Recovery: What Can I Expect Right After My Reversal Surgery?
Immediately After Surgery
Immediately after ostomy reversal surgery, patients are closely monitored as they recover from anesthesia and begin the early stages of healing. You’ll spend time in a post-surgical recovery area, or will be moved to a room on a med-surge floor.
During this time, medical staff closely monitor vital signs such as heart rate, blood pressure, breathing, and oxygen levels. It is common to feel groggy, tired, or slightly nauseated as the effects of anesthesia wear off. Communicate closely with your care team so they can keep you as comfortable, pain-free and free of nausea as possible.
First Day or Two After Surgery
Patients may experience abdominal soreness around the surgical site, which is typically managed with prescribed pain medications. The range of pain varies greatly by patient. Some need only Tylenol after the first day, some require stronger pain medications for several days. This will depend upon your general health, surgical complications, the type of surgery (robotic, laparoscopic or open), and pain tolerance. Many patients report little to no pain after surgery, so it’s not a sure thing that this will be a painful and uncomfortable procedure.
The area where the stoma was located will be covered with a surgical dressing, and in some cases a small opening may be left to drain fluid as the incision heals. You may have a surgical drain such as a bulb attached to your abdomen. An intravenous (IV) line is usually in place to provide fluids, medications, and sometimes antibiotics.
Your Digestive System Will Wake Up
The amount of time that this will take will vary greatly by patient. Some are practically passing gas on the way back from surgery, some people take several days to have their first gas and bowel movement.
Typically, in the first day or two, the digestive system often needs time to “wake up.” This temporary slowing of bowel function is known as postoperative ileus. During this time, patients usually start with clear liquids to initially stimulate the bowel, before gradually progressing to soft, then solid foods as bowel activity returns.
Passing gas is often the first sign that the intestines are functioning again. Strong bowel signs and gas are a terrific sign that the bowel is waking up and starting to work again. Remember, that part of your body has been without anything to do for quite some time, and needs time to ‘realize’ it has to get back to work.
Potential Complications
The most common post-surgical complications are:
- The postoperative ileus may not resolve on it’s own; the bowels may not wake up and start working. This may require the insertion of a GI tube through the nasal passage. This tube will decompress the bowel, remove accumulated gas and fluids (giving them an alternative escape route), and relieve pain as the gut rests and relaxes and has time to heal and wake up fully.
- Infection may occur, either at the external stoma site or internally.
- Anastomic leaks may occur where the joins in the tract were located. This allows fluid and stool to leak into the body cavity, requiring immediate antibiotic intervention and likely surgery to repair the leak.
- Intestinal blockage, where the stool that is present becomes stuck on some feature in the bowel.
- If these occur in the hospital, intervention will take place immediately.
- If they occur once you’ve gone home, symptoms will likely be an increased body temperature/fever, pain, and an inability to pass stool. If you are at home and experience these systems, notify your medical team or get to the ER immediately! Do not waste time.
Speeding Up Healing & Bowel Activity
Nurses and doctors will also encourage early movement, such as sitting up and short walks, which helps promote circulation, bowel function, and overall recovery.
How can you speed things up?
- Stay hydrated
- Walk, walk, walk, and walk some more
- Chew gum! This introduces air and gets the saliva working, so many patients report that it helps to get things moving.
- If you can eat, do, as this will start moving material through your bowel. Follow your doctor’s order as to what to eat, and when, however.
Also, be aware that many of the pain-killing medications we are given after surgery can have a constipating effect. Take the meds you need, of course, but if you can wean onto something less-strong, like Tylenol, it will be a positive step toward getting your bowels moving.
The Poop WILL Hit the Fan
For almost all reversal patients (barring a small percentage who are really blessed with immediate, healthy bowel function), it’s going to get bumpy. The poop will start, you won’t be able to hold it back, and you’ll feel like it won’t stop. This may not happen until you get home. Whenever it does, have a good calming cream on hand to soothe sore tissues, use a bidet or peri bottle to rinse instead of wiping, and know that this too, will pass.
When Can You Go Home?
Each surgeon has their own preferred criteria for release. In general, if the patient is passing gas or stool (even a small amount), this demonstrates that their bowels are active, ‘awake’, and are beginning to function, and the patient will be released.
Speak with your surgeon ahead of time to find out their standards for release, and be sure to report honestly and accurately to your medical team about what’s occurring while you’re in the hospital so they can determine the best time to release you.
Recovery from ostomy reversal is not the time to be shy.
- Need to pass gas? Do it. Seriously. If your care team detects gas in the room, it means their patient is recovering beautifully and they’ll be happy. Nurses are built differently (God bless them), they won’t be offended.
- Need to poop? Yes!! That’s cause for celebration, your bowel is working!!
- Had an accident? No big deal, let’s clean it up and move forward.
- Tell your team everything and don’t be sensitive or shy. There is nothing your care team hasn’t seen, and knowing what you are experiencing is incredibly important.
The Trip Home
If you live a distance from the hospital, getting home may present a challenge. If you’ve not yet reached a point of strong bowel urgency, it may be no issue. But, if your bowels are fully awake and in overdrive, you may find it difficult to make the ride home without an accident. Mentally prepare yourself that it may occur, and remind yourself that a shower can take care of anything that happens.
Consider having towels on your seat to protect your car, and wear disposable underwear that can be discarded if an accident occurs. While unpleasant, it’s not the end of the world, and can be cleaned up. Do not be embarrassed! Your body is doing its best to return to normal function and needs time to re-learn what that means. It’s ok… give your body and yourself some grace.
And, bring a pillow to hug on the way home in case you are having pain or discomfort. Have water and some cough drops or hard candies in the car, too, as any coughing can be problematic to your surgical healing.
Bowel Function Immediately After Surgery
How will your bowels work after you get home from surgery? This is THE question!
- Some people go back to normal function almost immediately. They have normal bowel movements almost immediately, and never have urgency that can’t be controlled.
- Others have very little control of their bowels initially, reporting an inability to prevent stool from passing (accidents) in the days and weeks after surgery.
- Most are somewhere in between.
There are an almost infinite number of factors at play that determine how your bowel will bounce back after your reversal. As a result, it’s almost impossible to accurately predict how your recovery will look, but you can learn from other’s experiences so that you know the possible outcomes.
Typical Post-Reversal Healing Process
As we’ve said numerous times on this site, it’s virtually impossible to predict how the recovery process will look for you. But there are some experiences that can be considered common, and typical. Let’s run through them.
You may pass some blood and mucus before you pass stool.
A small amount is to be expected, as you’ve just had surgery and any blood needs to pass out of the body. Keep your doctor aware if you are passing blood, however, and let them decide if there is cause for concern. But, typically, this is normal.
You will have bowel distress at first.
Why? All ostomy reversal patients have some degree of disuse proctitis – it will vary based upon your personal medical background, your overall health, the health of your bowel, and how long your bowel was diverted via an ostomy.
Almost everyone has at least a few days of ‘colonoscopy prep level’ diahrrea, super-frequent bowel movements (up to 30+ a day), and discomfort. If you don’t experience this, you’re in the fortunate minority.
Don’t go into the surgery expecting to recover immediately and skip this part of the healing process. It’s normal, typical, and to be expected for most patients.
You will have extreme urgency at first.
Why? Your bowel has gone unused for a period of time, and no longer ‘knows’ how to do its job. The nerves in your sigmoid and rectum (if present) have not been receiving stimuli while you were diverted, and will have to relearn how to interpret the signals they are receiving as waste enters your bowel for the first times. Think of them as ‘misfiring’ wildly as the nerves are stimulated after a period of time of disuse.
Sometimes the urgency is because you really do need to release your bowels. But, sometimes, you’ll feel the urgency but ultimately won’t have to go at all, or just a little. This is because right after reversal the nerves in the rectum aren’t able to differentiate between real and imagined urgency, and will send the signal to ‘go! now!’ when any stool is detected. So you’ll be running for the bathroom, and often.
You likely won’t have good bowel control at first, and may have fecal incontinence (aka, ‘accidents’).
Why? The rectum will be ‘out of shape’ from not being used, and needs to learn it’s job again. (We use that expression many times, but it’s really the best way to think of these parts of the anatomy after reversal).
In normal function, the sigmoid colon and rectum act as a holding tank, holding onto fecal matter, and the nerves there will trigger the rectum that it’s time to ‘let go’ and evacuate. An uncompromised rectum will send these signals with plenty of time to find a bathroom and get the job done.
When someone’s bowels are diverted via an ostomy, these nerves haven’t been used, and won’t correctly alert your body when it’s time to go. As a result you may get the signal too late, and evacuation may begin before you want it to, resulting in an accident. This will smooth out with time, and, some patients never experience this situation.
Your gut biome will need work to return to normal.
Since your bowel has been unused, the flora that used to be present to help effectively digest food are probably no longer present, and are out of balance. This will contribute to your bowel function being compromised. You will likely be very, very, very gassy. As food and waste pass through your system, these flora will be restored.
Speak to your doctor about what you can consume (and when!) to speed up this process. For example, good quality yogurt with active cultures can work wonders, as can fermented foods (sauerkraut, kimchi) and kombucha.
Good gut flora = better digestion and processing of food waste.
The first days after reversal can be rough.
Expect it. Understanding your body and what it’s been through, and why it is going into poop-production overdrive, can be a huge help in being patient with yourself during this healing time. Patients who don’t understand their anatomy and the impact of an ostomy reversal are more frustrated and afraid of the process of healing.
Anticipate that the time after reversal will have you running for the bathroom, foods that you ate before with no issues may trigger a rapid bowel movement, and that you’ll need to ease back into eating your favorite foods slowly.
If you don’t experience this, WONDERFUL! But, it’s better to expect a difficult season so you’re not surprised if it happens.
You MUST be careful about using medications or fiber to slow or stimulate bowel movements too soon. This is very important. Don’t self medicate without speaking to your doctor. We cannot stress this enough.
Speak with your doctor before taking anything to slow down your bowel. If you are not having bowel movements at all, this could indicate an ileus (bowel slowdown), so speak with your doctor quickly. Whichever way your bowel is leaning – constipated or too loose – most surgeons will not want you to take anything too quickly to slow down or speed up your bowel.
Why? The bowel and rectum need to naturally resume normal function.
If you take Immodium, for example, to slow down the bowel, the medication is doing that work and the body doesn’t have to learn to adapt. When your bowel is working so erratically, it’s also easy for medication to cause you to slip into constipation; hard, compact stool can actually do damage to the surgical joins.
Disuse colitis means inflammation. An inflamed colon isn’t working correctly, and the body needs time to get that under control. If we prematurely medicate to slow or speed the bowel, we can do harm to that healing process and prevent the body from relearning to digest food and waste.
If your digestive system will not calm down after a period of time deemed normal by your surgeon, you can discuss the use of medications to balance the bowel. Do not take anything before that time.
Hygiene, Stoma Site Closure Care
After an ostomy reversal, the stoma site can be closed using different surgical techniques. The choice depends on the patient’s condition, risk of infection, and surgeon preference.
1. Primary Closure (Linear Closure)
In a primary closure, the surgeon closes the stoma site by suturing the layers of the abdominal wall and skin in a straight line. This method results in a more traditional incision that is fully closed at the time of surgery. While it may heal faster cosmetically, it can carry a slightly higher risk of wound infection because fluid may become trapped under the skin.
2. Secondary Intention (Open Healing)
With secondary intention, the wound is left partially or completely open and allowed to heal from the inside out. The deeper layers close gradually through natural tissue growth (granulation). This approach reduces the risk of infection but requires regular dressing changes and takes longer to heal.
3. Purse-String Closure
A purse-string closure is a hybrid technique where a circular suture is placed around the wound, leaving a small opening in the center for drainage. This method helps reduce infection risk while improving cosmetic outcomes compared to fully open healing.
Each method has advantages, and your surgeon will choose the best option based on your individual needs.
Wound Hygiene
You’ll be instructed on how to care for your surgical wound. Typically, you will clean and re-dress the wound daily. Most patients are allowed to shower as soon as they are home, with instructions to let the water run over the wound – no scrubbing.
Most wounds will heal within ~ 6 – 8 weeks.
Your Diet After Reversal
This one’s easy – talk to your surgeon. Each doctor varies in their approach and the diet that they recommend. Some people will eat solid food almost immediately after surgery, some will be on a liquid or low-waste diet for up to a few weeks after.
Whatever they recommend, ease into food carefully. For example, you may have consumed milk with no issues in the past, but after reversal it can send you running.
Some people can eat almost anything they did before or while they were an ostomate. Others find that they must be restrictive to keep their bowel calm. We’re all different, and unfortunately we all have to find what works for us through good old trial-and-error.
Does your surgeon not have solid recommendations about your diet?
Consult others who have been through the surgery to gain some insight into what worked well for them. But, remember, each of us has a unique set of circumstances, so really, we all have to learn for ourselves what works, and doesn’t work.
Stay Hydrated!
Especially right after surgery when you are running to the bathroom perhaps dozens of times per day, you’ll be losing fluid quickly. Stay hydrated. Drink water. Drink electrolyte drinks. Just keep your body supplied with water! This is incredibly important – bowels that don’t have enough fluid will never work correctly.
Your Best Weapon – Fiber
Fiber is critical for effective bowel function. However, the addition of fiber must be timed well. Take it too early, and it can greatly irritate an already inflamed bowel. Do not increase your fiber intake, or stop eating a low-fiber diet, until instructed by your surgeon.
What does fiber do?
Fiber essentially bulks up the stool. If your stool is too loose, your rectum will have a hard time holding it back. If it’s bulkier and thicker, the rectum has a fighting chance to hold it back. If you tend to be constipated, fiber will draw water from the bowel into the stool, loosening it up and allowing it to pass.
Natural vs Supplements
Ideally, we’d consume our fiber through our food. Some high-fiber foods are prunes, beans, lentils, berries, avocados, flax, and quinoa. Chia seed pudding can work wonders! At first, you’ll want to go slow, introducing fiber-rich food when given the go-ahead by your care team. Find out which ones agree with you, and which ones give you large amounts of gas.
The Bristol Scale
The Bristol Scale is a mechanism used to track how well your body is forming stool. Too loose? Small pellets? Cracked in appearance? These are all indications of how hydrated your body is, the amount of fiber you are consuming, and how your body is producing stool as a result. You can compare your output to the chart, and let your doctor know where you fall on the scale. They can then recommend a fiber intake level to level out your bowel function.