Passing gas after surgery...

[MikeyJ, RN]

Generally speaking, how long after laparoscopic surgery should the patient begin passing gas? Is there a general rule as to how long before the doctor should be notified? And finally, any nursing interventions to promote passing gas?

[colleennurse, ASN, RN]

I don't know of a general amount of time, but having the patient ambulate is one way to get bowels moving.

[ginger58, ASN, RN]

One thing I might add also is when I had laporscopic gyn surgery, the CO2 they pumped in really put pressure on my bladder and when I went to urinate hours later I became very lightheaded on the toilet. It was 30 years ago but I remember something like that happening. It was very frightening. I don't remember anyone being worried about passing gas.

[BaByNuRsE07, BSN, RN]

Hi,

On our general surgery unit, we expect a pt to begin passing gas by post-op day 2.

Ambulating will work wonders to help pass gas when the abdomen is distended. Sometimes a little ginger ale helps too.

When making rounds, most of our surgeons ask if the pt is passing gas in order to advance their diet by day 2.

Hope this helps!

[TiredMD]

Although there is really no good evidence for it, we traditionally describe a "normal" postoperative ileus as lasting 2-3 days, and "paralytic" postop ileus as >72hrs. The small bowel will normally return to normal function before the colon, which is why we hear bowel sounds before the patient starts passing gas or pooping.

The duration of the ileus will be dependent on a number of factors, including the type of surgery, the type of anesthesia, any postoperative narcotics being used, and whether or not the patient is being fed.

As mentioned above, walking is a commonly accepted method to speed the return of bowel function, and some studies seem to bear it out. Interestingly, gum chewing has also been shown to reduce the time to ileus resolution, as has early feeding, NSAIDs, and laxatives.

The General Surgeons love asking about flatus. Personally, I don't. Too often patients either don't know they are passing gas or don't like to admit it. There is also some question as to whether flatus is a true marker of ileus resolution.

I try to get them out of bed as soon as possible, keep them on a good bowel regimen, and wait for stool. Ortho doesn't see nearly as many paralytic ileuses as General Surgery, so that usually does the trick.

[HM2VikingRN, RN]

Might be the sorbitol/xylitol in the gum... I know that those sweeteners can have a laxative effect...

[sharann, BSN, RN]

It can take hours to a day or 2. IT also is extremely(REALLY) painful. As a former lap hyst patient and as a recovery RN I have experienced this from both ends (ha ha ends...). The gas pains can also cause chest pains and shoulder pains(both referred from gas trapped under the diaphragm. It can be worse than labor pains. Please, medicate heavily for this because until the patient gets walking(a few hours) the pain will be horrible at times. Don't judge the surgery based on those "little band aids). It is bad.

Walking and turning in bed from side to side makes things move.

Tired MD, I heard about the gum chewing as well moving things along. Stimulates digestive enzymes and peristalsis.

[NurseNature]

So... in school we are taught to check each quadrant for 5 minutes before declaring no bowel sounds... my question is this- do all you practicing nurses actually do this on each assessment post-op? I don't see how the nurses would have time to do a twenty min bs check, especially when you don't expect them to have any for at least one day. Just wondering.

[putmetosleep]

FutureNurseLori said:

So... in school we are taught to check each quadrant for 5 minutes before declaring no bowel sounds... my question is this- do all you practicing nurses actually do this on each assessment post-op? I don't see how the nurses would have time to do a twenty min bs check, especially when you don't expect them to have any for at least one day. Just wondering.

Simply put....NO. I don't know a single nurse who listens for 5 minutes for BS in each quadrant. Interestingly, the AACN recommends 2-5 minutes in each quadrant. If I've listened for 2 minutes in one quadrant and not heard any bowel sounds, I'm going to say that they are extremely hypoactive or more than likely absent. Period. If my pt is 3-4 days post-op, I might listen a little bit longer. But there is no way in **** bedside nurses have the time to do this. Besides, when is the last time you saw an MD listen for 5 mins in each quadrant?

[KBANDME]

Thank you so much for the confirmation. No one is believing me about this pain. I wasn't sure if I was having a heart attack (shoulder pain). The gas pain is horrendous!! Feeling better now after walking around. Thanks again, Shar.

[JonLak]

I second that the gas is extremely painful. It causes seriously intense pain in my neck/shoulders/bowel area without any warning. Almost crippled me and I think I have a pretty high pain threshold as I took no painkillers and was able to tough it out when I had appendicitis. After my surgery though, the gas pains were perhaps the sharpest pains I've experienced.

One important thing, DON'T take painkillers. It sounds like that would suck, but they really don't do a whole lot for the gas pains that you get (in my opinion anyway) post surgery.

Tough it out and drink lots of water, have lots of fruit and veggies and wash it down with hot tea (don't drink cold water with your food as it slows the digestive process further - hot drinks speed it up). I think it's best to avoid any grains, meat or dairy products. The less processed the food, the quicker you'll go to the toilet (in my experience at least). Walk around as well. My nurse told me off for getting up constantly, but I knew that staying bed ridden wouldn't help me much anyway.

Good luck to anyone who reads this, I hope your gas problem is solved quickly because the 24 hours after my surgery were among the most painful of my life.

[carolmaccas66, BSN, RN]

It's usually within about 8-12 hours, but they MUST have passed a good amount of wind before being discharged.

Some ways to help pass gas: walking, warm water bottles (not hot!) on the abdomen, getting the patient to rub their tummy gently and even sitting on the toilet every now and then can help promote the movement of the bowels.