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Regaining bowel control after surgery

Following surgery, your bowel will need time to settle and it may never be quite as it was before. How long this takes will vary – it could be weeks or months – and it is important not to expect too much during these early days.

Problems with regaining bowel control are most likely to arise after stoma reversal surgery. However if you have had a large section of bowel removed or if you had surgery on your rectum, you may also have temporary problems with your bowel control. You may experience:

  • increased frequency of bowel movements
  • increased urgency – little or no warning of when you need to go
  • diarrhoea or loose poo
  • constipation
  • pain in your bottom on passing poo
  • passing small amounts of poo frequently (stool fragmentation)
  • leaking poo or being unable to control your bowel (faecal incontinence)
  • increased wind, and being unable to distinguish between wind and poo.

 

This group of bowel symptoms is known as Anterior Resection Syndrome.

 

It is also useful to note that radiotherapy and chemotherapy can have a lasting effect on your bowel function, and this may not become obvious until you have completed all your treatment and surgery, or sometimes even years later. Specialist support and advice are available to you if this is the case.

 

Managing your diet

While your bowel heals, you may wish to eat small, bland, low-fibre meals, little and often, gradually starting to increase the variety and quantity of food. Drink plenty of fluids and eat nutritious snacks throughout the day to increase your calorie intake and give your body the extra energy it needs to heal.

 

Some people experience bowel movements during the night, which disrupts sleep. You may be able to manage this by eating your main meal earlier in the day. If it helps, keep a ‘food diary’ so you can record what you eat, when you eat and the effect this has on your bowels (including what happens and when).

 

Jelly sweets, marshmallows, bananas and mashed potato are also good for firming up watery poo. You may need to limit known culprits like beer, lager, and red wine, very high fibre vegetables, cereals and fruits, and spicy or very fatty foods.

 

Controlling symptoms

Given time, the bowel should settle down into a manageable pattern. If after several weeks you are still having problems, despite having tried to manage it through diet, you should speak to your GP or specialist nurse. They can prescribe medication to control diarrhoea (such as loperamide or codeine phosphate) or a bulk-forming medication to give more reliable control. They will also advise you how to manage the dose of medicines to prevent other complications and side-effects from them.

 

If constipation is a problem, it is important to continue to drink plenty of water (around 8 glasses per day) and to eat enough food to help keep your bowel moving. Try to take some gentle exercise every day and avoid long periods of sitting still.

 

Common remedies for excess wind and cramps may include fennel or peppermint tea, or baby’s gripe water in warm boiled water. Eating your food slowly to avoid swallowing air, and chewing food thoroughly can help.

 

Diarrhoea is common as less water is reabsorbed from your stool as it travels towards the anus. Some foods and drinks can make diarrhoea worse e.g caffeine in tea and coffee, gas in fizzy drinks and chemicals in some beers and wines.

 

Protecting your skin

You may find it helpful to use unfragranced moist toilet paper, wet wipes or a shower head to clean your bottom and gently pat dry after each bowel motion.

 

Whenever possible, wash around the anus after a bowel motion, using warm water (don’t be tempted to use disinfectants or antiseptics). Barrier creams,  such a zinc and caster oil, Sudocrem or Vaseline, can also help to prevent your bottom from getting sore as a result of frequent trips to the toilet.

 

Retraining your rectum, anus and pelvic floor

You are more likely to have problems regaining bowel control if you have had stoma reversal surgery. The longer your rectum and pelvic floor muscles have been out of use while you had a stoma, the more likely it will be that you will need to exercise to make them strong again.

 

For more information on exercises to control your sphincter muscles and to help you overcome the fear associated with urgency please refer to our Bowel Control Exercises factsheet.

 

Radiotherapy and chemotherapy treatments can have a lasting effect on your bowel function, and these may not become obvious until you have completed all your treatment and had your stoma reversed.

 

You can get help with this from your community incontinence team or from your specialist colorectal nurse, if the problem does not seem to be improving.

 

Please see long-term-changes in bowel habit for advice on what to do if things aren’t settling down.