Pain and a pulling sensation around the incision are expected after abdominal surgery. Pain is usually more noticeable in the first few days, then gradually eases. There is no single timescale for everyone: how you feel and how quickly you recover may differ after gallbladder removal and after removal of part of the bowel. Some tenderness may last for weeks after major surgery.
The key is not for pain to disappear completely every day. Your medication plan should allow you to rest, breathe deeply and walk short distances. If pain that had been easing becomes worse again, or new symptoms develop, it is not appropriate to wait and assume this is a normal part of healing.
How does expected pain change?
The incision may hurt more when you turn in bed, stand up or cough. Less pain when lying still, relief after medication and easier movement as the days pass are signs of improvement. However, the location of the pain alone cannot establish its cause. The extent of the work done inside also affects the discomfort you feel.
In laparoscopic surgery, the surgeon works through small incisions using a camera and instruments. You may also have abdominal bloating and shoulder pain afterwards. The gas introduced into the abdomen irritates the diaphragm, the muscle separating the chest from the abdomen, and the pain is felt in the shoulder. This discomfort often eases in the first few days. Chest pain and shortness of breath, however, should not be put down to gas and left to settle.
Two people who have had the same operation may experience pain differently. Pre-existing pain, medicines, lack of sleep and anxiety can contribute to this difference. Someone else being pain-free does not mean that you should stop your medicine too. Pain that does not ease over the weeks and disrupts sleep and movement should be specifically assessed at a scheduled appointment.
How is a pain relief plan developed?
The surgeon and anaesthetist, the doctor who manages anaesthesia and monitors vital signs during surgery, choose a pain relief plan suited to the extent of the procedure and your health. The plan may combine several methods. Medicines such as paracetamol, an anti-inflammatory painkiller for suitable patients and local anaesthesia around the surgical site may form part of this approach.
For more extensive procedures, a local anaesthetic is sometimes given around a nerve, or an epidural is used. With an epidural, medicine may be given through a thin tube placed in a specific space within the spinal canal in the back. These techniques are not needed for every patient. The choice depends on the medicine's benefits as well as the risk of bleeding, other health conditions and any other medicines you take.
For severe pain, stronger painkillers called opioids may be prescribed for a short time. They can cause drowsiness, nausea and constipation, and slow breathing. You must therefore not increase the dose on your own. If the pain relief plan is not sufficient, the next step is to contact your treatment team before taking additional medicine.
Tell the team beforehand about kidney or liver disease, stomach ulcers, medicine allergies and any blood-thinning medicines you take. Even medicines sold without a prescription are not suitable for everyone. Products in two different boxes may contain the same ingredient; taking paracetamol in more than one product, in particular, can lead to an accidental overdose.
Reducing pain when moving
Staying in bed all day for fear of pain makes recovery more difficult. Prolonged immobility increases the risk of clots in the veins of the legs. Getting up early with help from a healthcare professional, taking short walks and doing the breathing exercises you have been shown are part of the recovery plan. You may feel dizzy the first time you get up, so you should not try this alone.
When getting out of bed, first rolling onto your side, bringing your legs over the edge and using your arms to push yourself into a sitting position may reduce strain on the abdominal muscles. Gently supporting the wound with a pillow when coughing may also help. Practising these movements with a nurse or physiotherapist on the ward makes them easier to use at home.
Explaining when your pain gets worse helps the team adjust your treatment. For example, pain that is bearable at rest but prevents you from breathing deeply is not adequately controlled. If your medicine has been prescribed at regular times, follow that schedule rather than waiting until the pain becomes severe.
Which symptoms need urgent assessment?
Contact your surgeon or the ward where you had your operation if you notice any of the following changes, without waiting for your scheduled appointment:
Abdominal pain that keeps getting worse and is not relieved by the prescribed medicine.
Pain accompanied by fever, chills or feeling increasingly unwell.
Repeated vomiting, increasing abdominal swelling and inability to drink fluids.
Spreading redness around the wound, pus, wound opening or increasing bleeding.
New pain, swelling and warmth in one leg.
Sudden shortness of breath, chest pain, loss of consciousness or heavy bleeding require emergency care. If someone is difficult to wake after taking a painkiller and their breathing is very slow, this is also an emergency. Do not wait for the surgeon to reply to your message in this situation.
Following the medication plan at home
When you are discharged, you should be clear about each medicine's name, dose, dosing interval and when it should be reduced. The conditions for taking an extra dose should also be set out in writing. Combining an opioid with alcohol or sleeping medicines that your doctor has not approved is dangerous. People who have been taking these medicines for a long time need a separate plan for stopping them.
Recording which medicine you have taken and at what time helps prevent duplicate doses and makes it easier to explain your situation to the surgeon. When you call, it is useful to describe where the pain is, when it changed, when you last took medicine and any other symptoms. Your discharge paperwork should include a contact number for help during the day and at night.