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Bowel surgery

Bowel surgery involves removing parts of your bowel that have been affected by disease, such as cancer or inflammatory bowel disease.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

You may need to have surgery to remove part of your bowel if you have a condition such as bowel cancer, diverticular disease, large polyps (fleshy growths), a problem with the blood supply to your bowel or inflammatory bowel disease (IBD). IBD is a term used for both Crohn's disease and ulcerative colitis. 

The exact procedure you have will depend on the nature of your condition and on how much of your bowel is affected. An operation to remove part of your bowel is called a colectomy. Specific types of bowel surgery include the following.

  • Total colectomy – removal of your entire bowel.
  • Proctocolectomy – removal of your entire bowel, the rectum (back passage) and anus.
  • Hemicolectomy – removal of either the left (descending) or right (ascending) side of your bowel.
  • Sigmoid colectomy – removal of the part of your bowel that is closest to your rectum and anus.
  • Transverse colectomy – removal of the part of your bowel that joins the left and right sides (the transverse colon).
  • Proctectomy – removal of your rectum and anus.

Your bowel may be rejoined afterwards, or an artificial opening (stoma) may be created on your abdomen (tummy). This opening may be temporary or permanent.

Your surgeon will discuss with you what the most appropriate procedure for you is.

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An image showing a right and left hemicolectomy
An image showing a transverse and sigmoid colectomy

Details

  • Preparation Preparing for bowel surgery

    You will usually be asked to attend a pre-assessment clinic a few days before your operation for routine tests and advice about how to prepare. At the hospital, your nurse will check your heart rate, blood pressure and temperature, and test your urine.

    You may be asked to follow a special diet for a day or two and be given laxatives to take the day before. You may also be given a bowel washout (enema), which involves having a liquid injected into your rectum to flush out the remaining contents of 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 what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

    Bowel surgery is done under general anaesthesia. This means you will be asleep during the procedure. You will be asked to follow fasting instructions, which means not eating or drinking, typically for about six hours beforehand. It's important to follow your surgeon's advice.

    You may be asked to wear compression stockings and will have an injection of an anti-clotting medicine (such as heparin) to help prevent blood clots forming in the veins in your legs.

    Some hospitals offer an enhanced recovery programme for bowel surgery. This involves drinking nutritional supplements before and after your operation, and starting to move around as soon as possible to speed up your recovery. Speak to your surgeon to see if this programme is available at your hospital and whether it would be suitable for you.

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  • The procedure What happens during bowel surgery?

    You may have a keyhole procedure (your surgeon will put small instruments and a tube-like telescopic camera through small cuts in your abdomen) or you may need open surgery (your surgeon will make a single, large cut into your abdomen to reach your bowel). If you have keyhole surgery, you may have a quicker recovery, however, this type of operation isn’t suitable for everyone or for every type of bowel condition.

    Your surgeon will remove the diseased parts of your bowel. He or she may then join the two healthy ends together using stitches or staples. This is called an anastomosis. If necessary, your surgeon will bring the healthy ends of your bowel through your abdominal wall and onto the surface of your skin to form a stoma. A stoma is an artificial opening on your abdomen. This procedure is called a colostomy if it involves your large bowel and an ileostomy if it involves your small bowel. You will need to wear a bag over your stoma to collect waste produced by your bowel.

    If you have a stoma, it may either be temporary or permanent, depending on the type of surgery you have and how much of your bowel is removed. The type of surgery you have will also determine the size, shape and location of your stoma.

    If you have open surgery, you may be given an epidural anaesthetic as well as a general anaesthetic. This involves your anaesthetist putting a thin tube into a small space in your spine, just next to your spinal cord. There is a continuous flow of local anaesthetic into the tube to help control any pain you may have after your surgery.

  • Aftercare What to expect afterwards

    You will need pain relief to help with any discomfort as your general anaesthetic wears off. You may be offered patient-controlled analgesia. This is a pump connected to a drip in your arm that allows you to control how much pain medicine you have. If you have keyhole surgery, rather than open surgery, you're likely to need less pain relief.

    You may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes running out from your wound. These drain fluid into another bag and are usually removed after a day or two.

    You will have a drip inserted into a vein in your hand or arm to give you fluids. When your bowel function returns, you will be allowed to eat and drink again. If you have any changes in your bowel movements, your doctor or nurse will help you to manage them.

    To help prevent deep vein thrombosis (DVT), you will need to have a daily injection of an anti-clotting medicine (such as heparin) in your skin, usually on your abdomen. You will also need to wear compression stockings to help maintain your circulation. You will be encouraged to get out of bed and move around as soon as possible, as this will help prevent chest infections and blood clots forming in your legs.

    You will usually be able to go home between three and 10 days after your surgery, depending on the type of operation you had and how well you’re recovering. Before you’re discharged, you will be given some painkillers and a nurse will advise you 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.

    You may be able to return to work between three and six weeks after your operation. Follow your surgeon's advice about strenuous exercise, lifting and driving.

  • Risks What are the risks?

    Bowel surgery is a commonly performed procedure and generally safe. However, in order to make an informed decision and give consent, you need to be aware of the possible side-effects and the risk of complications.

    Side-effects

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

    • sickness as a result of the general anaesthetic
    • pain and discomfort in your abdomen
    • changes in your bowel movements, for example, constipation, diarrhoea or urgently needing to have a bowel movement
    • scarring – this is permanent, but the scars should fade gradually over time

    Complications

    Complications are when problems occur during or after your surgery. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing DVT.

    There are complications that are specific to bowel surgery. If you develop any of the following complications after your surgery, you may need further treatment.

    • Infection of your wound. Your wound may become swollen, red and tender to touch. Seek medical help if you develop these symptoms. Your doctor may prescribe you antibiotics, or you may need to have the infected fluid released from the wound.
    • Colostomy. If the ends of your bowel can’t be rejoined as planned, your surgeon may have to form a temporary, or sometimes permanent, colostomy.
    • Bands of scar tissue (adhesions). These can develop in your abdomen after surgery and may cause your tissues or organs to stick together. If you have adhesions, you may have abdominal pain and they can occasionally obstruct your bowel.
    • Bleeding or leaking of the new join in your bowel. This is known as an anastomatic leak and can cause pain in your abdomen. If an abscess forms, you may need to have it drained. Alternatively, you may need another operation to repair the leak and, occasionally, a colostomy will then be required.
    • Nerve damage. If nerves are damaged during surgery, this can lead to loss of sensation. Very rarely it can impact on your sex life or bladder function. See your doctor if you think you're affected.
    • 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, vomit or have problems with your bowel movements. It can be treated by putting a tube in your stomach to keep it empty and giving you fluids through a drip in your arm until you recover.

    The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

  • FAQs FAQs

    Will I be able to eat normally after having bowel surgery?

    Answer

    Generally, yes. You will usually be seen by a dietitian after your operation who will advise you about what you should or shouldn't eat. Some foods may affect your bowel movements and it may take a few months for them to get back to normal.

    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 make sure you drink enough fluids, so you don't become dehydrated. You may also find you have more wind than before, which can build up in your abdomen and cause pain. Your doctor may suggest you drink peppermint water or take charcoal tablets to help relieve your symptoms. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    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 you will need to be patient in finding out which ones affect you and which ones don't. If your bowel movements don't seem to be returning to normal, see your dietitian or doctor for advice.

    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 experience problems if the nerves to your sexual organs have been damaged during surgery.

    Explanation

    When you have surgery near your rectum it may cause damage to your pelvic nerves. If you’re a man, you may have erection or ejaculation problems. If you’re a woman, sexual intercourse may be painful because of the narrowing and shortening of your vagina. There are medicines that can help, so talk to your doctor if you’re experiencing 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, you may feel self-conscious about having sex. Speak to your doctor if you’re finding it difficult to resume a normal sex life after your surgery. Talking to a counsellor may also help.

    How will a colostomy or ileostomy bag affect my life?

    Answer

    Having a colostomy or ileostomy bag shouldn't stop you living a normal life. It may, however, have an impact on your body image.

    Explanation

    When you're in hospital, your nurses will care for your stoma and make sure your colostomy or ileostomy bag is emptied as often as you need. You will also be in contact with a specialist stoma nurse who will be able to advise you on what to eat and how to look after your stoma.

    When you’re feeling well enough, you will be shown how to clean your stoma and change your bag. Once you've left hospital, you will be able to get a supply of new bags on prescription from your chemist, through a mail order company or an online supplier. The bags are all designed to fit discreetly under your clothing, are easy to change, leak-proof and odour-tight.

    At first, you may feel upset or self-conscious about having a stoma and will need time to come to terms with your altered body image. Your stoma nurse will be able to provide you with advice on how your stoma can fit in with your day-to-day activities.

    See Related information for more information about stoma care.

  • Resources Resources

    Further information


    Sources

    • Types of surgery for bowel cancer. CancerHelp UK (Cancer Research UK). http://cancerhelp.cancerresearchuk.org, accessed 21 March 2011
    • Bowel cancer surgery: your operation. Beating Bowel Cancer. www.beatingbowelcancer.org, published January 2012
    • After your operation for colon cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 January 2010
    • Laparoscopic surgery for colorectal cancer. National Institute for Health and Clinical Excellence (NICE), August 2006. www.nice.org.uk
    • Bowel cancer treatment: your pathway. Beating Bowel Cancer. www.beatingbowelcancer.org, published September 2011
    • Complications in colorectal surgery. American Society of Colon and Rectal Surgeons. www.fascrs.org, accessed 21 March 2010
    • Surgery for colon cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 October 2010
    • Intestinal obstruction. The Merck Manuals. www.merckmanuals.com, published September 2007
    • Ileus. The Merck Manuals. www.merckmanuals.com, published September 2007
    • Colostomy. Bladder and Bowel Foundation. www.bladderandbowelfoundation.org, accessed 27 March 2012
    • Clinical nurse specialists: stoma care. Royal College of Nursing. www.rcn.org.uk, published 2009
  • Related information Related information

  • Author information Author information

    Produced by Krysta Munford, Bupa Health Information Team, July 2012.

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