How to cough after abdominal surgery

After your operation, you will need to take deep breaths and cough several times each hour to keep your lungs fully expanded. By deep breathing and coughing, you will help speed your recovery and reduce the risk of developing breathing problems. To help you with deep breathing and coughing exercises, your doctor may order an incentive spirometer. This special tool will help you cough and deep breathe better. It will also let you and your nurse know how deeply you are breathing. A respiratory therapist or nurse will show you how to use the incentive spirometer.

How to Use the Incentive Spirometer

1. 
   Sit on the edge of the bed or sit up as much as you can in bed.
2. Hold the spirometer upright.
3. Put the mouthpiece in your mouth and tightly seal your lips around the mouthpiece.
4. Breathe in slowly and as deeply as possible. Watch the disc inside the spirometer rise to the top. Try to keep the disc between the two arrows on the spirometer as you breathe in.
5. Hold your breath as long as possible and then exhale slowly as you watch the disc fall.
6. Rest.
7. Repeat the sets above 5–10 more times.
8. Do this as frequently as told to you by your nurse or therapist.
9. After using the incentive spirometer, follow the steps below.

Coughing and Deep Breathing

How to Take a Deep Breath

To deep breathe correctly, practice the following exercises two or three times a day before surgery. That way, you will be able to do it more easily after surgery.

1. Lay down on your back and get into a comfortable position. You may want to bend your knees slightly as you try to relax.
2. Place one hand on your chest and the other over your upper abdomen. Close your mouth and breathe in deeply through your nose. As you do, concentrate on feeling your abdomen rise without expanding your chest. If the hand on your abdomen rises as you breathe in, you are doing the exercise right.
3. Hold your breath for five seconds.
4. Now “Purse” or pucker your lips, as though you are about to whistle. Breathe out completely through your lips using your abdominal muscles. Squeeze all the air out.
5. Rest several seconds, then continue the exercise until you have done it 5–10 times.

If you are having abdominal surgery, you may be more comfortable if you hold a small pillow over your incision. Lace your fingers together across the pillow to hold it in place. Then do the deep breathing exercise, as described.

How to Cough

After your surgery, the nurse will remind you to do coughing exercises. Coughing helps keep your lungs free of mucus.
You should practice coughing before your surgery, so you can do it easily afterwards.

1. Sit on the edge of your bed. Bend your body slightly forward. (After surgery, you may also perform this exercise while lying in a comfortable position instead of sitting at the edge of the bed.)
2. If you are having chest or abdominal surgery, you will be more comfortable if you hold a small pillow over your incision as you cough.
3. To begin your coughing exercise, take two slow, deep breaths.
4. Take a third deep breath and hold it for five seconds. Let the air out by coughing forcefully.
5. Repeat this exercise at least once more.

Oral (Mouth) Care

Good oral (mouth) care is important for many reasons. Besides helping to prevent dental problems, good mouth care can help lower your risk of certain infections such as pneumonia (lung infection). Your health-care team will tell you about mouth care based on your specific needs. This may include use of a toothbrush (please bring a new toothbrush with you to the hospital), toothpaste, and/or salt and soda rinses. You will also be told how often you should do mouth care. It is also very important to take proper care of dentures. Please remember your denture supplies.

Ask Questions

If anything in these information sheets is unclear to you, please ask you nurse or therapist for help.

Getting Up and Moving Around After Surgery

Getting up and moving around about as soon as possible while in the hospital can help lower your risk of developing problems, such as soreness, weakness, getting tired easily, and swelling. Walking and other physical activity have been shown to help prevent serious problems, including pneumonia (lung infection) and blood clots. Your health-care team is committed to helping you get up and move as soon as possible. They will tell you when you will be getting up for the first time, how often you will need to get up, and for how long you need to stay up. If you are having difficulty moving, feel unsteady, or have questions about exercising, ask your doctor for a referral to physical therapy.

How to Exercise your Shoulders

Start with your hands on your thighs. Lift your arms up and back down slowly and in a controlled manner. Breathe in while raising your arms, and breathe out while letting them down. Do this 10 times in a row, five times a day.

How to Exercise Your Legs and Feet

Perform the following exercises: 1. Push the toes of both feet toward the foot of the bed. Relax both feet. 2. Point toes toward the chin. Relax both feet. 3. Circle both ankles, first to the right, then to the left. Repeat three times. Relax. 4. Sit in a chair for good posture. Without slouching, straighten your leg in front of you and point toes up to the ceiling.

Return to a resting position. Do one leg at a time. Repeat 10 times on each side. Do 3-4 times a day.

In addition to leg exercises, compression sleeves that go from the ankle to below the knee will be applied before going to the operating room. These help to maintain adequate circulation during and after surgery.

Bed Positioning

Unless your doctor orders positioning restrictions based on your particular operation, you will be encouraged to keep the head of the bed up at all times while you are resting in bed. This makes it easier to clear things out of your throat.

Pain Management

Good pain control is important for many reasons, including helping you to get up and move around. Pain control options include different medications. Your health-care team will work with you to develop a plan to meet your needs. If your pain is not under control, please tell your nurse.

Video: How to Take Opioids Safely After Surgery

If you have more questions, call your surgeon or the Pre-Admission Testing Office at 215-728-2566.

Coughing probably doesn't seem like a big deal in your day-to-day life. You feel the urge to cough, and then you cough. You may not even think about it because it's second nature.

That may change after having surgery. Coughing is not nearly as easy when you are recovering after a procedure, and it certainly isn't painless, either.

After surgery, coughing is essential for preventing pneumonia and keeping the lungs clear. Pneumonia can be a life-threatening problem after surgery and should be avoided at all costs.

Many patients avoid coughing because it can be very painful; however, it is imperative that you cough enough to prevent lung complications.

You may not have thought about coughing before, but it does fulfill a necessary objective in the human body: it keeps the lungs clear of normal secretions, infectious material like pus, foreign objects and can help keep the lungs open and well-expanded.

Coughing after surgery helps prevent pneumonia by encouraging deep breathing. It keeps the lungs expanded and clears any secretion that may have accumulated as a result of mechanical ventilation, intubation, or anesthesia. 

For patients who avoid coughing, or are too weak to cough, it may be necessary to provide assistance in keeping the lungs clear.

In the hospital, suction can be used to assist patients with keeping their lungs clear; however, coughing is much more effective and preferable to suction.

When you feel the urge to cough, you should brace your incision if you have had a chest or abdominal surgery.

That means taking your hands or a small pillow and hugging it to your incision when you cough, applying gentle but firm pressure. This bracing action will help support your incision and reduce the stress on the site.

If the incision is on your chest, such as after open-heart surgery, hug a pillow to your chest directly over the incision. If you had abdominal surgery, you would do the same over the abdominal incision while slightly tensing the stomach muscles.

If no pillow is available, you can use your hands to brace the incision, as the pillow is primarily used for comfort.

Even if your incision is not on your chest or abdomen, bracing may help with pain control. Crossing the legs can also provide bracing if your surgery was in the genital or rectal areas.

Bracing your incision is very important for several reasons. Holding pressure on your incision while you cough decreases the stress on it, which can significantly decrease the pain you feel.

In addition, the support you give your incision can prevent it from pulling apart and opening, a complication called dehiscence, which can become very serious.

During your routine incision care, be sure to inspect your incision for any signs that it is pulling apart or gaps are forming. Detecting small openings in an incision is not always an issue, but these openings can lead to larger openings if the incision continues to be under significant stress.

For example, a person with cold may cough and sneeze frequently, putting more stress on their abdominal incision than what is typical. This increases the risk of the incision opening so extra care should be given to support the incision when coughing.

The same idea applies to sneezing. Bracing will help protect your incision and help minimize the pain.

Never stifle a sneeze. Doing so may cause the rupture of blood vessels in the throat, damage the eardrum and inner ear, or even trigger an aneurysm. Simply brace the incision, tighten the abdominal muscles, and sneeze.

Coughing and deep breathing (CDB) is a technique used to help keep the lungs clear during the first few days or weeks after surgery. 

Repeated several times per day, the cough and deep breathing exercises are a very effective tool to prevent pneumonia and atelectasis, a lung condition where the lungs don't expand the way they should.

The technique varies slightly between facilities and physicians, but the general idea is the same. To perform a CDB exercise:

1. Take a deep breath, hold for several seconds, and slowly exhale.
2. Repeat five times.
3. Brace your incision, and attempt to cough deeply.
4. Repeat the entire procedure every one to two hours.

Coughing properly may seem too simple to be truly effective in the prevention of serious complications after surgery, but it can prevent major issues from happening in the days and weeks following surgery.

A failure to cough, most often due to pain, can lead to pneumonia very quickly. Coughing improperly, without bracing the incision, can lead to the opening of an incision or even more serious conditions.

If you are caught off-guard and a cough or sneeze causes a rupture in your incision or sutures, seek medical help.

• If you notice an opening in your incision, even a small one
• If you notice blood after coughing
• If coughing causes severe pain
• If you cannot brace an incision because it is is too painful
• If you feel too weak to cough or are not strong enough to cough effectively
• If you have difficulty breathing or cannot catch your breath

Frequently Asked Questions

• Is coughing up phlegm after surgery normal?

  Coughing up phlegm or mucus after surgery is a normal process. It's a natural, vital way that the body gets rid of excess mucus in the lungs. If mucus is stuck in the lungs for too long, an infection can start. This is why it's important to regularly cough after surgery, even if it can be unpleasant.

• Dehiscence, also called wound separation, is a surgical complication where the edges of a repaired wound begin to pull apart, either on their own or due to force. This is why the wound must be handled especially carefully during the first two weeks after surgery, as it is considered the time period when an incision can most easily come apart.

• Why am I wheezing after surgery?

  If you are wheezing after surgery, this may be due to a lung (pulmonary) complication. A pulmonary complication can appear if proper deep breathing and coughing exercises aren't performed in the first 48 hours after surgery. Other symptoms can include chest pain, fever, and a cough. If you experience these symptoms after a surgery, contact your doctor.

• Is sneezing dangerous after surgery?

  Only if it's done incorrectly. Try not to stifle a sneeze—holding it back can cause further issues, such as an incision opening. If you feel a sneeze on its way, brace the incision, tighten your abdominal muscles, and then sneeze.