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.
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.
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).
Questions for Your Doctor
If you’re worried about having an ostomy, or if you know you’ll need one, here are some questions to ask your doctor:
♦ Do you think I will need a colostomy or ileostomy?
♦ Will it be temporary or permanent?
♦ What will it look like?
♦ Will it be noticeable through my clothing?
♦ Will I be able to do the activities I did before?
♦ Is there an ostomy nurse who will mark the right spot for the ostomy before surgery and who can help me at the hospital after the operation?
♦ Is there an ostomy nurse who can help me at home after surgery?
♦ What diet changes or modifications should I make with my stoma?
♦ How should I care for the skin around the ostomy?
♦ What potential problems can occur and how will I recognize them?
♦ What types of pouching systems are available for me?
♦ Where can I order ostomy supplies?
♦ What supplies will my insurance cover?
♦ Can I have the supplies sent to me and refilled automatically?
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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Reprinted with permission from Frankly Speaking About Cancer: Colorectal Cancer, 3rd edition, copyright © 2011 Cancer Support Community. All rights reserved. For more information, visit cancersupportcommunity.org.
This article was originally published in Coping® with Cancer magazine, March/April 2012.