In many patients, bowel function changes after surgery, because the surgeon has removed part of the large bowel and the bowel is now shorter than before; stool passes through more quickly, it may be looser, and you may need to open your bowels more often. Sometimes it takes months for the bowel to settle down and get used to the new situation, although for most patients the symptoms become manageable over time. Although bowel function and bowel habits will not be the same as before the operation, most patients establish a new pattern. Try to eat smaller amounts more often, chew your food well and do not skip meals. Drink plenty of water during the day, and do not drink tea, coffee or fizzy drinks. Common problems after surgery for colorectal cancer are as follows:
- Patients have frequent bowel movements and open their bowels several times a day
- Patients have to rush to the toilet to open their bowels (urgency)
- Faecal incontinence (loss of bowel control)
- Difficulty emptying the bowel completely
- Excessive wind (gas)
- Loose stools or diarrhoea
- Constipation
- Slowing down bowel activity
- If your stools are loose and you open your bowels several times a day, do not eat high-fibre foods in the first few weeks after the operation; a rapid, large increase in fibre may cause diarrhoea, wind and bloating.
- Slowing the movement of stool through the bowel gets rid of the problem of frequent bowel movements and makes the stool firmer, so controlling your bowels becomes easier. Fibre plays an important role in regulating the function of the large bowel. There are two types of fibre:
- Soluble
- Insoluble. Insoluble fibre speeds up bowel movements. Soluble fibre slows down bowel movements and makes the stool firmer.
- If you have diarrhoea or loose stools, cut down on the following foods:
Bran, seeds, and breads and breakfast cereals that contain bran or are made from mixed grains or whole grains; some fruits such as grapes, apricots, all kinds of plums, peaches and all kinds of berries; vegetables, especially beans, broccoli, sprouts, peas, cabbage, onions, peppers, corn on the cob, spinach and garlic; spices such as red pepper (chilli) and curry; caffeine in coffee, tea, chocolate drinks, cola and energy drinks; and chocolate. Of course, once your bowel movements have slowed down and the problem of frequent bowel movements has cleared up, you can include these foods in your diet again. Foods that slow down the bowel and make the stool firmer: oat porridge, white bread, plain boiled rice and pasta, peeled apples and pears, bananas, mashed potato, fish and chicken, yoghurt, peanut butter. If changing your diet is not enough to control your bowels, you may need to take a soluble fibre supplement or anti-diarrhoea tablets.
Faecal incontinence: if part of the rectum is removed during surgery for colorectal cancer, the muscles around the anus – the sphincters – are damaged, so the patient cannot tighten these muscles enough to stop stool coming out. Controlling wind: after surgery for colon cancer you may suffer from bloating, and the bowel may produce more gas. Sitting still for a long time may make you uncomfortable; try to move and change your position every half an hour, so that gas does not build up and get trapped in the bowel. Try to cut out foods that increase wind, and instead of one heavy meal, eat more frequent, smaller meals. Foods that produce gas: sprouts, broccoli, cabbage, beans, onions, spinach, cucumber and corn on the cob, dairy products and fatty foods, nuts, lentils and bran, spicy foods, and chewing gum. Surgery may also damage the nerve supply to the muscles, so that the nerves send the wrong signals to the brain; this makes it hard for the patient to recognise when stool or wind is about to pass. When patients feel that they may need to open their bowels at any moment and cannot control it, as a natural reaction
they tighten all their muscles, hold their breath and rush to find a toilet so as not to be embarrassed. It is better, however, to stand or sit still, breathe deeply and tighten the anal sphincter muscles until the urgent need to go passes. Exercising the sphincter muscles strengthens them, so you can control your bowel movements better and stop stool or wind from escaping. The more you exercise, the stronger and more effective the muscles become. Ask your doctor to teach you sphincter exercises.
Prepared by: Zahra Zahiri