Changes in bowel function
Depending on how much of the intestine is removed, up to 90% of patients will have a change in their bowel habits after rectal surgery. These symptoms include urgency to get to the toilet, frequent small bowel movements (1-2 tablespoons every 5-10 minutes after eating) or possibly 3-15 times after each meal, inability to hold stool or having incontinence without being aware of it until it has happened, having stools at night, feeling like you have not completely emptied all of the stool, being unable to tell whether there is just gas or solid stool in the rectum and other symptoms. Together these symptoms are known as “Low Anterior Resection Syndrome” or LARS. You should be able to use the internet to read more about this condition.
Why does this happen?
Again, whether it happens and how much trouble you might experience is due to the length and location of the segment of the colon that was removed. If you had a portion of the rectum removed (which is located just above the 2” of the anus), you will have lost the section of the bowel that helps to “hold or accommodate” the stool. The rectum can normally expand to hold from 650 to 1200 ml or 22 to 40 oz of fecal waste. (To put this in perspective, a 12 oz mug has approximately 360ml). In addition, there are 2 sphincters in the anus that help to keep the stool in the rectum and an automatic reflex that prevents the stool from coming down into the rectum. The surgery may have damaged these “automatic controls” when the section of the colon was removed, the nerves were cut or damaged, or the sphincters were stretched at the time of the surgery. The use of a rectal stapler (inserted through the anus) to attach the remaining colon ends can damage the sphincter muscles too.
Can a person recover normal bowel function after surgery?
How well a person will recover a normal stool pattern will again depend on the type and extent of the surgery. However, one report indicated that an “automatic control” in the rectal nerves recovered in 85% of patients in 24 months. This helped to reduce the stool leaking.
What are some treatment options?
In some surgical situations, a rectal pouch is created at the time of the excision which will help to “hold the stool” like the rectum that was removed. If this was not created, then using 1 to 2 Imodium or lomotil tablets before or with each meal is quite helpful. These drugs will slow the intestine down and increase the pressure at the anus to keep the stool from coming out. You can also add extra fiber supplements, but sometimes that increases the volume of stool and may make the problem worse. If you are getting chemotherapy and find that the stool is softer or more liquid, you could add over the counter digestion enzymes with each meal that might help to counteract the effect of the chemotherapy on the small intestine digestion enzymes. (If that helps only a little, you might ask your doctor for a prescription for pancreatic enzymes to try.) Biofeedback therapy has also been shown to be effective as well as a daily morning enema of 500-1000cc of warm water which cleans out the left colon. Practical suggestions include wearing a protective pad in your underwear to help reduce soiling. Keeping a record of how many stools you have daily while you experiment with the Imodium, fiber, biofeedback, or enemas is a practical way for you to determine what is or isn’t working. Bottom line: Don’t give up and be willing to experiment. It should steadily improve with time.