Advice on training after operation and low iron blood count?

tonysj Posts: 391
Hi All,
At the end of August I had a major operation and 2 weeks in hospital.

I have Crohn's and the op was to remove a section of intestines and rejoin them. The recovery is slow and after just over 2 months I have started to go out cycling again.

The problem is the day before I had the operation I went for a steady 26mile ride, as I knew I would be off the bike for a while, and I averaged 17 - 18mph over the ride.

Since the op my blood checks have shown Im low on red blood cells/hemaglobin and lack iron. I have been given iron tablets and told it could take 3 months before my iron levels are normal.

I've been riding 4 times over the last 2 weeks and my fitness is SH*T averaging 15mph on a good day. I tire quickly and my BPM is up on my pre op rides.

Has anyone gone through something similar or has any advice on training and riding that would help me improve the best over a shorter period.




  • Think i'd be happy just to throw a leg over a bike, good luck on your recovery
    I'm sorry you don't believe in miracles
  • I am curious how low your hemoglobin / hematocrit is (and also what your iron or ferritin levels are). I suspect your decreased fitness is more related to not biking for 2 months and less due to your hemoglobin levels unless they are significantly lower than your baseline. If your H/H was low before the operation, you have likely adapted to being anemic and any low blood counts now may not be the main reason why you feel so puny. When I take 2 weeks off the bike, I see a 25-30% reduction in my Strava fitness metric (not to say that is the most accurate assessment of fitness), so 2 months off could have a much more pronounced effect on your exercise capacity than a relatively mild drop in your red blood cell count.
  • FatTed
    FatTed Posts: 1,205
    why not ask for an intravenous iron infusion / injection?
  • tonysj
    tonysj Posts: 391
    My levels were low red blood cells and the lower level of normal for iron, but they are improving.
    I generally look after myself with my diet as the meds per op i had side effects so had to manage my Crohn's by diet only. I eat health foods, fruit and veg, with very little "crap" and have regular blood checks and anemia has never been mentioned in the past.

    The intravenous iron injection were discussed but they said it was too expensive but would sort the levels instantly. NHS cutbacks I suppose...

    I suppose I just need to stick with it. My last ride was on a mountain bike over 24 miles on trails but average mph was 11.5mph.

    Is there a certain riding done that would help me better than others?

    That way I can do that to spped up my overall recovery.

    Thanks for the replies.

  • cougie
    cougie Posts: 22,512
    I don't think focusing in your speed will help much. You know you're recovering so take it easier than nornal. It will come back in time. Smashing yourself too early will surely hinder your recovery.
  • shazzz
    shazzz Posts: 1,077
    I went through something similar but more invasive. My op didn't go well and I ended up in hospital for 3 months. My HGB fell very low (<50) while I was in hospital and was ~100 when I went home. I had also lost a lot of weight and all the fitness that I had.
    My advice after such an experience would be to let your recovery run its own course and don't push it. Obviously your circumstances are specific to you but the combination of recovery from major abdominal surgery, lost fitness and anaemia is significant. You are lucky to be back on your bike already - just enjoy riding. In time (perhaps quickly) you will recover. I started riding again when I felt ready, just taking things easy. About four months after that I was feeling good and my blood tests confirmed that my levels for most key markers were back to normal, with HGB getting close to 130. That was when I felt ready to start 'training' again. It took a while, but I am back in the swing of things now, and certain that pushing things harder sooner would have done more harm than good.
    Feeling shit, tiring quickly and having a higher heart rate than normal are all pretty clear indicators that you need to take it easy!
  • timothyw
    timothyw Posts: 2,482
    Yep, be glad that your op was at the end of summer rather than the start of spring - take it easy, build slowly, give your body time to recover.

    This is the off season. Short rides, take it easy, it will get better. Everyone is feeling slow at the moment with the cold air and stiff breeze.
  • Sounds to me that you're doing v v well. Maybe drop the use of Garmin & Strava for a while and just enjoy being out on the bike in the fresh air ( Says he who got the Garmin straight out once out on the bike after my hip replacement last year! I'm not a good example!)
    Best wishes on your ongoing recovery- the fitness will return especially as noted above when we get back to warmer weather next Spring.
  • serkie
    serkie Posts: 10
    Hi Tony,

    Fellow Crohnie here, I also had a bowel resection back in 2013 and know how it feels getting back on the bike.

    First and foremost don't rush it. It took me around 9 months to fully recover physically.

    Secondly, speak with your gastro consultant ASAP and get them to prescribe you a 3-month course of Feraccru. It's been available on the NHS since 2016 and it's the best oral iron supplement you can get if you have Crohns. It's also cheaper than Monofer Iron infusions so the preferred option if you suffer with poor bowel absorption and have low HB and Ferritin levels.

    I've suffered with anaemia for years because of my Crohns, the Monofer infusions work really well but they tend to only last approximately 3 months or so. The Feraccru is slower but very effective and saves the hassle of going into a day unit for regular infusions. My levels are pretty much normal following a 3 month course and it can be for 4 to 6 months following before the levels dip back below normal and you start the process again.

    Normal HB and ferritin levels make a massive difference, I notice considerable performance gains as my levels stabilise.

    It's not ideal having to take regular oral iron but unfortunately until a cure for this horrible disease is found, it's just about managing the situation as best as you can.
  • keef66
    keef66 Posts: 13,123
    Three times I've become anaemic (each time detected when donating blood, and later confirmed by the usual comprehensive blood test) and been prescribed iron tablets. Never have discovered why I was becoming anaemic. Diet's pretty good. Maybe I absorb dietary iron poorly?

    Because it crept up on me slowly I never realised it was affecting my cycling until I started on the iron tablets. Then I felt I slowly regained some fitness.

    In your case I imagine it's the combination of surgery, time off the bike and low hb. I'd say just take it easy for the next few weeks. Maybe increase the distance gradually, but don't go upping the intensity till your bloods are improving. And don't worry about average speed...