Swelling after an operation – 5 causes not to ignore
Swelling can occur for many reasons. It normally presents as an increase in the size of the affected body part or a change in the shape. You might notice heat and pain around the same area but not always. Swelling can be due to a number of different reasons. Often it is not worrying or concerning and can be treated relatively easily. Sometimes it can be an indication of something more serious happening and should be brought to the attention of your doctor or specialist as early as possible.
*Picture shows swelling after an ankle sprain
Swelling after an operation
Having an operation can be a worrying time for anyone. It’s not something that anyone likes to have to go through and it hopefully for most of us it is something that doesn’t happen that often. This does mean that we are often not aware of how we should be feeling afterwards and at what stage and time certain parts of the healing will occur. Swelling will make up a perfectly normal part of most operations due to the unavoidable impact that cutting into our tissues and repairing or even just looking at our internal workings can have. Any cut that is made to look into a joint or to remove a piece of tissue such as a loose body or torn piece of cartilage will cause swelling to occur. This normal response is to ensure that the correct healing chemicals and building blocks are brought to the area where they are needed to aid repair and recovery and also so that these chemicals stay put in that area whilst healing occurs. Otherwise, these chemicals and building blocks would be transported on and away from the area relatively quickly and this may mean that total healing does not occur.
This is one of the reasons why anti-inflammatory medications are not encouraged in the first few days after an acute injury now. It is thought that this may reduce the bodies natural healing process by limiting the inflammation (which makes up the swelling we see in the area) and we think this might not be helpful.
Warning signs to be aware of if swelling sign of something more serious
After an operation it is therefore helpful to have a certain amount of swelling for repair in the area involved but there are several causes of swelling that are warning signs of more serious problems that should be identified as early as possible in order to get the best treatment. Below are five of the important ones that your medical team and physiotherapist will be looking out for and keeping an eye on:
1) The lungs:
After any surgery and resultant period of bed rest there is the risk to your lungs. This could be due to the lack of air movement in and out of your lungs increasing the risk of picking up Pneumonia or chest infections but also due to the lack of movement, the risk of blood clots forming and moving into the lungs where they can cause blockages known as Pulmonary Embolism (PE). A sign of this is swelling in the lower limbs as the body struggles to remove excess fluid from the tissues back into the circulatory system. This swelling is usually non-painful. It is not linked to any trauma or the site of injury or operation. It is usually in both legs and not isolated to one particular part of the leg but all of it in a ‘stocking’ distribution. It might also be associated with other symptoms such as a general feeling of unwell, fever or shortness of breath. Medical professionals will particularly look out for this in the first few days after an operation but it can occur some weeks afterwards too.
What can you do? This is one of the reasons that Physiotherapists will encourage you at the earliest safe opportunity to get up out of bed, do breathing exercises and move around. This jeeps the blood and air flowing nicely in and out of the lungs and around the body. Helping to prevent blood clots and chest infections. Seek medical attention immediately if you have these symptoms.
2) Urinary Tract (water) Infections:
After an operation it is not uncommon to have a catheter inserted into your bladder if you are unable to get out of bed initially and therefore cannot take yourself to the bathroom. There is a risk of water infections from the insertion of a catheter. This can lead to generalised swelling in the legs. You might also feel generally unwell, have pain and/or burning when you try to go to the toilet and a temperature or fever. The swelling itself will not be particularly painful but may be a little achy.
What can you do? If you are allowed to get up to use the toilet then try to do this regularly. Keep yourself well hydrated with water by drinking water regularly if you are allowed and if you notice signs of a water infection tell your medical team as early as possible so it can be treated.
3) Deep Vein Thrombosis (DVT):
These blood clots in the veins can occur after surgery. Usually this is due to less movement and a period of bed rest. It can also be due to a limb being immobilised by a plaster cast or splint and so the body part is not moving as usual. This means the muscles are not pumping the blood around the body as effectively and clots can form. There are multiple reasons why clots can form and being aware of the signs is important for the first few months after an operation particularly. Usually the swelling that occurs due to a DVT will only be in that body part that is affected by the clot. If it is in the calf of the leg then swelling will occur everywhere down from that area that the vein connects to. This is because blood cannot now circulate past the blockage in the tube and so it backs up and fluid gathers behind it also. This swelling will come on quickly, for no apparent reason and will be very painful. The area might feel tight and bigger than usual and hotter. If the blood clot is in the lungs then, as already discussed, it is called a pulmonary embolism (PE) and can cause shortness of breath, fever and a feeling of unwell.
What can you do? Keep an eye on yourself for sudden swelling in one area. If it is very painful and the pain does not go away at all for even a minute then seek medical attention immediately. Try to keep yourself moving as instructed, pump your ankles regularly up and down if you are not able to move around much and try not to rest in positions when stop the blood to a certain body part such as resting with your legs pressed into a ridge in a chair or crossing your ankles over one another.
4) Wound Infections:
The skin acts as a physical barrier to bugs and infections getting into our body. When you have an operation that barrier is cut to allow the operation to occur. This will always be done in the most clean and safest method but there is always a small risk that a bug might make its way into your body via the wound. The signs of a wound infection include swelling in the area. This will be associated with the area that was operated and might also include oozing of puss from the wound or increased redness around the wound. you might feel unwell or have a fever and it will increase the pain you might feel in the area.
What can you do? Follow the instructions you get given by your medical team, nurses and physios on how to keep your wound clean and dry. Use the equipment given to you to keep it dry in the shower when you are allowed to wash and make sure you do not pick scabs or touch the scars too much as they heal inititally. Eat healthily and try not to smoke or drink as this slows the healing process.
5) Reactions to drugs and IV lines:
Sometimes after or during an operation you will be given certain drugs and medications. Some of these might be given via an intra-venous (IV) line that goes into your body via a needle in your hand or other area. This porthole, whilst totally necessary for your treatment, is another opening that is at risk of bugs getting in and causing problems as mentioned above. Sometimes the drugs that we take cause a reaction in the body that can cause problems with our circulation or heart. This can present as swelling in both legs that is not particularly painful but includes all of the legs.
What can you do? Keep an eye on yourself and tell a medical professional if you feel unwell or notice the swelling. This is the case for most swelling that starts after an operation. Keep an eye on yourself for the first 4-6 weeks particularly and mention the symptoms to either your physio or doctor at the earliest opportunity.
Chartered Physiotherapist, Physiocomestoyou Ltd