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How to prepare physically and mentally for rectal cancer surgery

by Dr. Cristi Blajut
surgery preparationrectal cancerERASpreoperativesurgery

Physical and mental preparation for surgery

Proper preparation before rectal cancer surgery can significantly affect postoperative recovery. Studies show that patients who actively prepare have faster recovery, fewer complications and shorter hospital stays. This guide gives you a practical preparation plan.

The ERAS protocol — enhanced recovery

ERAS (Enhanced Recovery After Surgery) is a set of evidence-based measures that optimize recovery. Key principles include:

  • Comprehensive patient information before surgery
  • Optimized preoperative nutrition
  • Minimizing the preoperative fasting period
  • Early mobilization after surgery
  • Optimal pain management

Physical preparation

4-6 weeks before

Physical activity (prehabilitation)

  • Walking: 30-45 minutes daily, brisk pace
  • Breathing exercises: deep breaths, 10 reps 3 times a day — strengthen respiratory muscles and reduce the risk of pulmonary complications
  • Kegel exercises: pelvic floor muscle contractions, 10 reps 3 times a day — will help recover continence after surgery
  • Strengthening exercises: squats, sit-to-stand, light weight exercises

Nutrition

  • Higher protein: 1.2-1.5 g per kg body weight per day (meat, fish, eggs, dairy, legumes)
  • Nutritional supplements: protein shakes if you can’t eat enough
  • Iron: if you have anemia, iron supplements may be needed

Quitting smoking

  • The single most important thing you can do — smoking dramatically increases the risk of complications
  • Even quitting 2-4 weeks before surgery significantly reduces complication risk
  • Talk to your doctor about nicotine replacement therapies

1 week before

  • Blood tests and preoperative consultations
  • Anesthesia consultation
  • Discussion with the surgeon about the operative plan and possible stomas
  • Preparing the items you need for the hospital

The day before surgery

  • Eat normally (modern ERAS protocols no longer require prolonged fasting)
  • Clear liquids can be drunk until 2 hours before anesthesia
  • Carbohydrate drink — some hospitals provide a special maltodextrin drink the evening and morning before surgery
  • Bowel preparation — if your doctor recommends it (not always necessary)
  • Preoperative shower with antiseptic soap

Psychological preparation

Information is power

  • Ask anything you want to know — there are no bad questions. Write your questions before the consultation
  • Understand the procedure — knowing what will happen step by step reduces anxiety
  • Discuss the stoma — if there is a possibility, mental preparation beforehand is much easier than the surprise after surgery

Anxiety management techniques

  • Diaphragmatic breathing: inhale through the nose for 4 seconds, hold for 4, exhale through the mouth for 6
  • Mindfulness: free guided meditation apps (Headspace, Calm — they have surgery preparation sections)
  • Positive visualization: picture your recovery and return to normal activities
  • Talk about your fears — with family, friends or a psychologist

Emotional support

  • Identify 1-2 trusted people who will help you in recovery
  • Organize practical matters: who will take care of the house, children, pets
  • Take medical leave — don’t put pressure on yourself to return to work

What to bring to the hospital

Necessary

  • ID, admission paperwork, test results
  • Current medications (with a complete list)
  • Comfortable pajamas (2-3 sets), closed slippers, robe
  • Personal hygiene items
  • Mobile phone and charger
  • Book or tablet for waiting times
  • Headphones — music or audiobooks help with relaxation
  • Personal pillow — may be more comfortable than hospital ones
  • Light snacks — crackers, dried fruit (for after eating resumes)

What to expect on the day of surgery

  1. Morning: identity verification, signing consent, preparation (gown, antithrombotic socks)
  2. In the operating room: IV placement, monitoring, general anesthesia — you will fall asleep within seconds
  3. Surgery: lasts 2-4 hours; family is updated during the operation
  4. Waking up: in the recovery room, then in the ward; you will be drowsy and may feel nauseated
  5. First evening: pain management, IV fluids, monitoring

After surgery — first days

  • Day 0-1: mobilization to the edge of the bed, clear liquids
  • Day 1-2: walking in the corridor (with help), progressive feeding
  • Day 2-3: increased activity, urinary catheter removal
  • Day 3-5: solid food, stoma care (if applicable)
  • Day 5-10: discharge (depending on recovery)

A message of encouragement

Rectal cancer surgery is a major procedure, but thousands of patients go through it every year with excellent outcomes. Active preparation — physical and mental — is the most important thing you can do. You are stronger than you think.

This article is for informational purposes only and does not replace medical consultation. Discuss your personalized preparation plan with the surgical team.