Coughing after abdominal surgery is often painful, leading many to instinctively avoid the action to protect the incision site. While this reluctance is understandable, certain techniques can significantly minimize the strain on the abdomen. Intentionally coughing is necessary to protect the lungs and is a significant part of post-operative recovery. Special methods are required to stabilize the surgical area, allowing for effective clearing of the airways without compromising the surgical site.
Why Coughing is Critical for Recovery
Anesthesia and reduced mobility after surgery can lead to shallow breathing, causing small air sacs (alveoli) in the lungs to deflate. This common post-operative complication is known as atelectasis. When these air sacs remain closed, mucus and secretions accumulate in the airways, creating an ideal environment for bacteria to multiply. This buildup significantly increases the risk of developing a respiratory infection, such as pneumonia, which can slow recovery. Consistent deep breathing and controlled coughing help fully re-inflate the lungs and move secretions out, keeping the respiratory system clear.
The Technique of Abdominal Splinting
The most effective way to manage coughing pain is through abdominal splinting, which involves applying firm counter-pressure to the incision. This external support stabilizes the tissues and muscles that would otherwise stretch and strain during the forceful exhalation of a cough. To perform this technique, sit upright in a chair or on the edge of a bed for the most controlled effort. Hold a small, firm pillow, folded blanket, or rolled-up towel horizontally across the entire incision and the surrounding abdominal area.
Apply steady, firm pressure with both hands, pulling the pillow tightly against the abdomen before beginning the cough. Take a slow, deep breath in, and then perform a single, firm cough while maintaining the tight pressure. The goal is to create a secure barrier that prevents the incision from bulging outward, which typically causes the sharpest pain. Release the pressure only after the cough is complete and you have returned to relaxed breathing. Repeat this process as frequently as instructed by your healthcare team to keep the lungs clear.
Modified Coughing and Breathing Exercises
When a full, deep cough feels too painful, even with splinting, less forceful methods can help clear the lungs and maintain respiratory function. The primary technique is focused deep breathing, which expands the alveoli and moves secretions toward the larger airways. To practice, breathe in slowly and deeply through your nose, expanding your belly and lower rib cage. Hold the breath for three to five seconds, then exhale slowly through pursed lips, ensuring all the air is squeezed out without force.
Another modified technique is “huffing,” a less intense way to mobilize secretions without the sharp impact of a traditional cough. To perform a huff, take a medium breath in, then force the air out in a short, sharp burst through an open mouth, as if trying to fog up a mirror. This action uses the abdominal muscles to create an expulsive force that pushes mucus upward without the significant muscle contraction of a full cough. These techniques should be practiced regularly, often every hour while awake, to complement splinting and support lung recovery.
When to Seek Medical Guidance
While some pain and a mild cough are expected after abdominal surgery, certain signs indicate a complication requiring immediate medical attention. Contact your healthcare provider if you develop a persistent high fever (101°F or 38.3°C or higher). Other warning signs include severe shortness of breath, new or worsening chest pain, or coughing up blood. Also, look for changes at the incision site, such as excessive redness, swelling, or fluid drainage that appears yellow or green.