Walking Again to Jogging and the Bits In Between

  • The Technique of Walking
  • Getting into and Out of a Chair and the Toilet
  • Having a Wash or a Shower
  • Improving Your Walking
  • Returning to Jogging

Walking is Not That Simple

While recovering from the surgery, you will soon discover that walking and moving are not that simple or straightforward from the get-go. What was something that came to your naturally will now need to be relearned and then followed with a lot of practice. Your normal style and speed of walking will take a few weeks to progressively return to normal.  This will enable easier, faster, and less tiring walking done with a better style and efficiency.

Following a surgical procedure, whether it’s been undertaken laparoscopically or more intensively through open surgery, you will definitely have some scarring on the anterior stomach wall and along with it, some abdominal pain. This will cause you to be reluctant to straighten out your legs, stretch or stand upright. Instinctively, you will adopt a crouched-over posture where your back will be arched to relieve some of the pain from the scars. Moreover, you will also likely walk with a wide stance. You will place your feet aide apart and instead of walking, you’ll shuffle your feet along the floor in small short steps. This will allow you to minimise the pressure and stretch on the abdominal musculature. Don’t worry when this happens as it pretty normal. The discomfort in the abdominal musculature and the surgical scars will improve rapidly and should largely settle over two to three weeks.

You will also need to strengthen your abdominal muscles. You can do this by doing some exercises that engage and activate your abdominal muscles. There will be some discomfort, but eventually, this will encourage strengthening of the muscles over time. In addition you should work at the technique and style of walking in order to return to that upright posture and confident stride.

I will describe a progressive schedule of points to remember. If these are put into practice, your walking will progressively improve; such that after a week or possibly two, you will be walking upright with confident steps, which is a good efficient style. Overall, this will facilitate and improve your rehabilitation and enable a more rapid recovery and return to normal.  you to be rehabilitated gradually.

1           The postoperative crouch

The post-operative crouch is the position you will adopt after surgery when first getting out of bed to stand up. As I mentioned previously, you will do this to avoid causing any further pain in the abdominal muscles. When you remain crouched over, you avoid stretching or putting pressure on the abdominal muscles in the front of your abdomen. This results in less pain and discomfort. In the crouched position, you’ll find yourself bending both knees a little and leaning forwards. This is because when you’re crouching over, your centre of gravity moves forward. So your body counteracts this by bending the knees and moving the pelvis backwards a little. This allows you to move the centre of gravity back over the feet and keeping your balance.

The remedy for this is firstly that the pain should initially be controlled with painkillers, analgesia or the local anaesthetic nerve blocks put in at surgery. When you first stand, transfer to a chair or walk o the bathroom, take this opportunity to stretch and stand up as straight as possible as your pain will be managed with the medicine. Once you’re standing, take a moment to get your balance and then try to:

  • Stretch upwards
  • Reach for the ceiling with the top of your head
  • Push backwards with the shoulders
  • Push the pelvis forwards and
  • straighten the knees

Try to hold this position as you walk. Remember to take time to stretch out and adopt this position each and every time you stand up or start to walk. Even if it is only to the bathroom.

2           The post-operative shuffle

Following surgery, any leg or hip movement will also move the pelvis; which is connected to the musculature of the lower abdomen and stomach. Consequently, you will try to walk in a way that minimises any hip and leg movement. Don’t fret if you have to walk like this for a while as it is quite normal to do so. Recognise this limitation and try on each occasion to:

  • Stand up straight and tall
  • Lift the feet with each step
  • Stretch out each step just a little bit further than the one before

Initially, you will require a considerable amount of analgesia and pain relief medication. If the pain is controlled, take this opportunity to avoid the shuffle and to lift the feet and stretch out each step just a little whilst walking.

3           Turning around when on your feet

For the first few days, or perhaps as long as 10 days, twisting or turning around may feel a wee bit sore in the abdominal muscles. This can simply be avoided by taking small steps to gradually turn around, twisting the foot to the side. It will probably take you three steps to turn 180 degrees.

4           Getting into and out of a chair

Following abdominal surgery, getting into a chair is more difficult than getting out of one. If you have undergone an anastomosis of the large bowel onto the rectum or an abdominal-peroneal resection, where the rectum is removed through your bottom, the local trauma may make sitting for any length of time painful, uncomfortable and problematical. For the purpose of this blog and to give some advice, I will assume that this is not the case for you.

The technique for sitting in a chair is firstly to choose your chair carefully. The kind of chairs provided in hospitals, with a high back and arms is the best choice. Once you have one, turn round in front of it and move backwards so that both your calves and back of the knees rest against the front of the seat. Feel behind with both hands to locate the arms of the chair. Once you have the arms in your hands, gently lower yourself into the seat. In the beginning  placing a pillow or cushion in the seat before you sit, may be more comfortable. I found that a pillow placed sideways in the seat so that it was under my thighs and bottom made it comfortable for me to sit down. As a bonus, this also prevented me from slipping forward in the seat and down on the ground.

In order to get out of the chair, you need to do the reverse of what you did to get into in. First pull your feet back under your knees and the front of the seat, place both hands on the arms of the chair, pushing yourself upwards on your arms and legs and reaching up to a standing position. Remember that you may feel faint while doing this. So, take a few moments before letting go of the arms of the chair and beginning to walk.

5           Getting onto or off the toilet

Getting onto or off the toilet is the same technique as getting into or out of a chair. A toilet with disabled facilities in the hospital will have handrails either side. If you are elderly or unable to use your legs properly, portable toilet rails are available, and can be installed by social services for the home toilet. This can be arranged by your General practitioner doctor, the district nurse, occupational health or the social services. You can call in and ask the ward, call your GP or search the internet before going into hospital. These rails provide something for you to hold onto. As an alternative, the sink, radiator or a cupboard at hand will be strong enough for you to hold on to.

Grab handles are also readily available from Social Services or the internet. If the requirement is temporary, a grab handle with suction pads can be used on tiled bathroom areas. If you don’t even have that, the resort is to hold on to the toilet seat’s sides while you get on and off it. (Suction Grab Bar: www.nrshealthcare.co.uk/bathroom-aids, www.completecareshop.co.uk/bathing-aids )

While emptying an ileostomy bag, it will be necessary for you to approach the toilet bowl from the front. Ideally, you can use a small stool or footrest to sit on; so that you can lean forwards and the bag can be emptied into the toilet. If you are travelling and the bathroom doesn’t have a footrest or stool, I found that kneeling on one knee in front of the toilet bowl allowed me to easily lean forwards and empty my bag. To make it more comfortable, I used a folded up small hand towel and placed it under my knee to provide some padding. The technique is described in the advice sheet – “How Best to Empty Your Ileostomy Bag”.

6           Having a wash or a shower

I was very fortunate in having a fairly new hospital room with a spacious adjacent wet room with a tiled floor. I am sure that they used non-slip tiles but they did not look too non-slip to me. So, as a precaution, I made sure to take careful steps to avoid slipping on the floor. Even the toilet had railings, which I did not end up using. Regardless, the bathroom did make it easy for me to use the toilet. The shower, however, did not have any curtains. While this was probably more hygienic, the water went everywhere, soaking the whole floor of the wet-room. This made me very worried about slipping: which would have been very painful. So I was very cautious and careful when the wet room floor was wet. While there were plenty of hooks for my towel and clothes, there was no soap tray. So I had to balance my shower gel and shampoo on the rail fitting. There were handrails for the shower too. I didn’t need their support but rested my foot up on the rail to wash my legs and feet more easily.

My advice for showering is to get partially undressed before entering the wet room and taking only clean underwear and your towel with you. There were a plethora of towels already in the bathroom, so I used one for drying myself and one as a bathmat at the entrance so that when I left the wet room, my feet were dry and all the water left inside. I was amazed by the efficiency of the NHS cleaners as the wet room was cleaned or tidied perhaps three times a day. I felt a little guilty leaving the floor all wet but that was a design fault. Besides, I couldn’t possibly clean it myself as I was in pain, ill and immobile.

Once getting home, I was fortunate enough again to have a tiled bathroom floor and a 120 x 90 cm spacious shower. Although the shower tray is raised perhaps 100mm the access over that step is easy and was not a problem.

7           Improving your walking step 1: Days 1 to 4

Initially, you will adopt the post-operative crouch and shuffling gait. As described, each and every time you stand up to take a few moments to stretch up as tall as you can; raising the top of your head to the ceiling, holding your shoulders back, pushing your pelvis forwards and straightening your knees. Once you have done that, only then try to walk. Try to hold this stiff upright position as you walk, even if your steps are short and more like shuffling than walking.

You will find that you walk with a wide stance, with your feet wide apart. As your balance becomes better, try to narrow your stance gradually by keeping your knees straight so that at least you are walking on straight legs. To avoid shuffling, try to hit the ground with your heel first and then roll it forwards onto the balls of the feet. When stepping forwards, try to push off with the big toe of the rear foot and then push yourself forwards onto the other foot.

8           Improving your walking step 2: Days 5 – 10

As you progress in your recovery and the stiffness and pain settle, you will need to work on improving the efficiency, style and speed of walking. Do not try to carry anything whilst walking and have your hands and arms free to move and swing. When you try to walk, you might notice that your hands remain still by your sides. This is not your normal style. So try to pay attention to your arms and try swinging them reciprocally with the opposite leg. Don’t go overboard with the swinging. Start slowly. You will notice that swinging the arms introduces a little rotation of trunk and abdominal muscles. One important reminder here, it might feel a little sore in the beginning but that’s normal. Once you get through with that, quickly progress to an active arm swing. This will help in lengthening your steps, the speed and power of walking. It will also eradicate the shuffling.

Besides the arms, you’ll notice that your pelvis does not initially move from side to side or rotates when walking. Like the non-swinging arms, this is not your normal style. The pelvis swings slightly forwards on the side of the front leg and backwards with the rear leg. This will help in lengthening the stride and reducing the sway from side to side. Concentrate on this and coordinate the movement with the arms and legs. Again, this may initially be uncomfortable but swing the pelvis a little more each day to make an overall improvement in your gait.

With the knees, remember to straighten them fully before the heel hits the ground. This momentum forwards will help with the speed and power of each step. Like the knees, straighten the leg fully before it hits the ground with the heel. This again lengthens the stride. So remember to push off each step with the big toe, using the calf muscles and hit the ground with your heel and the knee straight.

To reiterate some important reminders – remember to:

  1. Stand up straight and  don’t look down, push your chin up, look forwards, shoulders back, and push your chest out.
  2. Concentrate on your balance and avoid any sway from side to side
  3. Rotate your pelvis with your legs to lengthen your stride
  4. Gently swing your arms.
  5. Stretch out each step a little further

By checking all of these off the checklist, you’ll not only look stylish but also feel much better. As you walk with the new and improved gait, the miles will pass by. However, remember that you will tire easily as you’re still in recovery and your abdominal muscles are weak. Increase the distance a little each day. As you get tired, concentrate more on the style and slow down the speed a little. Remember to focus on your balance and try not to trip or fall; particularly if you are tired towards the end of your walk. Remember to take your time and increase a little each day.

9           Improving your walking step 4: Jogging

Once you’ve made significant improvement and progress in your walking you may consider more active exercise and a return to the gym. This should be started slowly and only once you can walk several miles without any pain or discomfort. This should not be undertaken strenuously or with weights initially as there is always the risk of producing a hernia in the weak abdominal musculature.  Remember to empty your bag before start exercising. Also, the best time to exercise is early in the morning, before having anything substantial to eat as this is when the stoma is at its lest active. If the jiggling of the bag is uncomfortable a stabilising strap for the bag is available from your stoma care supplier.

Start on a treadmill, grass or any other kind soft surface. Remember to wear comfortable clothes that don’t pressure on the stoma and use trainers or running shoes. Start at a slow speed with a short stride, slowly building it up to lengthen it. When jogging, remember all the finer points about the technique of walking we have already discussed. All these points are equally as important when jogging. So stand tall, shoulders back and ensure that the legs straighten out with each step, landing on the heel first rather than the toes. Push off with the back foot, then your calf and big toe. Use the pelvis rotation from front to back to lengthen the stride. To maintain your balance, use a narrow stance with the feet passing close by each other on parallel lines. Minimise your side to side sway. Do not try to run too far or too fast or quickly. Since the ileostomy bag will be on your abdomen it might move around when you jog. If movement is painful on your abdomen, pelvis from the jiggling of the ileostomy bag, reduce the speed, distance or time you jog for. Alternately get a supporting bag strap from your stoma care product supplier.

Disclaimer: This information is only provided for general and background reading. The information should not be relied upon for treatment. The views provided are not necessarily those of the author or of the website. You should always take advice from your own general practitioner or treating specialist before a treatment is commenced or altered. In individual circumstances liability is not accepted for any reason by my-ileostomy.co.uk