analgesics was low. The difference in bowel behaviour caused
concern and questions.
Discussion
This study shows that, although fast-track colon surgery
functions well in routine clinical practice, patients express
different symptoms in a longer follow-up. The continuing
symptoms of extreme fatigue, bowel disturbances, nausea
and anxiety impair everyday life at home, with decreased
activity, mood and ability to enjoy life mostly seen during the
first two weeks at home. These symptoms must be recognised
if they are to be reduced.
In this study, we concentrated on symptoms and on finding
ways to improve our current strategies. Symptom can occur
alone from another, but more often, multiple symptoms are
experienced simultaneously. If two or more symptoms occur
at the same time, they are likely to affect each other, e.g. pain
is worse when fatigue or nausea occurs at the same time and
the intensity of a symptom, such as pain, may ‘dominate’ or
‘mask’ other symptoms, e.g. fatigue (Dodd et al. 2001). In
contrast to tiredness, subjective fatigue is abnormal, unusual
or excessive whole-body tiredness unrelated to activity or
exertion. It may be acute or chronic and not easily dispelled
by sleep or rest (Piper 1993). Olson (2007) suggests that
fatigue is not a continuum but rather a state along a
continuum with tiredness and exhaustion as distinct states
located at the ends of an adaptation continuum. This is in line
with Lenz et al. (1997) who points out that an individual’s
distress dimension of a symptom experience refers to the
degree to which an individual is bothered by it. Anxiety was
described in many different ways and was often related to
bowel movements, flatulence and the contents thickness. The
‘different’ bowel movements were sometimes painful, which
created anxiety.