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Bowel surgery

You might need to have surgery to remove part of your bowel if it’s been affected by disease, such as bowel cancer or diverticular disease. You might also need to have an operation if you have inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis. The exact procedure you have will depend on what condition you have and how much of your bowel is affected.

Your bowel (also called your intestine) is made up of your large and small bowels. The information here is about surgery for your large bowel which you may also hear called your colon.

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Image showing the large and small bowels

Details

  • Types Types of bowel surgery

    An operation to remove part of your bowel is called a colectomy. Types of this kind of surgery include:

    • total colectomy – an operation to remove all of your large bowel
    • proctocolectomy – your surgeon will remove your large bowel and back passage (rectum )
    • hemicolectomy – an operation to remove either the left or right side of your large bowel
    • sigmoid colectomy – surgery to remove the part of your bowel that’s closest to your back passage
    • proctectomy – an operation to remove your back passage

    Your surgeon will talk with you about the most appropriate procedure for you.

    Your care may not be quite as we describe here as it will be designed to meet your individual needs. But you’ll meet the surgeon carrying out your procedure beforehand to discuss what will be involved.

    An image showing a right and left hemicolectomy     An image showing a transverse and sigmoid colectomy
  • Preparation Preparing for bowel surgery

    You’ll need to stay in hospital for between two and nine days if you have bowel surgery.

    You may go to a pre-assessment clinic a few days before your operation for routine tests. Your surgeon will explain how to prepare for your operation. If you smoke, it’s highly likely that you’ll be asked to make a real effort to stop. This is because as well as the many other problems it can cause, smoking increases your risk of getting a chest and wound infection. This may mean it takes you longer to recover.

    You may need to follow a special diet for a day or two before your operation and take laxatives on the day or the day before. Or you may need to have a bowel washout (enema). This involves having a liquid injected into your back passage (rectum) to flush out anything that is still in your bowel.

    Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand exactly what will happen. You might find it helpful to prepare some questions to ask about the risks, benefits and alternatives to the procedure. This will help you to feel really well informed about what is going to happen so you can give your consent for it to go ahead. You’ll be asked to sign a consent form before the operation.

    You’ll have bowel surgery under general anaesthesia. This means you’ll be asleep during your operation. An anaesthetic can make you sick so it’s important that you don’t eat or drink anything for six hours before your operation. Follow your anaesthetist or surgeon’s advice. If you have any questions, just ask.

    You may need to wear compression stockings to keep your blood flowing in your legs. And you may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

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  • The procedure What happens during bowel surgery?

    There are two main ways you can have bowel surgery.

    • In keyhole (laparoscopic) surgery, your surgeon will make small cuts in your tummy (abdomen). They do the operation by putting small instruments and a tube-like telescopic camera through these. Images from the camera are shown on a monitor so your surgeon can see what they are doing. People often recover more quickly from this type of surgery.
    • In open surgery, your surgeon will make a single, large cut into your tummy to reach your bowel.

    Your surgeon will remove the diseased parts of your bowel and may join the two healthy ends together using stitches or staples. This is called an anastomosis.

    It’s possible that your surgeon will bring the healthy ends of your bowel through your abdominal wall and onto the surface of your skin. This will make a stoma, which is an artificial opening on your tummy. This is where waste products will leave your body if the end of your bowel has to be removed. You’ll need to wear a bag over your stoma to collect the waste from your bowel.

    Having a stoma can have a big effect on you. If your surgeon thinks it’s likely you’ll need a stoma, they’ll arrange for you to see a specialist stoma nurse before your operation. They will give you information about living with a stoma and can help you decide on the best position for the opening.

    A stoma can either be temporary or permanent, depending on the type of surgery you have and how much bowel your surgeon removes. The type of surgery you have will also determine the size and shape of your stoma, as well as where it is. The procedure is called a colostomy if it involves your large bowel and an ileostomy if it’s done from your small bowel. To find out more about stomas, read our FAQ: How will a colostomy or ileostomy bag affect my life?

  • Aftercare What to expect afterwards

    You might have some discomfort as the anaesthetic wears off. But you’ll be offered pain relief as you need it.

    You may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes (a drain) running out from your tummy to drain fluid into another bag. These are usually removed after a few days.

    You’ll have a drip inserted into a vein in your hand or arm to give you fluids. You can eat and drink again as soon as you feel able to. If you have any diarrhoea or constipation, your doctor or nurse will help you to deal with this.

    To help prevent deep vein thrombosis (DVT), you’ll have a daily injection of an anti-clotting medicine (such as heparin). You’ll also need to wear compression stockings to help keep your blood flowing well. Try to get out of bed and move around as soon as possible. This will help prevent chest infections and blood clots forming in your legs.

    You’ll be able to go home a few days after surgery but exactly when will be different for everyone. It’ll depend on what operation you had and how well you’re recovering. You’ll usually need to have gone to the toilet and be able to eat (even if it’s just a liquid diet) before you can leave. You will also need to be up and about and able to walk.

    Before you go home, your nurse will give you some advice on how to care for your healing wounds and stoma, if you have one.

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  • Recovery Recovering from bowel surgery

    If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. To try to prevent constipation, make sure you drink enough fluid and don’t take painkillers that contain opiates (such as co-codamol).

    You may be able to return to work anything from one to six weeks after your operation but follow your surgeon’s advice. Ask them about when you can get back to exercise, heavy lifting and driving too.

  • Side-effects What are the side-effects of bowel surgery?

    As with every procedure, there are some risks associated with bowel surgery. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. The possible side-effects of bowel surgery include:

    • pain and discomfort in your tummy (abdomen)
    • changes in your bowel movements, such as constipation or diarrhoea
  • Complications What are the complications of bowel surgery?

    Complications are when problems occur during or after your surgery. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing DVT.

    Complications of bowel surgery include the following.

    • Leaking of the new join in your bowel. This is known as an anastomatic leak and can cause pain in your tummy.
    • An infection. Your wound may become swollen, red and tender to touch. Contact your hospital if you develop these symptoms.
    • Bands of scar tissue (adhesions). These can develop after surgery and may cause your tissues or organs to stick together. If you have adhesions, you may have pain in your tummy; they can also block your bowel.
    • Nerve damage. If nerves are damaged during surgery, this can lead to loss of sensation. This could affect your sex life or how well you can control your bladder.
    • Temporary paralysis of your bowel. Sometimes your bowel may be slow to recover from the surgery and won’t contract as usual. This is known as an ileus and may cause you to feel bloated, be sick or have problems with your bowel movements. Your hospital team will give you fluids to help you recover.
  • FAQ: Will I be able to eat normally after having bowel surgery? FAQ: Will I be able to eat normally after having bowel surgery?

    Answer

    Generally, yes. Your surgeon or nurse at your hospital will advise you about what you should or shouldn’t eat. If you have any problems, they will refer you to see a dietitian.

    Explanation

    After any kind of bowel surgery, some foods may give you more problems than others. For example, if you eat high-fibre foods, such as fruit and vegetables, you may get diarrhoea. If this happens, it’s important to drink enough fluids so you don’t get dehydrated. You may also pass more wind than before. If this builds up in your tummy, it can be painful. Drinking peppermint tea might help to relieve your symptoms.

    Sometimes it can take months for your bowel movements to get back to normal after your surgery. Different foods affect people in different ways, so there will be a certain amount of trial and error in finding out which ones affect you. If your bowel movements don’t seem to be returning to normal, ask your doctor or dietitian for advice.

  • FAQ: Will I be able to have a normal sex life after bowel surgery? FAQ: Will I be able to have a normal sex life after bowel surgery?

    Answer

    There is usually no reason why you can’t have a normal sex life after your operation. However, it’s possible that you may have problems if the nerves to your sexual organs were damaged during surgery.

    Explanation

    Having surgery near your back passage (rectum) may cause damage to your pelvic nerves. This can cause erection or ejaculation problems in men. In women, sex may be painful. There are medicines that can help, so talk to your doctor if you’re having problems.

    With other types of bowel surgery there isn’t usually any medical reason why you shouldn’t be able to enjoy a normal sex life. However, if you have large scars or a colostomy (or ileostomy) bag because of a stoma, you may feel self-conscious about having sex. Speak to your doctor if you’re having any difficulties after your surgery.

  • FAQ: How will a colostomy or ileostomy bag affect my life? FAQ: How will a colostomy or ileostomy bag affect my life?

    Answer

    If you have a stoma and need a colostomy or ileostomy bag, it shouldn’t stop you doing any of the things you used to do. Bear in mind though that but it can take time to get used to having one.

    Explanation

    When you’re in hospital, your nurses will care for your stoma and empty your colostomy or ileostomy bag. A specialist stoma nurse will advise you on what to eat and how to look after your stoma.

    When you’re feeling well enough, your nurse will show you how to clean your stoma and change your bag. Once you’ve left hospital, you can get a supply of new bags on prescription from your chemist. Alternatively you can get them through a mail order company or an online supplier. The bags are all designed to fit discreetly under your clothing, and are easy to change. They won’t leak or smell.

    At first, you may feel upset or self-conscious about having a stoma and need time to come to terms with it. Your stoma nurse will give you advice on how your stoma can fit in with your day-to-day activities. Lots of people and places can support you in adapting to having a stoma – have a look at the organisations mentioned in our Further information section.

  • Resources Resources

    Further information

    Sources

    • Colorectal cancer. National Institute for Health and Care Excellence (NICE), December 2014. www.nice.org.uk
    • Map of Medicine. Diverticular Disease. International View. London: Map of Medicine; 2014 (Issue 3). 
    • Inflammatory bowel disease. Medscape. www.emedicine.medscape.com, published 7 January 2015
    • Stedman’s Medical Dictionary. www.medicinescomplete.com, accessed 24 July 2015
    • Colon resection. Medscape. www.emedicine.medscape.com, published 23 April 2013
    • Open left colectomy. Medscape. www.emedicine.medscape.com, published 29 May 2013
    • Understanding bowel cancer. Beating Bowel Cancer. www.beatingbowelcancer.org, published March 2013
    • Bowel cancer. Cancer Research UK. www.cancerresearchuk.org, published 29 August 2013
    • Patient information for laparoscopic colon resection surgery from SAGES. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). www.sages.org, accessed 9 March 2015
    • Patel S, Lutz JM, Panchagnula U, et al. Anesthesia and perioperative management of colorectal surgical patients – a clinical review (part 1). J Anaesthesiol Clin Pharmacol 2012; 28:162–71. doi:10.4103/0970-9185.94831
    • Laparoscopic surgery for colorectal cancer. National Institute for Health and Care Excellence (NICE), August 2006. www.nice.org.uk
    • Inflammatory bowel disease. Medscape. www.emedicine.medscape.com, published 7 January 2015
    • Stomas of the small and large intestine. Medscape. www.emedicine.medscape.com, published 26 April 2013
    • Catena F, Di Saverio, S Kelly et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2010 evidence-based guidelines of the World Society of Emergency Surgery. World J Emerg Surg 2011; 6:5. doi:10.1186/1749-7922-6-5
    • Common postoperative complications. PatientPlus. www.patient.info/doctor, reviewed 11 February 2013
    • Constipation. NICE Clinical Knowledge Summaries. cks.nice.org.uk/constipation, published February 2015
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