What Can I Expect Right After My Reversal?

So, what impact do these factors have on your reversal?

As you can see, there are an almost infinite number of combinations of considerations that may apply to you. For this reason, it’s hard to receive a valid, predictive answer to the question, ‘What is life and my bowel function going to be like after my reversal?’

For example:

• You may be a 40 year old Ulcerative Colitis patient who had part of your colon removed and a short-term ostomy during healing.
• Perhaps you are an 18 year old who was in a car accident and suffered damage to your abdomen and needed a temporarily ileostomy during the healing stage.
• Or, you may be a 50 year old colon or rectal cancer patient who has been through radiation and chemo, and surgery to remove the tumor. You’ve had an ostomy for a year, and are through treatment and ready to have your reversal.
• You may be a 35 year old cancer patient who is also diabetic who has had an ostomy for 6 months during treatment.

All of these special factors make us entirely unique, and that can make it difficult to predict the outcome with absolute certainty.

Typical Recovery

Some patients have their ostomy taken down (the normal pathway of their bowel restored), and go back to normal very quickly, sometimes within days. This is the best case scenario! It may not be entirely typical, but it happens and may be your outcome.

For others – perhaps even most – the recovery is more challenging.

The First Stool

Immediately after your surgery, the distal bowel (the part that’s not been used during the time you’ve been diverted through an ostomy) will start receiving waste for the first time in months or even years. In layman’s terms, it’s likely to ‘freak out’ and behave badly. Most patients experience diahrrea with incredibly strong urgency. You may have problems getting to the bathroom in time, and are somewhat likely to have accidents. (Some patients are blessed and don’t experience this).

The best advice is to expect it, and if it doesn’t happen, great! If it does, strip your clothes, get cleaned up, and move forward. Everything will wash, including your clothes. (Products that sanitize laundry are very useful at times like this). While unpleasant, it’s not the end of the world to soil yourself at a critical healing time like this.

The Impact of a Compromised Anatomy

Did you have a part of your rectum or sigmoid colon removed due to cancer treament surgery? If ‘yes’, then your body’s ‘holding tanks’ for stool will be less effective than they should be.

A smaller sigmoid cannot hold the same amount of waste that you were accustomed to, so your urgency may be higher than normal – your body literally can’t store as much waste without evacuation.

If part of your rectum has been removed, then the final ‘gatekeeper’ will be less effective. Damage to the rectum from radiation can cause the nerves and sensations to be lessened, so you may not have the signals that it’s time to go that a typical person would.

Any changes to your anatomy can have an impact on the results of your reversal. However, this does not mean it can’t be successful! Some people have had their entire large colon, sigmoid and rectum removed, and still been successfully reversed. None of these factors mean it won’t work! It’s just important to keep these anatomical changes in mind to understand how your body is responding to having your ostomy reversed.

Disuse, Diversion or Radiation Colitis

Most patients have what’s called Disuse Colitis (aka Diversion Colitis), inflammation of the bowel in the unused portion. Those patients who have had radiation can also have inflammation due to that treatment.

The cause may vary, but the end result will be an inflamed, ‘angry’ bowel that has not been used, and that will react to having stool pass through it. Anticipate runny stools that are very difficult to control – you’re likely to feel that you cannot hold back the flow, no matter what you do. While unpleasant, this is normal. Your rectum and anus haven’t been used, and are like out of shape muscles with no strength. They’ll get stronger fast, but at first they won’t have much power.

Because of this inflammation, the flow of stool into the bowel is likely to be uncomfortable at first. You’re probably going to feel crampy, and passing stool may be painful. Your rectum and anus have not been used in months, and will also respond poorly to the acidic waste that’s moving past them. Your anus will sting, and may even be very painful for the first few days.

The use of a ‘butt cream’ like Calmoseptine is highly recommended to dull the sting and provide a barrier for that delicate tissue. Just dab a little bit on a piece of clean toilet tissue, wipe the area around your anus, then discard the tissue. Use it with every bowel movement to keep that area protected.

Note that it’s not unusual to pass blood with the first bowel movements due to colitis. Always tell your doctor, but the inflammation may actually cause some bleeding – for the most part, this is normal. (But, again, tell your doctor and let them decide if it’s normal, or cause for concern).

Diahrrea – how long will it last?

This varies greatly from patient to patient. Some never have it, some have it for a few days, some a few weeks, and some, unfortunately, develop LARS (Lower Anterior Resection Syndrome) and have ongoing bowel function issues, perhaps permanently.

All of the factors in the list at the top of this page contribute to your outcome. The bottom line is that almost all patients should expect diahrrea at first, and for some time to come as your body adjusts to the new normal.

Medications

Your doctor will advise you about when it’s time to take medication to stop the diahrrea. It’s typically not advised right away, as the bowel needs to relearn it’s job, and adding medication to the mix right away may hinder that process. DO NOT take medication without speaking with your doctor first!

In Summary

The bottom line? While it’s hard to predict your outcome, be aware that resuming the use of your bowels after an ostomy reversal will probably be challenging at first.

• Expect diahrrea.
• Expect some discomfort.
• Expect some degree of bleeding.
• Expect that food will have a big impact on how your bowels are working.
• Expect that your bowel will not go back to ‘normal’ right away – healing time is needed, dietary adjustments are needed, and medication may ultimately be needed.
• Expect and envision yourself with a healthy bowel, living life to the utmost! A positive mindset is incredibly important in the healing process.