves itself when nutrition and weight stabilize. Hair loss usually occurs anywhere from three to nine months after surgery.
To minimize hair loss, take your multivitamins daily and consume at least 75 grams of protein per day. Nioxin shampoo has been shown to be helpful for some patients, as well as biotin tablets or powder.
We recommend avoiding hair treatments and permanents to prevent stressing your hair from the outside, too.
Skin texture and appearance may also change after bariatric surgery. It is not uncommon for patients to develop acne or dry skin after surgery, since protein, vitamins and water intake are also important for healthy skin.
Scars are expected after any surgery. The size of your scars depends on the type of bariatric surgery you had (open versus laparoscopic), the sutures used and how your body heals. If you would like to make your scars less visible, once your incisions are fully healed, you may start using silicone pads and scar-minimizing creams to make the scars look softer, smoother, flatter and closer to your skin's natural color.
Be sure to keep your scars out of the sunlight to help them heal properly.
Sexuality and Pregnancy
You may resume sexual activity when you feel physically and emotionally stable.
Women need to use a mechanical form of birth control, as fertility may be increased with weight loss and oral contraceptives may not be fully absorbed.
Many severely obese women are also infertile, because the fatty tissue soaks up the normal hormones and makes some of its own as well. This may confuse the ovaries and uterus and cause a lack of ovulation. As weight loss occurs, this situation may change quickly.
You may start planning a pregnancy after weight loss stabilizes, but it is imperative not to become pregnant during the first 18 months after your surgery, since both you and the baby need to be healthy and safe.
If you do become pregnant, please arrange for your obstetrician/gynecologist to contact your surgeon's office. They will discuss specific information about your surgery, so they can work together to provide you with the best prenatal care.
A Lifelong Commitment
Surgery gives you a physical tool to assist with weight loss, but you must be committed to making the mental and emotional changes necessary for long-term weight loss and maintenance.
After surgery, you must be committed to regularly taking vitamins and supplements, eating healthfully, attending follow-up appointments with your doctor, exercising and participating in support groups for life. Your emotional and physical well-being depends on this commitment.
Lack of exercise, poorly balanced meals, constant grazing, eating processed carbohydrates and drinking carbonated beverages are common causes of regaining weight after surgery. You will need to manage your food intake and exercise for the rest of your life.
Adhering to healthy nutrition guidelines after weight loss is essential for long-term success and weight maintenance. For optimal health, we recommend incorporating all of the food groups according to the American Dietetic Association (ADA) guidelines.
Support groups are an integral part of the healing process, physically and emotionally. All patients are encouraged to incorporate a support group into their monthly schedule.
In a reduced calorie state, the body's natural tendency is to use muscle for immediate energy needs. Therefore, it is essential to follow a strict fitness program after surgery. Exercising at least three times a week conserves lean muscle mass, burns fat and increases your potential for long-term success.
Because bariatric surgery changes the digestive process, lifelong vitamins and nutritional supplements are essential. Vitamin deficiencies are often predictable and preventable. Take your vitamins and supplements and commit to seeing your surgeon on a regular basis for lab work and follow-up.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
Bariatric Surgery Center
400 Parnassus Ave., Second Floor
San Francisco, CA 94143
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