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Managing the Impact of Colorectal Cancer Surgery

Immediate and long-term compli­cations that occur after surgical treatment for colorectal cancer can include pain, infection, scarring, adhesions, and fecal incontinence. Managing an ostomy may also be a new part of your life after surgery.

Pain and Infection Immediately after Surgery
Pain and infection are the most common concerns immedi­ately after colon or rectal surgery. It’s important to talk with your healthcare team if you are in pain so you get ad­equate relief when you need it while in the hospital and during your recovery at home. Post-surgical pain can inter­fere with healing, so it is important to manage pain before it becomes a prob­lem. If narcotics are prescribed for pain management, ask your doctor how you can prevent constipation – a common side effect of these drugs.

Signs of infection can include fever, redness, tenderness, and a discharge or pus at the surgery site. If you get a bacterial infection, antibiotics will be prescribed. Ask your healthcare team about signs of infection to watch for when you return home.

Scarring and Adhesions
Surgery for colorectal cancer involves opening the abdomen, the site of many impor­tant organs, including your small and large intestines. Since the intestines are a long, flexible tube of tissue in constant motion as food is digested and waste is excreted, surgery can cause adhesions (scar tissue) that prevent the intestines from moving freely. If food is unable to move easily through the intestines dur­ing the digestive process, the intestines can become obstructed (or blocked), a painful and dangerous complication.

Before your operation, ask your surgeon about the plan to reduce the risk of adhesions for you.

Surgeons use special techniques during surgery to decrease the risk of adhesions. These include using biode­gradable or absorbable membranes or gels to separate organs at the end of surgery, or performing laparoscopic surgery, which reduces the size of the incision and manipulation of the ab­dominal organs. Before your operation, ask your surgeon about the plan to re­duce the risk of adhesions for you.

Fecal Incontinence
The normal mechanisms that control bowel move­ments include muscles and nerves in the rectum and anus. If surgery or ra­diation damages the rectal nerves or muscles, you may not be able to com­pletely control your bowel movements. They may be more frequent or urgent, or you may not know when your bowels are moving. To deal with this situation, you may need to wear pads and change them regularly.

This condition can improve over time, and you may be able to learn ex­ercises to strengthen the muscles in the anus to improve control. Changes in your diet can also be helpful. A food diary (where you write down all of the foods you eat in a day or over time) can help you identify which foods create problems so you can avoid them.

If you are unable to control your bowel movements, don’t be shy – talk to your doctor or nurse about strategies to manage the problem. In extreme cases, if you are unable to control bowel move­ments over a long period of time, an ostomy may be considered.

Ostomy
An ostomy creates a new path for stool by surgically connecting the end of the colon or small intestine to a stoma (an opening in your abdo­men). An ostomy pouch that fastens to the skin over the stoma is used to collect waste. A colostomy bypasses part of the large intestine (colon), and is used more frequently in rectal cancer than in colon cancer. An ileostomy by­passes the entire colon and is made at the end of the small intestine (ileum).

The need for a colostomy or ileos­tomy after surgery for colorectal cancer depends on many factors, including the type of surgery you have, which part of the colon or rectum is removed, and how much time was available to pre­pare for surgery. Frequently, a reversible ostomy is used to allow tissues to heal safely after surgery. Once recovery is complete, another surgery (colostomy or ileostomy reversal) will reconnect the colon or rectum, so bowel move­ments can pass through the anus again.

If emergency surgery is required because the colon or rectum is blocked by cancer, there may be inadequate time to cleanse the intestinal tract and empty out stool. An ostomy may be created during emergency surgery to prevent infection or complications, and you may have little time to prepare yourself for this significant change in your life.

If surgery is not an emergency, talk to your healthcare team about the possibility that an ostomy will be needed. Permanent ostomies are uncommon after surgery for colon or rectal can­cer, except for cancers located low in the rectum.

Many people dread having an ostomy but find that once they have one, they can lead an almost entirely normal life. Still, it takes some getting used to, and it helps to know what to expect. An ostomy nurse or support group can help you adjust.

Before you leave the hospital with a stoma, an ostomy nurse, who specializes in care of the ostomy and stoma, will show you how to empty and replace the pouch, care for the skin around your stoma, manage your diet and daily activities, and recognize potential problems.

Once you leave the hospital, a visit­ing ostomy nurse can help you learn to manage your ostomy at home, recom­mend alternative pouching systems, and troubleshoot problems. You may have to try different pouching systems before you find the one that’s best for you.

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