How can you help your surgical patient control pain during coughing and deep breathing?

Performing respiratory exercises will help you prevent respiratory system complications. Deep breathing, coughing, and incentive spirometer exercises may speed your recovery and lower your risk of lung problems, such as pneumonia. Learn the following exercises and practice them every day before your surgery.

Deep breathing

To deep breathe correctly, you must use your abdominal muscles, as well as your chest muscles.

• Breathe in through your nose as deeply as possible.
• Hold your breath for five to 10 seconds.
• Let your breath out through your mouth, slowly and completely. As you breathe with pursed lips (like blowing out a candle), your stomach should be going in. Exhale twice as long as you inhale.
• Rest and then repeat these steps with 10 repetitions.

Coughing

To help you cough:

• Take a slow deep breath. Breathe in through your nose and concentrate on fully expanding your chest.
• Breathe out through your mouth and concentrate on feeling your chest sink downward and inward.
• Take a second breath in the same manner.
• Take a third breath. This time hold your breath for a moment, then cough vigorously. As you cough, concentrate on forcing all the air out of your chest.
• Repeat this exercise two more times.

Coughing probably doesn't seem like a big deal in your day-to-day life. You feel the urge to cough, and then you cough. You may not even think about it because it's second nature.

That may change after having surgery. Coughing is not nearly as easy when you are recovering after a procedure, and it certainly isn't painless, either.

Purpose

After surgery, coughing is essential for preventing pneumonia and keeping the lungs clear. Pneumonia can be a life-threatening problem after surgery and should be avoided at all costs.

Many patients avoid coughing because it can be very painful; however, it is imperative that you cough enough to prevent lung complications.

You may not have thought about coughing before, but it does fulfill a necessary objective in the human body: it keeps the lungs clear of normal secretions, infectious material like pus, foreign objects and can help keep the lungs open and well-expanded.

Coughing after surgery helps prevent pneumonia by encouraging deep breathing. It keeps the lungs expanded and clears any secretion that may have accumulated as a result of mechanical ventilation, intubation, or anesthesia. 

For patients who avoid coughing, or are too weak to cough, it may be necessary to provide assistance in keeping the lungs clear.

In the hospital, suction can be used to assist patients with keeping their lungs clear; however, coughing is much more effective and preferable to suction.

How to Cough After Surgery

When you feel the urge to cough, you should brace your incision if you have had a chest or abdominal surgery.

That means taking your hands or a small pillow and hugging it to your incision when you cough, applying gentle but firm pressure. This bracing action will help support your incision and reduce the stress on the site.

If the incision is on your chest, such as after open-heart surgery, hug a pillow to your chest directly over the incision. If you had abdominal surgery, you would do the same over the abdominal incision while slightly tensing the stomach muscles.

If no pillow is available, you can use your hands to brace the incision, as the pillow is primarily used for comfort.

Even if your incision is not on your chest or abdomen, bracing may help with pain control. Crossing the legs can also provide bracing if your surgery was in the genital or rectal areas.

Preventing Dehiscence

Bracing your incision is very important for several reasons. Holding pressure on your incision while you cough decreases the stress on it, which can significantly decrease the pain you feel.

In addition, the support you give your incision can prevent it from pulling apart and opening, a complication called dehiscence, which can become very serious.

During your routine incision care, be sure to inspect your incision for any signs that it is pulling apart or gaps are forming. Detecting small openings in an incision is not always an issue, but these openings can lead to larger openings if the incision continues to be under significant stress.

For example, a person with cold may cough and sneeze frequently, putting more stress on their abdominal incision than what is typical. This increases the risk of the incision opening so extra care should be given to support the incision when coughing.

The same idea applies to sneezing. Bracing will help protect your incision and help minimize the pain.

Never stifle a sneeze. Doing so may cause the rupture of blood vessels in the throat, damage the eardrum and inner ear, or even trigger an aneurysm. Simply brace the incision, tighten the abdominal muscles, and sneeze.

Coughing and Breathing Exercises

Coughing and deep breathing (CDB) is a technique used to help keep the lungs clear during the first few days or weeks after surgery.  

Repeated several times per day, the cough and deep breathing exercises are a very effective tool to prevent pneumonia and atelectasis, a lung condition where the lungs don't expand the way they should.

The technique varies slightly between facilities and physicians, but the general idea is the same. To perform a CDB exercise:

1. Take a deep breath, hold for several seconds, and slowly exhale.
2. Repeat five times.
3. Brace your incision, and attempt to cough deeply.
4. Repeat the entire procedure every one to two hours.

A Word From Verywell

Coughing properly may seem too simple to be truly effective in the prevention of serious complications after surgery, but it can prevent major issues from happening in the days and weeks following surgery.

A failure to cough, most often due to pain, can lead to pneumonia very quickly. Coughing improperly, without bracing the incision, can lead to the opening of an incision or even more serious conditions.

If you are caught off-guard and a cough or sneeze causes a rupture in your incision or sutures, seek medical help.

When to Call a Doctor

• If you notice an opening in your incision, even a small one
• If you notice blood after coughing
• If coughing causes severe pain
• If you cannot brace an incision because it is is too painful
• If you feel too weak to cough or are not strong enough to cough effectively
• If you have difficulty breathing or cannot catch your breath

Frequently Asked Questions

• Is coughing up phlegm after surgery normal?

  Coughing up phlegm or mucus after surgery is a normal process. It's a natural, vital way that the body gets rid of excess mucus in the lungs. If mucus is stuck in the lungs for too long, an infection can start. This is why it's important to regularly cough after surgery, even if it can be unpleasant.

• What is dehiscence?

  Dehiscence, also called wound separation, is a surgical complication where the edges of a repaired wound begin to pull apart, either on their own or due to force. This is why the wound must be handled especially carefully during the first two weeks after surgery, as it is considered the time period when an incision can most easily come apart.

• Why am I wheezing after surgery?

  If you are wheezing after surgery, this may be due to a lung (pulmonary) complication. A pulmonary complication can appear if proper deep breathing and coughing exercises aren't performed in the first 48 hours after surgery. Other symptoms can include chest pain, fever, and a cough. If you experience these symptoms after a surgery, contact your doctor.

• Is sneezing dangerous after surgery?

  Only if it's done incorrectly. Try not to stifle a sneeze—holding it back can cause further issues, such as an incision opening. If you feel a sneeze on its way, brace the incision, tighten your abdominal muscles, and then sneeze.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

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