Colorectal surgery refers to operations performed on the large intestine (colon) and rectum. This type of surgery is commonly done to treat colon and rectal cancers, remove precancerous polyps, and repair various conditions affecting the colon and rectum like diverticulitis, ulcerative colitis, and intestinal obstruction.
If you are facing the prospect of having colorectal surgery, it is understandable to feel anxious and have many questions. This article provides a comprehensive overview of key things patients should know before, during and after colorectal surgery.
Types of Colorectal Surgeries
There are various types of colorectal surgery depending on the condition being treated. Common procedures include:
Partial Colectomy
- Removing part of the colon. Done for cancer, diverticulitis, trauma.
- The two healthy ends of the colon are reconnected (anastomosis).
-Hospital stay 1-7 days. 4-6 week recovery.
Low Anterior Resection
- Removing the upper rectum and reconnecting the colon to remaining rectum.
- For rectal cancer or polyps not removable by colonoscopy.
- Hospital stay 2-7 days. 4-6 week recovery.
Abdominoperineal Resection (APR)
- Removing the anus, rectum, and sigmoid colon.
- Done for very low rectal cancers. Permanent colostomy needed.
- Hospital stay 4-7 days. 4-6 month recovery.
Total Colectomy/Proctocolectomy
- Removing the entire colon. Often with removal of rectum and anus.
- For ulcerative colitis, familial polyposis syndromes, Hirschsprung’s.
- Hospital stay 4-7 days. Recovery typically takes 4-6 weeks.
Hemorrhoidectomy
- Removing hemorrhoids (swollen veins) causing bleeding or protrusion.
- Outpatient procedure unless extensive. Recovery up to 2-3 weeks.
Diversion Colostomy
- Creating an opening from the colon to the abdomen (stoma). bowel movements collected in a bag.
- Often temporary to rest an area like with traumatic injury or cancer.
- Hospital stay 2-4 days. 4-6 week recovery time.
Preparing for Colorectal Surgery
Proper preparation helps patients recover faster and prevent complications after colorectal surgery. Here are some important ways to get ready for the operation:
Pre-Op Testing and Evaluation
- Medical history and physical exam to assess overall health.
- Blood tests, urinalysis to check for any underlying issues.
- Cardiac testing if risk factors like smoking or family history.
- Colonoscopy to visualize the colon.
- Imaging scans (CT, MRI) to see affected area.
- Pulmonary testing if risk of lung problems during anesthesia.
Medication Management
- Review current meds with the surgeon.
- Stop medications that can interfere with surgery like blood thinners.
- Take antibiotics as prescribed to lower infection risk.
Diet and Bowel Prep
- Follow prescribed diet leading up to surgery. Low fiber, low residue.
- Take clear liquid diet 1-2 days before surgery.
- Complete bowel cleansing prep to fully empty colon.
What to Bring to the Hospital
- Comfortable loose clothing and slip-on shoes.
- List of medications and dosages.
- Insurance and payment information.
- Items like eyeglasses, dentures, hearing aids.
- Advance medical directive and legal documents if desired.
Questions to Ask your Surgeon
- Exact type of surgery being performed?
- Will you need a temporary or permanent colostomy?
- Expected length of hospital stay and recovery period?
- Pain management options after the surgery?
- Instructions for showering, bathing, caring for the incision site?
- Any activity restrictions after leaving the hospital?
- Surgical risks and possible complications to be aware of?
Thoroughly preparing mentally and physically can go a long way towards smoothing the colorectal surgery experience.
What To Expect During Surgery?
Here’s a typical overview of what happens during colorectal surgery:
- IV line placed to administer fluids, antibiotics, anesthesia medicines
- General anesthesia given to fully asleep and pain-free
- Abdominal area sterilized and surgical drapes applied
- Incision made (location varies by surgery)
- Colon/rectum freed by cutting ligaments holding it in place
- Diseased portions removed
- Remaining healthy sections reconnected (anastomosis)
- Temporary colostomy created if needed
- Incision closed with staples or sutures
- Possible insertion of drainage tube near incision site
- Bandages or dressings applied over closed incision
- Moved to recovery room to wake up from anesthesia
The length of the operation varies by procedure, from 1-4 hours typically. Minimally invasive laparoscopic surgery generally involves smaller incisions and less operative time.
Throughout the surgery, patients are continuously monitored by an anesthesiologist. Pain medications and fluids are given intravenously. Most patients have no awareness or memory of the procedure.
Recovering After Colorectal Surgery
The postoperative recovery period is different for each person. But here are some things commonly experienced:
Hospital Stay
- Hospital stay averages 1-7 days depending on surgery extent.
- IV fluids and antibiotics given for 1-2 days post-op.
- Gradually resumed on clear liquid diet, then solid foods.
- Assistance with walking to prevent blood clots.
- Breathing exercises to prevent lung problems.
- Pain management with IV/oral medication.
- Incision care by nurses until discharge.
- Instruction on caring for any stomas/colostomy.
- Monitoring for signs of infections and bleeding.
Early Recovery at Home
- Rest and limit activity for 4-6 weeks recovering.
- Leave surgical bandages intact until doctor’s visit.
- Take pain medications as needed per instructions.
- Contact surgeon if worrisome symptoms appear like high fever, bleeding, etc.
- Drink plenty of fluids and follow dietary recommendations.
- Begin gentle short walks around the house after a few days.
- Apply ice packs to reduce swelling and pain around incision site.
- Have someone available to assist with daily activities at first.
- Arrange outpatient nursing visit if available.
Longer Term Healing
- Expect it may take 4-6 months to feel fully recovered based on procedure.
- Refrain from strenuous activity, heavy lifting over 10 lbs for 6-8 weeks.
- Attend follow-up visit 1-2 weeks post-op for exam, staple/suture removal.
- Use sitz baths and topicals to ease discomfort from hemorrhoids/rectal surgery.
- Expect changes in bowel habits and stool consistency at first.
- Drink prune juice, take stool softeners to avoid constipation/straining.
- Begin adding higher fiber foods back into diet slowly.
- Use laxatives if prescribed to avoid straining with first bowel movements.
- Expect temporary fluid discharge from any stoma requiring bag changes.
- Monitor and care for stomas once instructed on proper techniques.
- Continue to increase daily walking and activity.
- Call surgeon for any concerns like abnormal pain, bleeding, fevers.
- Attend all follow up visits for monitoring and clearance before driving.
Following all postoperative instructions carefully ensures the best possible recovery from colorectal surgery.
Long-Term Outcomes after Surgery
For most people colorectal surgery is very successful, especially when cancer or disease is detected early. But it’s important to follow doctor’s orders for monitoring afterwards:
Possibility of Temporary Side Effects
- Changes in bowel habits, gas, bloating
- Abdominal discomfort, cramping
- Fatigue, low energy for several weeks
- Appetite changes or food aversions
- Trouble sleeping or concentration
- Temporary weight loss
Potential Long-Term Effects
- Scarring at incision sites
- Herbal sensation around scars
- Healed incision can feel numb
- Weakened abdominal muscles requiring exercises to rebuild strength
- Changes in urinary or sexual function after rectal surgery
- Require lifelong colostomy bag if large portion of rectum removed
- Possible infertility after extensive surgery
- Psychological effects and adjustment to body changes
Follow-up Care Needed
- Monitoring by surgeon for cancer recurrence
- Ongoing screening for new colon polyps
- Checking for malabsorption issues if large intestine removed
- Monitoring kidney function if diversion colostomy
- Yearly full physical exams and colonoscopy
- Lab testing for vitamin deficiencies
- Taking supplements like B12 injections if parts of colon removed
Working closely with your doctor after surgery as recommended allows any potential issues or recurrence to get promptly assessed.
Questions To Ask Your Doctor Post-Surgery
It’s common to have many questions and concerns after undergoing major colorectal surgery. Here are important things to discuss with your surgeon during follow-up:
- How often will I need follow-up exams and colonoscopy screening?
- When can I resume normal activities like work, exercise, driving?
- How will my bowel habits be affected long-term?
- What dietary changes will I need to make?
- Will I experience pain, numbness, or odd sensations around my incision site?
- Are there any activity restrictions I need to follow?
- Do I need to take any special medications or supplements?
- Could I experience hernias or abdominal muscle weakness?
- What signs and symptoms should I watch for?
- Is additional cancer treatment needed like radiation or chemotherapy?
- Will I need physical or occupational therapy?
- What precautions should I take regarding my colostomy/stoma?
- How can I manage issues with urinary or sexual function after rectal surgery?
Do not hesitate to ask any other questions you may have. Your surgical team wants you fully informed during recovery.
In Conclusion
Colorectal surgery is a major procedure with risks that must be balanced against potential benefits. For many patients it can greatly improve quality of life when done for appropriate reasons.
Being actively involved in the process, asking questions, and following preparatory steps can facilitate optimal surgical outcomes. While recovery takes time, most people can expect good long-term results by adhering to their surgeon’s post-operative instructions.
If faced with needing colorectal surgery, you should feel empowered to make the best decisions for your health and wellbeing. Seek support from your healthcare providers, loved ones, and any available resources along the way.
With proper care and vigilance, there is every reason to expect a positive surgical experience and continued good health.