The aim of this study was to determine the effect of abdominal massage and warm application on the excretory activity (time of first bowel sounds, defecation time and the amount of laxative used until discharge) after total knee replacement surgery performed with spinal anesthesia.

Abdominal massage and hot application will be applied to the patients at least 30 minutes after the morning and evening meals (08:30 am, 20:30 pm) for 15 minutes each, similar to the literature. The hot application will be applied to the abdominal area with a hot water thermophore for 15 minutes before the abdominal massage. After the hot application, abdominal massage will be started. In the abdominal massage, which will be applied clockwise to stimulate bowel movements, four basic movements will be used: superficial exertion, deep exertion, petrisage and vibration. Abdominal massage will be applied to the patients in accordance with the Abdominal Massage Application Checklist created by the researcher in line with the literature.

Warm application and abdominal massage will be applied to the study group from the first evening of the total knee replacement procedure, and the application will continue in the morning and evening hours until the first defecation. After the application, bowel sounds will be listened to in accordance with the application steps. In the control group, bowel sounds will be listened to at times corresponding to the hours of hot application and abdominal massage, daily laxative use will be determined and recorded in the Excretory Activity Form.

Inclusion Criteria:

• Written and verbal permission was obtained to participate in the study,
• 18 years of age or older,
• Conscious, oriented and cooperative,
• Speaks and understands Turkish,
• Total knee replacement with spinal anesthesia planned,
• No condition in which abdominal massage is contraindicated (inflammatory bowel disease, presence of abdominal tumors, surgical intervention or radiotherapy to the abdominal area, presence or suspicion of ileus, and pregnancy),
• No physician-diagnosed chronic constipation,
• Mobilized,
• Patients who do not have problems with transition to oral feeding and can be fed orally will be included.

Exclusion Criteria:

• Written and verbal permission to participate in the research could not be obtained,
• Under 18 years of age,
• Unconscious, disoriented and uncooperative,
• Can speak Turkish but cannot understand it,
• Total knee replacement with general anesthesia planned,
• Any condition in which abdominal massage is contraindicated (inflammatory bowel disease, presence of abdominal tumors, surgical intervention or radiotherapy to the abdominal area, presence or suspicion of ileus, and pregnancy),
• Physician-diagnosed chronic constipation,
• Non-mobilized,
• Patients who have problems with transition to oral feeding and who cannot be fed orally will not be included.

A biostatistician who is not involved in the study will be randomly assigned to groups A and B, which are formed by a biostatistician in the computer environment. As a result of the draw of lots, whether group A and B will be the study or control group will be determined by a coin toss at the beginning of the study. The information showing that the patients included in the research sample are assigned to groups A and B according to the randomization table will be placed in an opaque envelope. This envelope will be kept by the coordinator researcher (GAU), and when the researcher (AD) goes to the patient for the application, he/she will open the envelope after filling out the "Informed Consent Form" and learn which group the patient is in