In focus: stomas - reversal

[OvacomeSupport]

Hello

In this last post in our series on stomas, we’ll be looking at surgery to reverse a stoma and what happens after the operation.

You can ask your team whether stoma reversal could be an option for you. They can provide you with detailed information about the surgery, how long your hospital stay might be, how long you may take to heal, potential complications, and your expected bowel function in the short and long-term.

Not everyone chooses to have stoma reversal surgery. You may be comfortable continuing to live with your stoma and not want to have another operation if you are feeling healthy and well.

It’s important to realise that if you do have your stoma reversed it’s unlikely that your bowel habit will go back to the way it was before your diagnosis. The operations, cancer treatment and a period of a non functioning rectum are likely to have a long-term effect on your bowel. You may also have had a section of bowel removed, which will affect its function.

Your expectations will affect how satisfied you feel with the results of the surgery. Your surgeon and stoma nurse can explain in more detail what you can realistically expect depending on what operation you previously had.

If you decide to have your stoma reversed, you may be able to do this within a few months to a year of finishing treatment. The timing will depend on how you are recovering and your general health. There is no time limit for having the reversal surgery and some people have their stomas reversed up to several years after the stoma is created.

Before you have the surgery, your stoma nurse may advise you to do pelvic floor exercises. This can help with controlling the muscles around the anus after the surgery. This helps with controlling bowel movements and managing continence.

When you have the operation, the surgeon will open the abdomen at the site of the stoma. They will return the stoma to the inside of the abdomen and join the bowel together again so that faeces can pass through the intestines and out of the anus.

After the operation you will have a small surgical wound with stitches or clips in it covered by a dressing. A catheter isn’t usually needed, so you can use the toilet to pass urine if you’re well enough to walk to the bathroom.

You will have painkillers to manage pain issues. You may also have abdominal pain/discomfort that feels like trapped wind and can be very uncomfortable. If you’re able to drink, warm water or peppermint tea may help with this pain. If the pain is severe and the medication isn’t controlling it, you can ask the nurses for stronger painkillers.

You should start to pass bowel movements a couple of days after the operation. It is normal to experience urgency and frequency, diarrhoea or constipation while your bowel starts to function again.

This usually improves over time, but it can take several months for the bowel to settle into a regular habit, particularly for people who have had chemotherapy. During the period of adjustment after stoma reversal, you may experience effects including:

• Increased frequency – needing to open your bowels more times each day;

• Urgency – a sudden strong need to open your bowels;

• Diarrhoea;

• Passing a smaller amount of stool more often and feeling like you haven’t fully emptied your bowels each time;

• Leaking stool from the anus;

• Difficulty telling whether you need to pass wind or stool;

• Constipation;

• Traces of blood in your stools, which is temporary;

• Sore skin around the anus.

While your bowel is recovering from the surgery and hasn’t yet settled into its new pattern, you will probably experience a period of adjustment similar to when you first had the stoma. For example, you will find out how different foods affect your bowel movements and how long after eating you will need to open your bowels.

You can monitor how your diet affects your bowel habit. For example, foods high in fibre can make stools softer or increase the frequency of bowel movements, caffeinated and alcoholic drinks can make bowel movements looser and fizzy drinks can increase the amount of wind and cause more explosive bowel movements. While your bowel habit is settling down after the surgery, you may wish to avoid or limit your intake of foods and drinks that include:

• High-fibre foods such as vegetables, fruit and cereals, especially vegetables likely to cause flatulence such as cabbage, onions and Brussels sprouts;

• Caffeinated, alcoholic and fizzy drinks (you can leave fizzy drinks to stand for a while before drinking them;

• Acidic and citrus fruits like strawberries and grapefruit;

• Very spicy foods such as chilli and curries;

• Large fatty meals;

• Large amounts of beer or cider.

If you’re experiencing discomfort or your bowel habit is causing problems for your daily life, you can speak to your doctor or stoma nurse for advice. They may also recommend or prescribe medication for diarrhoea or constipation.

It’s important to be aware that you can still have very loose bowel movements when you’re constipated. This is because liquid stool higher up in the bowel can pass any firmer stool blocking the bowel lower down. This is called ‘overflow diarrhoea’ and can cause very watery diarrhoea. Ask your stoma nurse or another healthcare professional for advice before taking any medication.

Opening your bowels more often than you’re used to can cause the skin around your anus to get irritated and sore. Using moist toilet wipes can help with this. You can also use a barrier cream to reduce the irritation. It’s best if possible to gently wash the area with warm water and dry it before applying the cream. You can ask your stoma nurse for more advice about this.

You may also worry about protecting your underwear and clothes if you’re experiencing urgency and might leak stool. You can use pads in your underwear to protect your clothes, especially if you’re going out and don’t know whether you’ll be able to easily get to a bathroom. Some people continue to wear small liners in their underwear for a while to give them added reassurance.

You can find more information about stoma reversal at:

nhs.uk/conditions/ileostomy...

stgeorges.nhs.uk/wp-content...

colostomyuk.org/wp-content/...

If you would like to share your experience of stoma reversal or have any tips for people thinking about having the surgery, please comment on this post.

If you would like more information or if there’s anything we can help with, please call our Support Line on 0800 008 7054 or email [e-mail].

Best wishes

Julia (Support Services Officer)

[Eriksendi]

Thank you so much for this article I have found it very informative. I was diagnosed in June 2017 with stage 3b PPC/ ovarian cancer. I went to the doctors ass I lost my appetite, my stomach swelled up and I was having problems going to the toilet. I’ve had problems all my life with IBS so was not that worried about the bowel issues. After diagnosis I started chemo, the standard, and after my second chemo felt very poorly and my temperature was elevated. My husband took me to a and e and it was found that my bowel had perforated. I had peritonitis and they believed it had burst 4 days before. I was lucky to be alive. The a and e team sent a surgeon to see me who said he would have to operate immediately . I told him about my recent cancer diagnosis and he called the on-call surgeon at the hospital where my cancer was being treated. He operated and was able to construct a transverse loop colostomy. He said it was unlikely to be reversed. To move the story on, my chemo recommenced and my big op was done 2 months later at a cancer centre. My bowel was reconstructed at the same time and I was advised it would be reversible. I was pronounced in remission at the end of nov 2017. I began to have issues with my stoma blocking about a year later which after investigation they believed was partially due to a parastomal hernia. I went back to my original colorectal surgeon who had performed my op and he agreed that reversal would be the best option. My stoma was reversed in September 2017, 2 years after is initial creation. I have experienced many of the issues listed above but I am so glad that I finally plucked up the courage and had it reversed. Whilst it has been erratic, lots of constipation it is manageable. I’ve had ct scans since and another scope and all my initial joins have now expanded with use. For me, I am so glad I had the op, so I hope my experience gives others the confidence to have the surgery and to see that it doesn’t need to be immediate. I wish everyone else all the best x x

[Neona in reply to Eriksendi]

Thank you!

[OvacomeSupport Partner My Ovacome Team in reply to Eriksendi]

Hello Eriksendi

Thank you very much for sharing your experience of having a stoma and reversal.

Best wishes

Julia