Bowel surgery

Expert reviewer Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and
General Surgeon
Next review due June 2021

There are lots of types of bowel surgery. Here we look at bowel resection – an operation to remove part of your bowel. You might need to have this type of surgery if:

  • your bowel has been affected by a condition, such as bowel cancer or diverticular disease
  • you have inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis

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.

An image showing a diagram of the large and small bowels

Types of bowel surgery

The exact procedure you have will depend on what condition you have and how much of your bowel is affected.

An operation to remove part of your large 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 (see diagram, below)
  • sigmoid colectomy – surgery to remove the part of your bowel that’s closest to your back passage (see diagram, below)
  • transverse colectomy – surgery to remove the middle part of your large bowel (see diagram, below)

You may need to have all or a part of your rectum (back passage) removed – this is known as proctectomy.

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.

 A diagram showing the section of bowel removed during a right and left hemicolectomy

 A diagram showing the section of bowel removed during a transverse and sigmoid colectomy

Preparing for bowel surgery

You’ll usually need to stay in hospital for between three and nine days if you have bowel surgery without any complications.

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. For example, if you smoke, you’ll be asked to stop. This is because smoking increases your risk of getting a chest and wound infection. That can mean it will take you longer to recover from surgery.

Your doctor will check what medicines you’re normally on and advise if you should stop taking any of them before surgery.

You may need to follow a special carbohydrate-rich diet before your operation, especially if your condition means you’ve lost weight. You may also be asked to take laxatives on the day or the day before. Or you may need to have a bowel washout (enema). This involves having a small amount of liquid medicine inserted using a small nozzle into your back passage (rectum). This will help you to empty your bowel before surgery.

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 well informed and in a position to give your consent for the procedure to go ahead.

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 anything for six hours before your operation. You can usually drink water up to a couple of hours before your procedure, but always follow your anaesthetist or surgeon’s advice. If you have any questions, just ask.

You may also have a pain-relieving medicine injected into the space that surrounds your spinal cord – this is known as an epidural. Having an epidural can enhance your recovery, by helping your gut to return to normal working order and allowing you to get up and moving quicker after surgery. It can also reduce your risk of certain complications. Find out more about epidurals for surgery and pain relief.

You may need to wear compression stockings to keep your blood flowing in your legs. And you will need to have an injection of an anti-clotting medicine as well as, or instead of, wearing compression stockings.

Your doctor may also suggest you have an antibiotic injection before your operation to reduce the risk of infection.

Bowel surgery procedure

There are two main ways you can have bowel surgery. These are:

  • keyhole (laparoscopic) surgery
  • open surgery

In keyhole (laparoscopic) surgery, your surgeon will make small cuts and a slightly larger cut in your tummy (abdomen). They do the operation by putting small instruments and a tube-like telescopic camera through the smaller cuts and removing the appropriate section of bowel through the larger cut. 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, don’t have to stay in hospital for so long and may have less pain afterwards.

In open surgery, your surgeon will make a single, large cut into your tummy to reach your bowel.

If you need surgery for bowel cancer, the choice of procedure may depend on the stage, and where the tumour is. Your doctor will also consider factors like whether you’ve had surgery on your tummy before and if your bowel is blocked or torn.

Sometimes the surgeon will need to change from keyhole to open surgery during the operation. Robotic surgery, which gives the doctor more control over their surgical instruments, makes this less likely. It’s being used more often and is particularly suitable if you are very overweight (obese).

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. They want to make sure that there’s a good blood supply to what’s left of your bowel.

Stoma and ileoanal pouch

It’s possible that your surgeon will bring the healthy ends of your bowel through your abdominal (tummy) 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 (poo) 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’ll give you information about living with a stoma and can help you decide on the best position for the opening in your skin.

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.

Our FAQ explains in more detail how a colostomy or ileostomy may affect your everyday life.

Patients with ulcerative colitis may have an ileoanal pouch after they’ve had their large bowel and back passage removed. A ‘pouch’ is created in your bottom that does the same job of storing waste as the rectum would. This specialist surgery is being carried out more often, especially when the patient is young and generally healthy. But there is a risk of complications. For more information, speak to your surgeon.

Aftercare for bowel surgery

You’ll spend the first few hours after your operation in a special recovery unit. 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. Your surgeon will let you know when you can start to eat and drink again. Small, bland meals will be easier to digest at first. 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. 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. You may be shown exercises you can do while sitting or lying down too. This will help prevent chest infections and blood clots forming in your legs. You may also be shown how to do breathing exercises to clear your lungs.

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’ll 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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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.

Your doctor may suggest small changes to your diet in the early stages of recovery, while your bowel is sensitive. There’s some evidence carbohydrate-rich drinks can help you heal faster. Alcohol may irritate your digestive system and increase the risk of side-effects. Read our FAQ on what foods to eat after bowel surgery for more information.

It can take up to six weeks before you start feeling back to normal. It’s common to feel tired while you’re recovering and need more sleep. But sitting still for long periods can be uncomfortable. It can also increase your risk of complications such as blood clots in your legs and lungs, and chest infections. Try to change position or get up and move around every 30 minutes while you’re healing.

You may be able to drive and return to work within six weeks but should avoid heavy lifting and strenuous exercise for longer. Follow your doctor’s advice, including about any adjustments you might find helpful if you have a stoma.

Side-effects of bowel surgery

Side-effects are the unwanted but mostly temporary effects you may get after your operation. 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 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 or a chest infection because of it. Complications may also include excessive bleeding or developing DVT.

We haven’t included the chance of these complications happening as they are specific to you and differ for every person. Your surgeon will explain beforehand how these risks may apply to you.

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 in your pelvic area 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.
  • Narrowing where your bowel has been joined. This is known as an anastomotic stricture.
  • You may also get a urine infection or have breathing problems.

You should contact your ward or specialist if you’ve got a high temperature, diarrhoea or constipation, or you keep being sick, for three days or more.

You may need antibiotics to clear up an infection, or tests to check what the problem is, like a scan for blockages.

Frequently asked questions

  • 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 should try to drink small amounts of water frequently anyway.

    You may want to avoid ‘windy’ food like beans and fizzy drinks, including lager and cider, that could make you feel bloated. As well as passing more wind than before, wind can also build up in your tummy and be painful. Peppermint tea might help to relieve these symptoms.

    Try to eat regular meals, chewing your food slowly and thoroughly, to avoid getting wind. Stopping smoking, being active, not missing meals and not eating ‘on the move’ can also help your digestion.

    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.

    You may want to avoid alcohol, particularly red wine and strong beers, if you’re prone to diarrhoea.

    Our FAQ on how a colostomy or ileostomy may affect you also looks at possible changes to your eating habits.

  • Having surgery near your back passage (rectum) may affect your pelvic nerves and cause inflammation, changing the sensations you feel during sex. It can cause erection or ejaculation problems in men. In women, sex may be painful. This may be a temporary problem that will gradually settle down.

    Sometimes people notice a long-term loss of sensitivity or numbness around their genitals. Women who’ve had their rectum removed may find this causes vaginal dryness and they need to use a lubricant.

    Large scars, or having a colostomy (or ileostomy) bag because of a stoma, may make you feel self-conscious. You should discuss these concerns with your specialist stoma nurse who will be able to help and provide advice and support.

    Your doctor will talk to you about the possible impact on your sex life before you give your consent to the operation. And you should ask their advice if you’re having any difficulties after your surgery.

  • 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. But it can take time to get used to having one and you may need to make slight adjustments and plan ahead more.

    Before you leave hospital, a specialist stoma nurse will show you how to care for your stoma and your colostomy or ileostomy bag.

    There are different types of bag. The nurse will advise which is most suitable for you. Once you’ve left hospital, you can get new bags on prescription. This is usually free if your stoma is permanent. The bags are designed to fit discreetly under normal clothing. They shouldn’t leak or smell (except while being changed, and you can buy products to reduce any odour). You can bath or shower with one on.

    Your stoma nurse may visit you at home to give you more advice on day-to-day activities. For instance, you can get a device to stop your seat belt pressing on your stoma and the bag while driving. You may need to make adjustments at work to avoid lifting or other tasks that affect your tummy muscles.

    It can take time to see the difference what you eat, and when, makes to the waste that goes into the bag. Some foods may make you uncomfortable. You should chew food properly so it’s easier to digest and won’t cause a blockage.

    Lots of people and places can support you in adapting to having a stoma – have a look at the organisations mentioned in our Other helpful websites section, below.

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  • Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, June 2018
    Expert reviewer Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon
    Next review due June 2021