Your estimated discharge date

The Enhanced Recovery Nurses will discuss your estimated discharge date with you.

Introduction

This information aims to increase your level of understanding of how you can play an active part in your recovery, after your emergency surgery. If there is anything that you are unsure about, please ask. It is important that you understand how you can help yourself recover, so that you, your family and friends can be involved.

Enhanced Recovery is a programme offered by North Bristol NHS Trust for patients undergoing emergency bowel surgery. Having surgery as an emergency can be stressful, and this information will help your recovery.

What is Enhanced Recovery?

The aim of Enhanced Recovery is to get you back to full health as quickly as possible after your operation.

Research indicates that after surgery, the earlier we get you out of bed, exercising, eating and drinking, your recovery will be quicker and it will be less likely that complications will develop.

Some of the benefits include:

• A quicker return of normal bowel function.
• Reduced chest infections.
• A quicker return to usual mobility.
• Decreased fatigue.
• Reduced risk of developing blood clots after surgery.

In order to achieve this we need you to be partners with us, so that we can work together to speed up your recovery.

Before your surgery

There is evidence to suggest that keeping warm, before surgery, helps prevent infection. Please ensure you have a warm dressing gown or similar item of clothing to wear immediately before your operation.

If possible, please ask a relative or friend to also bring you a supply of comfortable ‘day clothes’ for after your operation. You will be encouraged to return to normality as quickly as possible, and this includes getting dressed.

Eating and drinking

In preparation for your operation, if you are allowed to eat and drink normally, you should aim to take 3 of the Fortisip or Fortijuce supplement drinks per day. The drinks will be supplied by the ward for two days before your surgery.

The supplement drinks are important to help with wound healing, to reduce the risk of infection and aid with your overall recovery. It is important that you also continue to have a variety of other non-fizzy drinks during your hospital stay.

As well as the supplement drinks mentioned, you will also be required to take special carbohydrate drinks called ‘Pre Op’. You will require two drinks the night before and 2 drinks on the day of your operation, three hours before surgery. If your operation is very urgent, you may only be given two ‘Pre Op’ drinks before surgery.

You may continue to eat for up to six hours before your operation and drink fluids for up to three hours before, unless otherwise directed by your doctor.

A few hours after your operation you will start to drink and eat if you wish. It is important that you eat and drink early after your surgery, however if your operation was for a blockage in the bowel, early eating may not be appropriate. The ward staff will help and advise you. You will be expected to recommence the supplement drinks to help build up your strength. The drinks will either be given to you by the ward staff or you can help yourself to the drinks from the patients fridge.

Studies show that chewing gum after an operation can be helpful towards improving your recovery by assisting the bowel to return to its normal function.

Please ask a relative or friend to bring some chewing gum in for you. After your operation chew gum for 15 minutes, three times a day, until your bowel function returns to normal.

Preparing for theatre

On the day of your operation you may be given an enema to empty your bowel contents.

In order to help prevent blood clots you will be required to wear special support stockings (TEDS). The nurse will need to measure your legs to obtain the correct size.

You will also be given a small injection called ‘clexane’ at approximately 6pm each day you are in hospital. This helps reduce the risk of blood clots by thinning the blood.

Some patients who are at higher risk of experiencing blood clots may have to continue with the injection once home. This would only be for a few weeks after surgery and will be fully discussed with you when you are in hospital. Most patients are able to administer the injection themselves or with the help of a relative or carer. The nurses on the ward will show you how to use the injection during your hospital stay. If you have any problems with administering the injection an appointment can be made with your practice nurse to carry this out each day, or we will arrange for a District Nurse to visit you if you are unable to leave the house.

It is important that you keep yourself warm before your operation and you are advised to dress accordingly, (warm dressing gown, socks, slippers, blankets). You will be asked to remove the warm clothing when it is time for your operation as you will be required to wear a hospital gown.

After your operation

Mobilising and exercising

Following your operation when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour. To do these you will need to:

• Be in an upright position.
• Take a deep slow breath in (feel your stomach gently rise).
• Hold the breath for 3 seconds.
• Breathe out slowly.
• Repeat 5 times.

You should cough regularly to make sure your lungs are clear of secretions. To do this, place a towel or pillow over your abdomen and wound. Support it with your hands and cough.

When you are sitting in the chair or lying in bed, you should also do frequent leg exercises, (as prevention against blood clots) pointing your feet up and down and moving your ankles as if making circles can achieve this.

Depending on what time you come back to the ward, the staff will help you out of bed about six hours after your operation. You may sit out of bed for up to two hours on the day of surgery and then up to six-eight hours out of bed on each subsequent day after surgery if you can manage this.

You will be encouraged to walk at least 60 metres four to six times per day after your surgery if you can manage this. By being out of bed in a more upright position and by walking regularly, lung function is improved and there is less chance of a chest infection after surgery. Circulation is also improved, reducing the risk of a blood clots and helping bowel function return to normal.

Try wearing your day clothes as soon as you feel able after your operation as this can help you feel positive about your recovery.

Pain control

It is important that your pain is controlled so that you can walk about, breathe deeply, eat and drink, feel relaxed and sleep well. Please let us know if your pain is not manageable so that we can help you.

It is also important for us to know if you are either allergic or sensitive to certain pain killers.

You may be given one of, or a combination of the following methods of pain relief, to keep you comfortable after surgery:

• Patient controlled analgesia (PCA). This is an intravenous pain killing medication, delivered by a machine, which is set up so that you can control it yourself. You will be given instructions on how to do this.
• Tap block. This is an injection given at the time of your operation to temporarily numb the abdomen and keep you comfortable immediately afterwards.
• Spinal block. This is an injection given at the time of your operation that will temporarily numb you from the waist down and will keep you comfortable afterwards.
• Ketamine infusion. This is a continuous intravenous pain killing medication which will run up to 24 hours after surgery.

The anaesthetist may discuss these options with you and explain more about it whilst you are in hospital, before your operation.

Alongside this, the doctors will prescribe other types of pain relieving medicines, which work in different ways. You will be given these regularly (three or four times per day) and you should feel more comfortable.

If the pain worsens at any time, please tell the nursing staff immediately and they will be able to help you.

Sickness

Sometimes after an operation it is not uncommon to feel nauseated and occasionally vomit. You will be given medication during surgery to reduce this, but if you feel sick following surgery please tell a member of staff who will be able to help.

Tubes and drips

During your operation a tube (catheter) will be placed into your bladder so that we can check that your kidneys are working well and your urine output can be measured. This tube will be removed as soon as possible.

You will have an intravenous drip put into your arm to ensure you do not become dehydrated. The drip will normally be removed the day after surgery, but you may still have the intravenous port (venflon) in place for a couple of days in case we have to give other drugs through it.

It is possible you may return from your surgery with a tube in your nose. The tube may stay in a few days which will help drain your stomach if your surgery was due to a blockage or an emergency. We aim to remove the tube as soon as possible. Please wait until the tube is removed before trying to eat. Staff can advise.

You may also be required to breathe extra oxygen for a short while after your operation.

Monitoring

Many different things will be monitored during your treatment including:

• Observations (blood pressure, pulse, temperature).
• Fluid in.
• Fluid out.
• Food eaten.
• When your bowel first starts working or you pass wind.
• Pain assessment.
• Number of walks achieved.
• Time spent out of bed.

You may be asked to tell us about what you eat and drink and what you pass so that we can record it.

Whilst you are in hospital you will be asked to participate in maintaining a daily diary / log (provided by the ward), so that you can keep a record of how well you are managing. This will help us monitor your progress.

Please remember playing an active part in your recovery will help you get better sooner. If you have any questions regarding your recovery please do not be afraid to ask a member of staff.

References and further information

For further information on the Enhanced Recovery Programme you may access the following websites:

www.nbt.nhs.uk/erp
www.gov.uk/government/organisations/department-of-health-and-social-care

How to contact us

Brunel building
Southmead Hospital
Bristol BS10 5NB

Surgical Admissions Unit
Gate 32B
Telephone: 0117 414 3233

Enhanced Recovery Nurses
Telephone: 0117 414 3610
Telephone: 0117 414 3611

Colorectal nurses
Telephone: 0117 414 0514

Stoma Care Nurses
Telephone: 0117 414 0270

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002721

What is cell salvage?

Cell salvage is a method of collecting blood you have lost during an operation, so that it can be given back to you.

The blood collected is washed and filtered to remove any contaminants. This blood can then be given back to you if the doctor thinks a blood transfusion is required. It is sometimes called autologous blood transfusion (using your own blood).

Cell salvage is a technique that is well established in many types of surgery and is regularly used at Southmead Hospital.

Why might I need a transfusion?

It is normal when having major surgery to have some blood loss during the procedure. In some cases this can be a large amount and will require the blood to be replaced by giving a blood transfusion. Blood used for these transfusions can either be:

• A supply of donor blood from volunteers; or
• Your own blood (by using cell salvage blood).

What are the benefits of using cell salvage blood?

Use of cell salvage can reduce the need for a blood transfusion using donor blood, which is in short supply and expensive.

Although the risk associated with receiving a blood transfusion from a donor are low, there are still a very small risk of infections being passed on (1:500,000 for Hepatitis B, 1:30 million for Hepatitis C, 1:5 million for HIV, less than 1:2 million for vCJD). Having your own blood returned to you removes these risks.

Likewise donor blood is stored before transfusion and this affects its properties. For instance, stored blood does not carry oxygen as well. Having your own blood returned to you straight away reduces these problems.

The cell salvage technique is sometimes seen as an acceptable alternative for those who for religious reasons will not accept a blood transfusion using donated blood.

Why isn’t it suitable for everyone?

Not all operations result in enough blood loss to enable cell salvage to be used. For some operations cell salvage is not recommended e.g. some bowel surgery.

What does this mean for you?

This information aims to help you make an informed decision on whether you would prefer cell salvage blood should you need a blood transfusion during your operation.

If you have any questions about cell salvage which are not answered by this information, please discuss them with your anaesthetist.

The following video will show you how to use P 6 acupressure to prevent or treat post-operative nausea and vomiting. It has been proven, by statistically summarising the results of 40 trials including 4858 patients, that this technique is as good in preventing or treating post-operative nausea and vomiting as taking an anti sickness medication. That does not mean that it will work for every patient, but it is worth trying first before you use some anti-sickness medication. 

• To find your acupressure points, you can take your index, and middle finger and place it on your wrist at the base of your palm.
• Alternatively, you can find them by identifying the two tendons in your wrist going in the middle of these and either going two or three finger widths from the crease in your wrist; this is your acupressure point.
• Take your thumb and your index or middle finger and press firmly on the points on both sides of the wrist. Do this when you feel nauseous and you should get relief within ten to thirty seconds, sometimes it can take a bit longer, up to five minutes.
• Alternatively, you can tap your wrists together gently at the acupressure points whilst taking deep breaths.   

Your estimated discharge date

The Enhanced Recovery Nurses will discuss your estimated discharge date with you.

Ask three questions - preparation for your appointments

We want you to be active in your healthcare. By telling us what is important to you and asking questions you can help with this. The three questions below may be useful:

1. What are my options?
2. What are the possible benefits and risks of those options?
3. What help do I need to make my decision?

Introduction

This information aims to increase your level of understanding of how you can play an active part in your recovery after your surgery. If there is anything that you are unsure about, please ask. It is important that you understand how you can help yourself recover, so that you, your family and friends can be involved.

This is the programme offered by North Bristol NHS Trust for patients undergoing planned bowel surgery. There may be circumstances where the programme will not be appropriate for some patients and if this is the case, you will be fully informed.

What is the Enhanced Recovery Programme?

The aim of the Enhanced Recovery Programme is to get you back to full health as quickly as possible after your operation.

Research indicates that after surgery, the earlier we get you out of bed, exercising, eating and drinking, your recovery will be quicker and it will be less likely that complications will develop.

Some of the benefits include:

• A quicker return of normal bowel function.
• Reduced chest infections.
• A quicker return to usual mobility.
• Decreased fatigue.
• Reduced risk of developing blood clots after surgery.

In order to achieve this we need you to be partners with us so that we can work together to speed up your recovery.

What will happen?

Before you come into hospital the consultant will see you in the outpatients department to explain your operation.

Following this you will be sent a date to attend the pre-operative assessment clinic, where trained staff will carry out routine tests that are required to ensure you are fit and safely prepared for surgery. Please note all patients are routinely screened for potential infections at this time.

The specialist enhanced recovery nurse will see you when you attend the pre operative assessment clinic and will explain the programme to you and your family. You will be provided with written information and given plenty of opportunity to ask questions.

You may be referred to the anaesthetist, colorectal nurse specialist and stoma nurse specialist as necessary.

The nurse will discuss your arrangements at home so that together we can plan for any help you may need after your operation. The nurse will also discuss diet and exercise with you and if necessary you will be referred to the dietitian. (For example if you have lost a lot of weight or your appetite is poor). If you have concerns about your appetite or diet before coming in for your operation please speak to the nurses at your pre-assessment visit. What you eat is important, as good nutrition now will help you recover faster from your operation.

You will be given the opportunity to sample special nourishing supplement drinks: these are called ‘fortijuce’ and ‘fortisip’. You will be given some of the drinks to take home with you even if your weight and appetite are normal. You can choose from a variety of flavours.

It is important to keep as active as you can before your operation and if you are a smoker you should stop now. This helps reduce breathing problems after surgery. You can see your GP or pharmacist for advice on products to help you stop smoking.

Please bring a supply of your own medications into hospital with you. These will be stored safely on the ward and will be returned to you on discharge.

Please also bring a supply of comfortable ‘day clothes’ as you will be encouraged to return to normality as quickly as possible after your operation, and this includes getting dressed.

Eating and drinking

Prior to your surgery you will be able to eat and drink as normal unless you are required to take medication to clear the contents of your bowel. If this applies to you it will be discussed with you at pre operative assessment.

In preparation for your operation and in addition to your normal diet, you should aim to take three of the “Fortisip/Fortijuce” supplement drinks per day, for each of the 2 days before admission. Each drink can be sipped over a few hours.

When you are admitted to the ward after your operation, the supplement drinks will continue to be available to you, and you will need to continue with three per day.

The supplement drinks are important to help with wound healing, to reduce the risk of infection and aid with your overall recovery. It is important that you also continue to have a variety of other non-fizzy drinks during your hospital stay.

As well as the supplement drinks mentioned, you will also be required to take special carbohydrate drinks called ‘Pre Op’. You will require two drinks the night before and two drinks on the morning of your operation.

You may continue to eat for up to six hours before your operation and drink clear fluids for up to three hours before.

A few hours after your operation you may start to drink and eat if you wish. It is important that you eat and drink early after your surgery. Staff will help and advise you. Initially some patients may find a low fibre diet more tolerable. You will be encouraged to help yourself to the supplement drinks from the fridge. You will be expected to recommence the supplement drinks to help build up your strength following surgery.

Recent studies show that chewing gum after an operation can be helpful towards improving your recovery by assisting the bowel to return to its normal function. On the day you come into hospital bring some chewing gum with you. After your operation chew gum for 15 minutes, three times a day, until your bowel function returns to normal.

Preparing for theatre

Before your operation you may need 1-2 enema(s) to empty your bowel contents. Some patients may be required to take medication the day before in order to achieve this. This will be fully explained if this applies to you.

In order to help prevent blood clots you will be required to wear special support stockings (TEDS). The nurse will need to measure your legs to obtain the correct size.

There is also evidence to suggest that keeping warm, before surgery, helps prevent infection. Please ensure you bring a warm dressing gown, socks, slippers, blankets or similar item of clothing to wear immediately before your operation. (You will be asked to remove the warm clothing when it is time for your operation as you will be required to wear a hospital gown.

After your operation

Mobilising and exercising

Following your operation when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour. To do these you will need to:

• Be in an upright position.
• Take a deep slow breath in (feel your stomach gently rise).
• Hold the breath for three seconds.
• Breathe out slowly.
• Repeat five times.

You should cough regularly to make sure your lungs are clear of secretions. To do this, place a towel or pillow over your abdomen and wound. Support it with your hands and cough.

When you are sitting in the chair or lying in bed, you should also do frequent leg exercises, (as prevention against blood clots); pointing your feet up and down and moving your ankles as if making circles can achieve this.

Depending on what time you come back to the ward, the staff will help you out of bed about six hours after your operation. You may sit out of bed for up to two hours on the day of surgery and then up to six-eight hours out of bed on each subsequent day after surgery if you can manage this.

You will be encouraged to walk at least 60 metres 4 – 6 times per day after your surgery if you can manage this.

By being out of bed in a more upright position and by walking regularly, lung function is improved and there is less chance of a chest infection after surgery. Circulation is also improved, reducing the risk of blood clots and helping bowel function return to normal.

You will also be given a small injection called ‘clexane’ at approximately 6pm each day you are in hospital. This helps reduce the risk of blood clots by thinning the blood. Some patients who are at higher risk of experiencing blood clots may have to continue with the injection once home. This would only be for a few weeks after surgery and will be fully discussed with you when you are in hospital.

Most patients are able to administer the injection themselves or with the help of a relative or carer. The nurses on the ward will show you how to use the injection during your hospital stay. If you have any problems with administering the injection an appointment can be made with your practice nurse to carry this out each day, or we will arrange for a District Nurse to visit you if you are unable to leave the house.

Try wearing your day clothes as soon as you feel able after your operation as this can help you feel positive about your recovery.

Pain control

It is important that your pain is controlled so that you can walk about, breathe deeply, eat and drink, feel relaxed and sleep well. Please let us know if your pain is not manageable so that we can help you.

It is also important for us to know if you are either allergic or sensitive to certain pain killers.

You may be given one of, or a combination of the following methods of pain relief, to keep you comfortable after surgery:

• Patient controlled analgesia (PCA). This is an intravenous pain killing medication, delivered by a machine, which is set up so that you can control it yourself. You will be given instructions on how to do this.
• Tap block. This is an injection given at the time of your operation to temporarily numb the abdomen and keep you comfortable immediately afterwards.
• Spinal block. This is an injection given at the time of your operation that will temporarily numb you from the waist down and will keep you comfortable afterwards.
• Ketamine infusion. This is a continuous intravenous pain killing medication which will run up to 24 hours after surgery.

The anaesthetist may discuss these options with you and explain more about it when you are in hospital.

Alongside this, the doctors will prescribe other types of pain relieving medicines, which work in different ways. You will be given these regularly (three or four times per day) and you should feel more comfortable.

If the pain worsens at any time, please tell the nursing staff immediately and they will be able to help you.

Sickness

Sometimes after an operation it is not uncommon to feel nauseated and occassionally vomit. You will be given medication during surgery to reduce this, but if you feel sick following surgery please tell a member of staff who will be able to help.

Tubes and drips

During your operation a tube (catheter) will be placed into your bladder so that we can check that your kidneys are working well and your urine output can be measured. This tube will be removed as soon as possible.

You will have an intravenous drip put into your arm to ensure you do not become dehydrated. The drip will normally be removed the day after surgery, but you may still have the intravenous port (venflon) in place for a couple of days in case we have to give other drugs through it. You may also be required to breathe extra oxygen for a short while after your operation.

Monitoring

Many different things will be monitored during your treatment including:

• Observations (blood pressure, pulse, temperature).
• Fluid out.
• Fluid in.
• Food eaten.
• When your bowel first starts working or you pass wind.
• Pain assessment.
• Number of walks achieved.
• Time spent out of bed.

You may be asked to tell us about what you eat and drink and what you pass so that we can record it.

While you are in hospital you will be asked to participate in maintaining a daily diary/log (provided by the ward) so that you can keep a record of how well you are managing. This will help us monitor your progress.

Please remember playing an active part in your recovery will help you get better sooner. If you have any questions regarding your recovery, please do not be afraid to ask a member of staff.

You will be seen, during your hospital stay, by the Enhanced Recovery Nurses (Monday – Friday) who will support you and advise you on your journey through the Enhanced Recovery Programme.

References and further information

For further information on the Enhanced Recovery Programme:

www.gov.uk/government/organisations/department-of-health-and-social-care

How to contact us

Enhanced Recovery Nurses

0117 414 3610

0117 414 3611

07808 201713

Colorectal nurses

0117 414 0514

Stoma Care Nurses

0117 414 0270

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002214

Ask three questions

As you prepare to leave hospital you may need to get certain things organised. To help you with your planning, make sure you get the answers to these three questions:

1. What are my options?
2. What are the possible benefits and risks of those options?
3. What help do I need to make my decision?

For further information please speak to the staff looking after you.

Your estimated discharge date

The Enhanced Recovery Nurses will discuss your discharge date with you.

When you leave hospital

Complications should not happen very often, but it is important that you know what to look out for.

During the first two weeks after surgery, if you are worried about any of the following, please phone the telephone numbers at the bottom of this page. You should be able to reach a member of staff on the ward at anytime. If you cannot contact the people listed, you will need to contact your GP or the NHS 111 service.

Abdominal pain

It is not unusual to suffer gripping pains (colic) during the first week following removal of a portion of bowel. The pain usually lasts for a few minutes and will go away completely in between spasms.

Severe pain that lasts for several hours may indicate a leakage of fluid from the area where the bowel has been joined together. This can be a serious complication, which fortunately, happens only rarely. Should this occur, it may be accompanied by a fever. On occasion leakage may occur which makes you feel generally unwell, causes a fever but is without pain.

If you have severe abdominal pain lasting more than 1-2 hours and/or have a fever and feel generally unwell, you should contact us on the telephone numbers provided immediately.

Vomiting

Occasionally after surgery you can experience some nausea which is not unusual. Persistent nausea and vomiting however is not to be expected as this could be a sign of obstruction. If this happens to you it could be a sign of obstruction which needs to be treated.

If you experience severe nausea and vomiting please contact us immediately on the telephone numbers provided.

Your wound

The ward nurses will check your wound dressing before discharging you home.

If you have had key hole surgery you might have paper stitches (steristrips) which may be left directly on the wounds. You can continue to bathe or shower and you can pull these off after 7 days during a soak in the bath. You shouldn’t need further dressings after this.

For other wounds it is possible that either dissolvable stitches or a special adhesive will be used and again you may continue to take light showers or baths. If you require a dressing for a longer period of time then the nursing staff will advise you.

It is not unusual for your wounds to be slightly red and tender during the first 1-2 weeks. You may also notice bruising.

Please let us know if your wound:

• Becomes more red, painful or swollen.
• Starts to discharge fluid/pus.
• Your wound edges separate.

As this may indicate an infection. You may also wish to contact your GP or practice nurse at your surgery for advice.

Your bowels

In the early stages following surgery to remove part of your bowel, your bowel habit may change and may either become loose or constipated. This can continue for up to 2-3 weeks.

Try to eat regular meals three or more times per day, drink adequate amounts, and take regular walks during the first two weeks after your operation. This will help improve bowel function.

Please note that if you have an ileostomy it is normal to pass loose stools more frequently than 3 times per day into the Stoma bag. The stoma nurse specialists will discuss this with you.

Please seek advice from the Enhanced Recovery Nurses, your GP or by contacting one of the telephone numbers at the bottom of this page if you are experiencing any of the following:

• Prolonged constipation or diarrhoea.
• Discharge, pus or bleeding from the back passage.
• If you are needing to empty your ileostomy pouch more than 6 times per day and if it is of a very loose, watery consistency.

Passing urine

Sometimes after bowel surgery you may experience the feeling of a full bladder.

This usually resolves, however if you experience ANY of the following problems please ring for advice:

• Unable to pass urine.
• Bladder pain or discomfort on passing urine.
• Excessive stinging when passing urine, as you may have an infection which will require treatment.
• Difficulty in emptying your bladder fully.

Diet

A balanced, varied diet is recommended and particularly eating 3 or more times a day. You may find that some foods upset you and cause loose bowel motions. If that is the case you should avoid those foods for the first few weeks following your surgery. You may find a low residue diet will help in the first two weeks after your operation.

If you are finding it difficult to eat it is still important to obtain an adequate amount of protein and calories to help your body heal. You may benefit from having three to four high protein, high calorie drinks such as Build-up or Complan (available in supermarkets and chemists) to supplement your food, or continue with the Fortisip or Fortijuce drinks which can be prescribed by your GP.

It is important to drink plenty of water. If you are suffering from diarrhoea then it is important to replace the fluid loss and to drink extra fluid.

If you are losing weight without trying or are struggling to eat enough you may benefit from a consultation with the dietitian, please contact any of the numbers provided below and someone will be able to help you, or ask your GP or consultant to refer you.

Helpful suggestions

• Eat small nourishing snacks between meals.
• Try not to skip meals, have a snack or nourishing drink if you cannot manage a main meal.
• Have nourishing drinks during the day. Avoid drinks up to 30 minutes before meals, as they may fill you up.
• If you are not eating as much as you normally would, try fortifying foods to make them more nourishing. See more information below on fortifying foods.
• Have a selection of easy-to-prepare foods in case you do not feel like cooking.
• Make use of your freezer and cupboards to store convenience foods.
• Aim to try and have 5 daily portions of fruit and vegetables to ensure a good vitamin and mineral intake. You may find it easier to digest if you remove the skin.

Important foods

Try to include high calorie and high protein foods at each mealtime.

High Protein Foods

• Meat and fish
• Eggs
• Soya
• Milk, yoghurt, cheese
• Nuts, beans, lentils

High Calorie Foods (if your appetite is poor)

Fatty and sugary foods such as:

• Biscuits and cakes
• Crisps and chocolate
• Puddings
• Cream and butter

Snack ideas

Try these snack ideas which are high in energy or protein:

Savoury

• 'Cream of’ soups
• Bombay Mix
• Individual cheeses
• Crisps and dips
• Peanut butter, nuts
• Quiche, cocktail sausages and pork pies.
• Cheese and biscuits
• Sandwiches
• Instant noodles

Sweet

• Milk puddings, rice pudding, mousse and custard
• Tea cakes and malt loaf
• Pastries and biscuits
• Cakes and muffins
• Trifle and ice cream
• Crumpets
• Full fat yoghurt
• Chocolate

Nourishing drinks

Milky drinks are high in energy and protein. Choose from the following:

• Full cream milk.
• Milkshakes and smoothies.
• Hot chocolate and malted drinks.
• Milky coffee and tea.
• Yoghurt drinks.
• Complan and Build Up.

If you dislike milk, try these high energy alternatives:

• Sugary fizzy drinks e.g. Lucozade, cola, lemonade.
• Complan and Build Up Soups.
• Fruit juice.
• Soya drinks e.g. OY or Provamel.
• ‘Cream of’ soups.

Fortifying foods

The following suggestions may help to add extra energy and protein to everyday foods if you have lost weight or are not eating much:

Milk

• Try using full cream milk instead of lower fat milks in tea, coffee, soups, sauces, jellies, milk puddings, porridge, custard.
• Add ice-cream or creamy yoghurt to milkshakes and smoothies.
• Try using condensed or evaporated milk.

Breakfast cereals

• Use full cream milk.
• Add extra dried fruit or nuts.
• Sprinkle extra sugar on top.
• Add jam, honey or syrup to yoghurt, porridge or cereals.

Toast

• Spread butter or margarine on whilst the toast is still hot.
• Spread jam, marmalade, honey or peanut butter on thickly.
• Try the above with crumpets, muffins and teacakes.    

Sandwiches

• Add mayonnaise or salad cream to fillings such as egg, tuna, cheese or meat.
• Spread butter or margarine thickly.

Soups

• Use ‘Cream of’ varieties.
• Add grated cheese.
• Add dumplings, baked beans or pasta.
• Add croutons.

Mashed potato

• Add butter, margarine, cream, grated cheese or extra milk.
• Mash hard boiled egg with potato and margarine or butter taste.
• Add flaked fish/corned beef/minced beef/fried onions.

Vegetables

• Melt butter or margarine on top.
• Sprinkle with grated cheese or chopped egg.
• Serve with a sauce e.g. cheese or hollandaise sauce.

Puddings

• Try to have a pudding after each main meal or as a snack in-between if your appetite is poor.
• Add cream, ice-cream, yoghurt, condensed or evaporated milk to puddings such as milk puddings, fruit or instant desserts.
• Add sugar, honey or syrup to ice-cream or other puddings.
• Make fruit fool using custard or double cream and pureed fruit.

Sample meal ideas

Breakfast

• Creamy scrambled egg with buttered toast.
• Porridge/cereals with honey/jam.
• Crumpets with butter and jam.
• Muesli with whole cream milk and natural yoghurt.

Main meal

• Shepherds pie with grated cheese topping and buttered vegetables.
• Chicken curry or dahl with rice or chapatti spread with butter or margarine.
• Cauliflower cheese made with fortified milk with grated cheese topping.
• Fish in cheese sauce with creamed potatoes and buttered vegetables.

Snack meals

• Beans on buttered toast with grated cheese topping
• Buttered jacket potato with tuna mayonnaise filling.
• Ham or cheese omelette, chips and salad with mayonnaise.
• A creamy soup with grated grated cheese and croutons.

Pudding Ideas

• Milk pudding e.g. rice/tapioca/ semolina.
• Baked egg custard.
• Crumble with ice-cream.
• Trifle with cream.
• Jelly made with fortified milk.

Exercise

We encourage activity from day one following surgery. You should plan to undertake regular exercise several times a day and gradually increase during the 4 weeks following your operation until you are back to your normal level of activity.

The main restriction we would place on exercise is that you do not undertake heavy lifting 4 - 6 weeks following your surgery. In addition, if you are planning to restart a routine exercise such as jogging or swimming that you wait until 2 weeks after surgery and start gradually.

Common sense will guide your exercise and rehabilitation; in general if the wound is still uncomfortable modify your exercise. Once the wounds are pain free you can undertake most activities.

Work

Many people are able to return to work within 2 - 4 weeks following their surgery. If it involves a heavy manual job then we would not advise heavy work until 6 weeks following surgery.

Driving

It is advised that you do not drive until you are confident that you can drive safely. Usually this is when you are doing most of your normal activities. In general this will be after 4 weeks of surgery. It is important that any pain has resolved sufficiently to enable you to perform an emergency stop. You should contact your insurance company to check their terms or you may not be fully insured.

Hobbies and activities

In general it is advised that you take up your hobbies and activities as soon as possible again after surgery. It enables you to maintain your activity and will benefit your convalescence.

We would not advise restricting these unless they cause significant pain or involve heavy lifting within the first 6 weeks following surgery.

Sexual activities

Feeling tired and weak after an operation or illness naturally affects your sex drive. As you gradually start to feel well again and your energy levels return to normal so should your sex drive. It is important for you and your partner to discuss your feelings openly.

Sexual intercourse can be resumed as soon as you feel comfortable, generally about two to four weeks after surgery. Occasionally, following surgery or radiotherapy to the rectum or lower colon, nerve and blood vessel damage can occur. In men this may cause ejaculatory problems or result in difficulty and/or maintaining an erection. In women, discomfort or vaginal dryness may occur.

These problems are usually temporary, due to inflammation and swelling after surgery, but in some instances may be permanent. If you do experience problems of this nature, please discuss it with your surgeon or colorectal nurse specialist, as specialist help is available.

Medications

You may continue with your normal medicines unless directed to stop by your doctor. You will be given a new supply of these if you do not have enough at home. You will also be given pain killers and any other medicines required, to take home.

It is a good idea to have a supply of non-prescription pain killers, such as Paracetamol, at home as a back up.

If you are required to continue with the ‘Clexane’ injections at home, you will be given enough pre-filled syringes to complete the course (usually for four weeks after your operation) and a ‘sharps bin’ to put the used syringes into. Your GP or local chemist will be able to advise you on how to dispose of the bin in your area.

Clinic follow up appointments

If you are under the care of one of the colorectal nurse specialists, your follow up appointment will be arranged by them. They will discuss this with you as soon as the biopsy results are available. This will usually be approximately two weeks after discharge home. Otherwise an appointment will be sent through the post as directed by the consultant.

Follow up appointments allows the team to see how you are and talk through any further treatment. Please do not hesitate to contact any of us on the numbers provided below if you need any help or advice following surgery.

If your surgery was planned (not an emergency) the enhanced recovery nurse will phone you at home each day for approximately four to five days to check on your progress. In between times, if you have any concerns, you can contact them on the number provided, or out of hours contact the ward.

When to seek urgent advice

If you experience any of the following please seek urgent advice by contacting us on the numbers below.

• Severe or uncontrolled abdominal pain.
• Persistent nausea and vomiting.
• Unable to eat and drink sufficiently.
• Urgent or serious wound problems.
• High stoma output (if you have a stoma following surgery).
• Persistent loose stools/ diarrhoea.
• A new difficultly passing urine.

References and further information

www.nhs.uk/conditions/enhanced-recovery

www.nbt.nhs.uk/erp

www.gov.uk/government/organisations/department-of-health-and-social-care

How to contact us

Enhanced Recovery Nurses

Telephone: 0117 414 3610

Telephone: 0117 414 3611

Colorectal nurses

Telephone: 0117 414 0514

Stoma Care Nurses

Telephone: 0117 414 0270

Surgical Admissions Unit

Gate 32B Brunel building

Southmead Hospital

Bristol

BS10 5NB

Telephone: 0117 414 3233

Telephone: 0117 414 3234

www.nbt.nhs.uk/erp

GMC Number: 7215355
Year & location of first qualification:
2010, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal

Specialty: Neuroradiology
Clinical interests:
Diagnostic Neuroradiology, Vascular and Skull Base pathology, Inflammatory and Autoimmune diseases

Secretary: Caroline Hawkins
Telephone number: 0117 414 9009

Dr Alves Rosa undertook core medical training in the West Midlands prior to radiology training in the Severn Deanery.

He completed a nationally competitive diagnostic and interventional neuroradiology fellowship at the tertiary neurosciences centre of North Bristol NHS Trust.

His qualifications include MRCP Lon (2014), FRCR (2018), and the European Diploma in Neuroradiology (2022). He also completed all modules of the European Course in Minimally Invasive Neurological Therapy in 2020.

Dr Alves Rosa has presented research at a national and international level and published in peer reviewed journals.

He is a fellow of the Royal College of Radiologists and an advisory editor for Clinical Radiology.

Email address: joao.alvesrosa@nbt.nhs.uk

Want to have your say? Listening to you, helps us too

Taking part in research doesn’t necessarily mean being treated as part of a study.

At NBT we have a variety of groups involving members of the public who help us to review and  improve the care we give to our patients.

Your involvement helps to ensure that our focus remains on what is most important – the people we look after. We believe that people with personal experience of healthcare are best placed to comment on what research is needed and how research should be done.

You don't need any research experience to join, just fresh perspectives that can guide our researchers, helping to make our research more relevant and acceptable to the people who use our services.

You will be able to:

• Comment on the researcher’s treatment ideas.
• Discuss how the treatment will be carried out.
• Read and give feedback on patient information sheets, letters to patients and patient questionnaires.
• Keep updated on how the research study is progressing.

You can be involved as much or as little as you wish, depending on your personal circumstances. Each group is different, with some meeting for approximately 2 hours every 8 weeks, and others meeting just once or twice in total.

Please see the some of our Current Opportunities below. 

If you are interested in a particular health condition that is not listed below, please do get in touch by emailing researchcommunications@nbt.nhs.uk

Women & Children's groups

What is Bell’s palsy?

Bell’s palsy is a medical problem causing weakness of the muscles on one side of the face. It is usually temporary - with most people making a full recovery within two to three months. It comes on suddenly and the cause is unknown. 

The facial nerve supplies the muscles in your face. In Bell’s palsy this nerve is affected, leading to weakness or paralysis of the muscles that control smiling, frowning, eating and closing the eyelids. It can also affect your ability to taste. 

Bell’s palsy can affect men and women of any age but is most common in 15-45 year olds. In the UK it affects approximately one in 70 people at some point in their lifetime. 

What are the symptoms of Bell’s palsy?

The symptoms of Bell’s palsy often occur very quickly, over a few hours or overnight. The weakness or paralysis usually affects one side of your face. 

The symptoms will vary and may include:

• Facial pain around your ear on the affected side.
• Drooping of the face on one side.
• When you smile, only one side of the face may move, you may not be able to frown, and speaking clearly may be difficult.
• Difficulty closing your eye. It may not fully close and may water or become dry.
• Difficulty when chewing food, you may dribble slightly.
• Altered or loss of taste on one side of your tongue.
• Sensitivity to noise. Noises may sound louder than usual which can be uncomfortable. 

Treatment

Medications

You may have been prescribed oral steroids (prednisolone) if your symptoms started in the last 3 days. If you have been prescribed steroids take 50mg (10 tablets) once a day for 10 days along with omeprazole 20mg once a day for 14 days then stop. Steroids may help to reduce inflammation and decrease the likelihood of damage to the facial nerve. 

Mouth care

As the facial muscle may not be functioning fully, food may become stuck around the teeth and gums on the affected side. Make sure you remember to clean this area well and remove all debris after eating. 

Eye care

Eye care is very important if your eye is affected. If your eye does not close when blinking: 

• The eye can dry up. You should use eye drops or artificial tears to keep the eye moist. Use artificial tear drops during the day and a thicker solution at night. Ask your pharmacist for advice.
• The eye will not have the normal protection from the eye lid closing. It is important to protect the eye and avoid scratching the cornea (the thin, transparent layer covering the eye). Do not use contact lenses until your eye returns to normal. You may be advised to wear an eye patch by day and to tape the affected eye lid closed at night if your eye does not close when you sleep. Tape such as transpore can be used for this. 

Advice for taping of the eye shut at night

1. Cut the tape slightly longer than the width of your eye.
2. If using night time ointments these should be inserted into the eye.
3. Look down.
4. Assist the eye closure with the back of your finger.
5. Apply tape from the inner corner to outer corner of the eye in a horizontal direction so that it extends beyond the width of the eyebrow.
6. Ensure that the eyelid is fully closed; the tape is on the upper lid and covers the area underneath the eye.

Video: How to Tape Your Eye Closed (Adults) - Facial Palsy UK

Exercises can be useful to tone the facial muscles as the movement begins to return, perform 10 each of these exercises 4 times a day:

• Gently raise your eyebrows – you can help the movement with your fingers.
• Wrinkle your nose.
• Try and flare your nostrils.
• Lift one corner of the mouth and then the other.
• Smile without showing your teeth, then smile with showing your teeth.
• Bring your eyebrows together in a frown. 

Prognosis

75-90 people in every 100 people who have Bell’s palsy start to improve within three weeks, and make a full recovery within two to three months. However, about 5-10 people in every 100 people who have Bell’s palsy have some slight weakness which remains forever. Rarely there may be little or no improvement. 

Do I need follow up?

Most people with Bell’s palsy make a full recovery in 3 weeks to 3 months. If you do not make a full recovery in 3 weeks then make an appointment with your GP. 

If you are unable to close your eye normally and develop pain, stinging or visual disturbance please attend the Eye Casualty at the Bristol Eye Hospital in the next 24 hours. The Bristol Eye Hospital Casualty is open 7 days a week from 8.30am - 4.30pm. Further information can be found at Bristol Eye Hospital - How to find us 

© North Bristol NHS Trust. This edition published June 2025. Review due June 2028. NBT003415.

If your child has ingested (swallowed) a super strong magnet

If your child has swallowed a button battery

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT003414.

Easy Read

VNS stands for Vagal Nerve Stimulator.

It helps treat your epilepsy.

It is a device in your body that send signals to a nerve. It helps calm down your brain activity when you have a seizure.

The battery on your VNS is low. 

You need to come to the hospital to have a new VNS battery.

Before your surgery, you will see the epilepsy nurses to make sure you are healthy and ready for surgery.  

You can't have food or drink before your surgery. 

You can have your normal medications. 

You will arrive at the hospital for your appointment at the time you have been told. 

Your family or carer can support you. 

You will go to Medirooms. It is in the blue zone. 

You will check in at the desk. 

You will wait in the waiting room.

Your name will be called. 

A nurse or healthcare assistant will show you to your room. 

You will wait in your room. This is your room for the rest of the day. 

The nurse will check you in. They will ask you lots of questions to check you are healthy for the surgery. 

The doctors and anaesthetist will see you in your room. 

You will have a cannula fitted to your hand or arm. 

You will be taken to the theatres. 

Your family member or carer can get dressed into scrubs and come with you.

The anaesthetist will give you medicines to help you sleep.

You will have your VNS battery changed.

You will be asleep and won’t feel anything.

You will wake up in your hospital room.

Your family or carer can be there when you wake up.

You might have monitors on your arm when you wake up.

You might still have a cannula in your hand or arm.

You will have a bandage on your chest.

If you feel sore, the nurses can give you medicine to help you.

Your nurse will look after you.

When you have woken up you can have something to eat and drink.

When you are feeling well enough you can go home.

Wear your bandage for one week.

Keep your bandage dry when you shower.

A nurse will take the bandage off.

You will see your epilepsy nurse to check the VNS.

If you have a learning disability or autism and have any questions, you can call the hospital learning disability and autism liaison team on 0117 414 1239.

© North Bristol NHS Trust This edition published December 2022. Review due December 2025. NBT003502 EASY READ