Coping With Fatigue After Surgery

Fatigue is common after having surgery. After major surgery, fatigue can persist for weeks and even months. Even relatively minor procedures can leave you feeling weak, tired, and drained for several days.

Fatigue is your body telling you that you need to rest. Healing takes up a lot of energy. Your energy levels should improve a little more each day as your body recovers. However, there is a fine line between normal fatigue and problematic fatigue that suggests something's wrong.

Post-surgical fatigue that continues longer than expected or worsens can indicate a secondary medical problem. Possible causes for excessive fatigue in the weeks following surgery include pain medications, infection, anemia, and depression.

This article discusses fatigue after surgery. It explores some factors that cause fatigue, a timeline of how long it can last, and what you can do to regain your energy.

What Is Normal Fatigue After Surgery?

Some level of fatigue is expected after having surgery. You may not feel well for the first day or so, and you should gradually improve little by little each day. There may be setbacks, but a slow and steady improvement is expected after surgery.

Fatigue is your body telling you that you need to rest. Factors that can contribute to post-surgical fatigue include:

• Your age and general health
• The type of surgery you had (for example, open versus laparoscopic surgery)
• Blood loss during surgery, which can lead to anemia
• Emotional stress and anxiety leading up to and following surgery
• Coping with pain
• Loss of sleep due to anxiety or pain
• Side effects of anesthesia
• Side effects of medications used to control blood pressure
• The need to fast before surgery
• The loss of appetite after surgery

Fatigue can come and go. You may feel energetic one day, only to have a down-swing on the next if you over-exert yourself.

It is helpful to have a recovery plan so you can give your body a chance to heal at a reasonable pace. Recovery can vary from person to person, but one thing is absolute: You cannot rush recovery.

Timeline for Healing After Surgery

Healing from major surgeries (those involving the heart, brain, bowels, or other organs or required incisions in the abdomen, chest, or head) will take longer than minor surgeries involving limbs or superficial tissue. 

Here's a quick look at how long fatigue lasts after surgery:

• First 24 to 48 hours: Expect fatigue and brain fog for the first few days after any surgery performed under general anesthesia. 
• One week: In some cases, people who had minor surgery will have their normal energy levels back at this point. However, you will likely still be exhausted if you have had major surgery or a lot of post-operative pain.
• Two weeks: After major surgery, most people will still have a lot of fatigue. You may start to feel a little more energetic and able to resume some activities. However, expect to tire easily. Fatigue from most minor surgeries should have resolved by this point.
• One month: Around this point, there should be a noticeable decrease in fatigue, but your energy levels may still be inconsistent, and some days will be better than others.
• Six weeks: Many people feel like themselves again by the six-week mark. However, if you had cardiac surgery, brain surgery, post-surgical complications, or are still in a lot of pain, fatigue may last a few more weeks.
• Two months: It is still normal to tire quickly two months after major surgery, especially if you are undergoing physical therapy. If you experience debilitating fatigue or a significant drop in energy after a period of feeling better, check with your surgeon.
• Three months: You should feel a lot better now, though some people may experience intermittent fatigue.
• Six months: By now, post-surgical fatigue should be resolved entirely. Talk to your healthcare provider if you are still dealing with low energy.

Abnormal Post-Surgical Fatigue

If your fatigue isn't getting better or is getting worse after surgery, there could be several reasons. Let your healthcare provider know if it continues for several weeks without significant improvement.

Here are some of the more common explanations:

Anesthesia Complications

Anesthesia is a standard part of many surgeries. Some people can have an abnormal reaction to anesthesia that can slow recovery time and prolong fatigue.

This is especially true after general anesthesia for older adults or people who are frail. In these situations, anesthesia may cause confusion and memory loss for weeks or months.

Anesthesia can also increase the risk of pneumonia (a severe lung infection) and thromboembolism (blood clots in the veins), adding to fatigue.

Iron-Deficiency Anemia

Anemia is a lack of healthy red blood cells. Anemia is common after surgery due to blood loss, and it will generally improve once your body builds up a new supply. The more blood loss, the more severe the anemia.

Blood loss may not be the only reason for anemia. In fact, the most common cause is a lack of iron in the blood. Your body needs iron to make hemoglobin, the protein that gives blood its red color and carries oxygen to cells.

Iron deficiency anemia is often caused by inadequate iron intake and can occur if you have poor nutrition following surgery. It can develop after certain surgeries, such as gastric bypass, that affect iron absorption in the gut. It may also be a sign of internal bleeding.

Postoperative Infections

Fatigue is a key symptom of postoperative infections. Pneumonia is a potential postoperative complication, particularly in people who have been placed on a respirator, a machine to help you breathe, for a long period of time.

A wound infection can cause fatigue, along with other symptoms such as fever, chills, pain, redness, and a pus-like discharge.

Internal infections caused by surgical drains or accidental contamination often pose a greater concern because they can turn serious. For infections of this sort, fatigue is often the first sign.

Depression

Major depression is common after major surgery. Having to undergo surgery can often stir fears about illness or death and can place financial and emotional strain on you and your family. Among people who have heart surgery, up to 40% will have signs of depression.

Even if you are recovering physically, you may not have the energy to get out of bed if you are depressed. Depression also makes people less likely to eat well or follow advice from their healthcare provider, and it increases the risk of alcohol misuse. All of these things can add to the fatigue you are already feeling.

If you have symptoms of depression—including ongoing sadness, trouble sleeping, and a loss of interest in things that usually make you happy—let your healthcare provider know. Untreated depression is linked to a higher risk of surgical complications, including death.

Pain Medications

Certain drugs used to control pain can cause fatigue. This includes opioids, which are known to cause drowsiness. Examples include Vicodin (acetaminophen/hydrocodone) and Percocet (acetaminophen/oxycodone).

Non-opioid narcotics like Ultram (tramadol) also cause drowsiness.

Anti-epilepsy drugs like Neurontin (gabapentin) and Lyrica (pregabalin) that are used to treat pain are also known to cause drowsiness.

Pain medications like opioids, gabapentin, and pregabalin can also cause or worsen sleep apnea, a condition in which you stop breathing for short periods of time while asleep. Symptoms include daytime drowsiness, fatigue, and lack of energy and concentration.

How to Regain Energy After Surgery

If you are feeling fatigued after surgery, there are some simple things you can do to improve your energy levels and speed healing:

• Hydrate: Drinking ample fluids, particularly water, can help improve energy levels. Avoid caffeine, which may boost energy temporarily but also cause a crash afterward. Alcohol is also a no-no.
• Eat well: Well-balanced nutrition is a good defense against fatigue. Add iron-rich foods to help boost hemoglobin levels, such as spinach, tuna, sardines, chicken, broccoli, nuts, and fortified breakfast cereals.
• Minimize pain medication: Take only the pain medication you need and no more. Too much can increase fatigue.
• Don’t overdo it: Pushing too hard and too soon after surgery is more likely to set you back than help. Instead, work with your healthcare provider on a recovery plan that sets reasonable goals based on your health and age.
• Get plenty of rest: You will need more sleep if you have had surgery. If you have trouble sleeping, speak to your healthcare provider or find ways to improve your sleep habits.
  

When to Call a Healthcare Provider

If fatigue persists after surgery or gets worse, let your healthcare provider know. It is important to speak with them to see if what you are feeling is normal.

If you experience any of the following symptoms, seek immediate medical care:

• High fever with chills
• Tarry, black, or bloody stools
• Vomiting blood or what looks like coffee grounds
• Blood in urine
• Extreme dizziness or fainting
• Unexplained weakness
• Chest pains
• Shortness of breath or shallow breathing
• Profuse, cold sweat

These may be signs of internal bleeding or an internal infection, which are considered medical emergencies.

Summary

Fatigue is your body's way of telling you that you need to rest. Fatigue is normal following surgery and should improve day after day as your body begins to heal itself.

Some people have it worse than others due to age, health, and the type of surgery they had, but with time and proper care, most will be able to build up their strength and energy levels.

Fatigue is abnormal if it continues for longer than expected or gets worse. Reasons may include infection, iron deficiency anemia, depression, or a reaction to anesthesia or pain medications. Whatever the cause, let your doctor know if fatigue seems abnormal or doesn't seem to get better after surgery.

A Word From Verywell

Surgery evokes a sympathetic stress response in the body. This causes an increase in energy expenditure, contributing to a feeling of fatigue. Make sure to listen to your body's cues and rest if you feel exhausted, dizzy, or weak. If symptoms worsen or do not resolve after an expected period of time, seek advice from a medical professional.

— ALEXIS APPELSTEIN, DO, MEDICAL EXPERT BOARD