RECOVERY AFTER STOMA REVERSAL

RECOVERY AFTER STOMA REVERSAL Information Leaflet Your Health. Our Priority.

of 6 Introduction Surgery to reverse a stoma is basically to reconnect the bowel and is a successful surgical procedure for the majority of patients. For most this represents a return to normality and normal bowel function, however it is important to remind you that for some the reality may not be as problem free as they might hope. Following a period of recovery your bowel function returns but it is unlikely to be exactly the same as it was prior to your initial operation; it may take a period of a few weeks, months or even a couple of years to settle into a new normal routine and it is important to be patient however difficult this may be. This leaflet aims to highlight the issues that may affect your post-operative recovery and bowel function, as well as providing brief yet simple advice that may be useful following your stoma reversal. After your operation Once your bowel has started to work again it remains difficult for healthcare professionals and yourself to predict what your bowel function will be like, everyone is different. It is not uncommon for individuals to have to re-establish their bowel routine, as previously highlighted this can vary from a few weeks, to a few months and/or longer, as will the perception of what is a satisfactory function. Your bowel function can become erratic and you may encounter problems with: Constipation or diarrhoea Increased frequency - needing to go more often. Increased urgency - when you need to go, you ve got to go now. Stool fragmentation - when you to pass a lot of stool but only pass small volumes. Faecal incontinence (soiling) - leakage of faeces or mucous, possibly throughout the day and during sleep. Persistent wind or bloating - losing the ability to distinguish between wind/stools. Sore skin around the back passage (anus) usually due to soiling. Advice following your stoma reversal It is recognised that each situation is different and individuals can have very different outcomes and experiences, furthermore what is acceptable for one may be intolerable for another. Quite often during this time there may be feelings of embarrassment, anxiety, fear, vulnerability and social isolation due to the unpredictable nature of the reversal procedure. We therefore encourage you to be honest and seek guidance, further information and discuss your individual situation in confidence with your Consultant, GP or Colorectal Nurse Specialist Team. Following is a selection of advice and/or remedies to aid your recovery after your reversal; Diet Following stoma closure it may take time to get back to eating a normal, healthy diet. The digestive system, including your stomach and bowel, may be temperamental. This will mean a settling period. During this period it is sensible to limit foods which can irritate the gut for example:

of 6 Acidic/citrus fruits e.g. grapefruit, oranges, strawberries, grapes Highly spiced foods e.g. curry, chilli con carne Big fatty meals Vegetables with a high flatulence factor e.g. cabbage, brussel sprouts, onions Large volumes of beer or lager and fizzy drinks It is also advisable to eat little and often rather than large meals. Some patients choose to avoid eating after 7pm to avoid having to get up overnight. You may find it useful to keep a food diary so you can record what you eat, when you eat and the effect on your bowels (including what happens and when). As your bowel function after reversal maybe looser you are at risk of dehydration. Please ensure you maintain your fluid intake. Medication If diet alone doesn t improve your situation anti-diarrhoea medication such as Imodium (Loperamide) or codeine phosphate, softeners (Lactulose) or bulking agents (Fybogel) may be required to regulate bowel action and may improve consistency. For wind, common remedies include peppermint or medication containing Colpermin. Please consult medical advice about medications that might be suitable for you. Skin care Frequent bowel movements particularly if loose can cause soiling in the area around the back passage, irritation or soreness may occur as a result. To prevent skin excoriation, skin care is of importance: After each bowel movement wash thoroughly with warm water and pat dry with a soft cloth Apply a protective cream to minimise any skin problems (e.g. Sudocrem) Do not use baby wipes, talcum powder or impregnated toilet tissue, as this could cause further irritation. If these steps do not help your skin problems please contact your G.P or Colorectal Nurse Specialist Team for advice. Protecting your underwear You may not be incontinent, but you may experience the fear that you might be. You might choose to use a pad to protect your underwear if you experience the problem of needing to go to the toilet in a rush urgency. If these simple steps do not improve your situation please speak with your healthcare team, there are other ways in which to try and regain bowel control. Patients who have a Colonic Pouch As part of your first surgery you may have had a colonic pouch formed (also known as a colonic J pouch), this is made from a section of colon. The reason you have had the stoma formed is to assist this pouch to heal, avoiding irritation and/or infection from stools. If you are unsure speak with your Consultant or Colorectal nurse. Depending on the length of bowel removed the colonic pouch is formed to increase the storage capacity for faecal matter, basically replacing

of 6 the function of the rectum. This may encourage fluid absorption from the faecal stream and result in a firm but soft stool. Forming the pouch may result in a reduction in the desire to have your bowels opened and decrease the possibility of faecal incontinence. If your stools remain loose or too frequent then the previous advice is appropriate for you. Recovery following reversal of your stoma is basically the same as the traditional reversal of stoma procedure. Another operation! General information Your stoma reversal has been performed as a planned operation and therefore aims to minimise the risk of post-operative complications. Your Consultant and associated team such as the anaesthetist and nurse specialists will have assessed all possible risks before the operation and put measures in place to prevent problems occurring. It is important to remember that you have had another operation and in general your recovery once home will be similar to that of the initial operation. A period of recovery is still necessary this may vary from a couple of weeks with a loop stoma or laparoscopic (keyhole) reversal up to a couple of months where the abdominal muscles have been cut again. When you return home you are likely to feel tired and need to rest. To help your recovery it is advised that you rest on your bed free from distractions, remember that you are convalescing so rest between chores and take time to spoil yourself! Resume your normal social activities as soon as you are feeling well enough. You should however discuss with your doctor when it is advisable to return to work. You should be able to return to a light job 3 to 4 weeks after surgery and any heavy jobs within 6 to 8 weeks. Sick notes can be obtained from the ward staff to cover your stay in hospital and from your GP for the rest of your time off work. Inpatient hospital stay and recovery can be imprecise and the most variable aspect of recovery is the establishment of acceptable bowel function. This makes getting back to normality unpredictable. If you are discharged home before your stitches/clips are removed then they will remove these on the first home visit. A district nurse will check your wound and see how you are progressing. Although, the need for district nursing input is becoming less likely due to the use of skin glue. You can drive as soon as you can make an emergency stop in the car without discomfort in the wound. This is usually two to three weeks. It is always advisable to contact your insurance company before you start driving again. Begin driving short distances to start with. You may also find it helpful to have a companion with you when you first go driving again. REMEMBER: having bowel surgery does not exempt you from wearing a seat belt. It usually takes six weeks for the deeper muscle layers of the wound to heal; therefore you should avoid heavy lifting for a length of time or any excessive physical activity. This includes carrying heavy shopping, doing housework such as vacuuming, also sports for example golf, swimming etc. Any pain or discomfort you may take oral analgesia on a regular basis to help settle the pain. However if the pain or discomfort does not respond to pain killers, please contact your GP or Colorectal Nurse Specialist Team.

of 6 You can restart sexual relations when you and your wound feel comfortable enough. This is usually two to three weeks after your operation. If you are experiencing problems please do not hesitate to talk in confidence to the Colorectal Nurse Specialist Team. From the point of view of your surgical procedure there is no reason why you should not go on holiday but it is advised to wait until you have your post-operative appointment. You will be seen in the outpatients clinic approximately six weeks after your surgery, to check your progress. There are many ways of reducing and managing post reversal problems; your Colorectal nursing team, G.P and Consultant are able to discuss your concerns and help you deal with them. It is possible for specialist involvement should these problems persist, we encourage you to open and honest with healthcare professionals.

of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678 Information Leaflet. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number SUR87 Publication date November 2014 Review date November 2016 Department Surgical and Critical Care Location Stepping Hill Hospital