How to Get in Shape After UC Surgery
Ulcerative colitis, ostomy, and physical therapy experts share how to get from day one of recovery to feeling strong again.
When it comes to living your fullest life with ulcerative colitis (UC), exercise is critical. And after surgery, that’s even truer.
Physical activity optimizes recovery, reduces the likelihood of surgical complications, and helps counter many of the potential long-term effects of UC, such as low bone density, back pain, joint inflammation, and a tendency toward stress-related symptom flares, according to Matthew Shultz, D.P.T., a physical therapist at the Cleveland Clinic in Ohio.
“The sooner we get people moving, the better they do,” Shultz says. “And by keeping them active and progressing with targeted exercises, people can not only return to their pre-surgery fitness levels—they can exceed them.”
To help you do just that, we spoke with leading gastrointestinal, physical-therapy, and ostomy experts. Consider this your blueprint for better function, pain management, energy, and mental health.
The First Days After UC Surgery
While your body does need rest in order to recover after surgery, for creation of a J-pouch or ostomy, it also needs movement.
Shultz explains that gentle exercise such as sitting up, standing, or even walking—as soon as your surgeon says it’s OK—can even help return cellular activity and blood flow to the gastrointestinal (GI) system. It also reduces the likelihood of post-surgical complications, such as blood clots, fistulas, abscesses, pneumonia, and muscle loss, says Vishal Gupta, M.D., a board-certified gastroenterologist with Gastroenterology of Greater Orlando. He notes that people can lose significant amounts of muscle mass during complete bedrest.
“Even on the day of surgery, we try to mobilize people,” Shultz says. Typically, in the first 24 to 48 hours of surgery, you may sit up in bed and perform gentle leg movements like ankle pumps and glute squeezes. You’ll also learn how to get out of bed without engaging your core muscles, he says. “Those muscles were cut into during surgery and will be very tender,” says Erin Testerman, R.N., a certified wound ostomy continence nurse at Columbia University Irving Medical Center in New York City.
Within 72 hours—sometimes even on day one of recovery—you may take your first steps, Gupta says.
The First Weeks After UC Surgery
When you first go home after UC surgery, your surgeon will send you with directives to not lift any more than five pounds for a couple of weeks, according to Gupta. You will likely also have some in-home nursing help as well as a physical therapist and/or occupational therapist to work with throughout your recovery. (In some cases, people go to rehabilitation centers before returning home, Shultz says.)
Follow your therapist-created activity plan, which typically involves daily rehabilitation exercises. Physical therapists identify areas you need to work on such as torso mobility or postural alignment and guide you through a custom program that fits your unique body and needs, Shultz says. Yours will likely have you get up and move around every hour or two while you’re awake. You’ll continue with the exercises prescribed in the hospital and, depending on your symptoms and progress, may begin isometric pelvic tilts to learn how to properly active your abdominal muscles without “bearing down,” he says.
To perform a pelvic tilt, lie face-up on a sturdy surface with your knees bent and feet flat on the surface. From here, press the small of your lower back against the floor. To do so, you will naturally engage your pelvic and core muscles. Breathe constantly to reduce abdominal pressure. Hold, then relax your core to return to start. Your lower back will regain a slight arch away from the surface.
Other common exercise progressions include seated marches and pillow hip adductions (squeezing a pillow between your knees). But Shultz emphasizes that what’s appropriate and safe for each person is different.
“During weeks one and two, you will have both good and bad days,” Testerman says. “If you’re doing short walks around your neighborhood, you’re doing an awesome job.” Later in the month, you will likely begin to take longer walks and engage in more routine tasks such as putting on your own shoes. These activities will provide a light stretch to your muscles, she says. Never push to the point of pain, and know that everyone recovers on their own timeline.
A few weeks into recovery, your physical therapist will also start to address ways you can use exercise to help control any chronic or “learned” pain. Learned pain refers to discomfort that develops from how you carry and move your body when you’re in pain from UC. To alleviate the pain, people have to “un-learn” maladaptive postures and movement patterns.
For example, guarding and tensing the body’s muscles—imagine yourself doubling over during bouts of GI pain—can cause a lot of musculoskeletal issues such as back pain. “We talk a lot about posture and letting go of muscle tension.” Shultz says. “We want people to have good positioning and support.”
The First Months After UC Surgery
This is when things start to get fun.
“When the surgeon says you no longer have activity restrictions, all exercise is ‘as tolerated,’” Shultz says. You and your therapist begin to progress your exercise variations and load used. For instance, if you’ve been doing bodyweight exercises, maybe now is when you start to add dumbbells to your at-home workouts.
You start to think not just about engaging your muscles during strength exercises, but fully fatiguing them, Shultz says. For that reason, while you can and should still get up and move with gentle rehabilitation exercises every day, you may want to perform strength every few days. Doing so will give your muscles the time they need to heal and grow between challenging workouts.
“You need to separate the types of exercise in your brain,” he says. “Cardiopulmonary exercise such as walking, moving around the house, or biking—that should be every day. The more muscularly challenging exercises that make you shake and cause some next-day muscle soreness—those are something else and require recovery.”
Your therapist may also increase the intensity of your core exercises, including moves such as hollow-body holds and dead bugs to take your abs to the next level. Here’s how to do these moves:
For both, begin by holding a pelvic tilt. To move into a hollow-body, extend your arms and legs so that your body forms a banana-like shape, and engage your core to hold the position.
To move into a dead bug, extend your arms and legs straight up toward the ceiling, then lower one arm and the opposite leg toward the floor. Pause, raise them back up, and repeat on the other side.
During both exercises, the most important thing—and biggest challenge—is to keep your lower back in firm contact with the floor at all times. This is what keeps the core working.
Testerman notes that developing strong core muscles will help hold your stoma—and therefore ostomy—in place.
The First Year and Beyond
What are your long-term fitness goals? Do you want to focus on overall health and independent living through the decades? Do you want to run a marathon? Get into rock climbing? Deadlift your body weight?
Your answers will determine what direction your training takes. While you may still see your physical therapist from time to time, it can also help to work with a certified trainer who specializes in helping people reach goals like yours. Just make sure they understand your individual needs and have experience working with people who have UC and/or ostomies.
No matter your fitness passion, it’s important to prioritize standing weight-bearing activities, such as strength training, to reduce your likeliness of bone loss, a common complication of UC.
There’s one surprising goal you might need to keep in mind: preventing excess weight gain. While with UC extreme weight loss can be a problem, many people do start to gain weight back after surgery. Gaining weight, especially from muscle, and getting to a healthy body composition is great. However, excess fat gain can not only reduce overall health—it can pull on the stoma and cause it to retract back into the skin, Testerman says. This can be both painful and negatively affect your ostomy bag’s fit.
Special Considerations When Exercising After UC Surgery
No matter where you are in your post-UC-surgery journey, these strategies will help make it a success.
Take a Team Approach
Every hospital approaches physical therapy from UC surgery slightly differently, but it’s important to take advantage of all available resources and experts, Testerman says. And regardless of whether your hospital sets you up with a long-term PT, most insurance companies do cover physical therapy.
“We don’t just give cookie-cutter plans, we determine exactly what individual people and bodies need, and help them progress from where they are to where they want to be,” Shultz says.
Make sure your physical or occupational therapist is in close contact with both your surgeon and gastroenterologist. That way, they can create a cohesive recovery program that takes all aspects of your health and fitness into account.
“The more a person has a team that’s built on trust, the better they can do,” Gupta says.
Learn How to Fit Your Ostomy to Your Workouts
“When exercising with an ostomy, the most important factor is fit,” Testerman says. “You can surf, swim, or whatever else if you feel secure with yours.”
To find the best fit for you, work with your ostomy nurse and try out ostomy underwear and/or an ostomy belt to help brace and conceal the bag, she says. A compression shirt can serve as an extra support layer, while wicking fabrics can help keep sweat at bay to things secure. Ostomy shields provide protection from any physical impact to the stoma during contact sports.
Listen to Your Body
You have to challenge your body to get fitter, stronger, or faster—but pain does not equal gain.
If you feel any sharp or stabbing pains during exercise, stop what you’re doing and consult your doctor. Shultz also recommends reaching out for a medical evaluation if you experience a deep, persistent ache. Any discomfort you feel during exercise should be focused in the muscles you’re working and just that, discomfort, not pain, he says.
Since the core muscles are typically cut into during UC surgery, it can be especially beneficial to train your core with a physical therapist. This can help you best find the line between strengthening and overstressing your abdominals.
Challenge Your Limits
It can be frustrating when, immediately after surgery, you have to pull back on your workouts or your fitness levels drop. But remember that the recovery period is temporary and sets the foundation so that, in the future, you can do anything you want to do, “without limits,” Testerman says.
For a constant, motivating reminder of what you can achieve after UC surgery, she recommends looking to ostomy athletes on Instagram, finding a support group through the United Ostomy Associations of America, and working out with other people who have had similar recovery journeys.
“It can be so inspiring, and mindset is everything in physical health,” she says.