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Life After Closure of a Temporary Stoma

A temporary stoma can be the result of emergent or planned surgery. Temporary ostomies can be as short as 3 months. The reversal is considered an elective procedure so many ostomates will plan to have this done around life events. Before a reversal can be done, healing from the first surgery should be completed. The process of healing, known as the inflammation phase, scarring and building new tissue takes about 3 months. Lifestyle changes once you have surgery with a stoma placement then changes again after the reversal.

Perforation

Emergent surgeries that end with the placement of an ostomy usually occur as the result of a perforation. Perforation of the colon leads to peritonitis (infection) in the abdomen which takes time for the body to resolve. When this occurs, waiting longer for the reversal is better, allowing adhesions time to resolve. The surgery is easier on the patient as well as the surgeon and is usually done about 6 months after.

Planned ostomy surgery can be the result of rectal cancer. The standard course of treatment for rectal cancer is radiation therapy with chemotherapy at the same time (neoadjuvant therapy). Once this treatment is completed, the waiting period to proceed with a diverting ostomy surgery is about 6-8 weeks, giving the body time to recover from treatment. Most often patients will resume chemotherapy (adjuvant therapy) for a period of time, once healed from surgery. Upon completion of adjuvant chemotherapy, reversal surgery can be planned. This can be anywhere from 6 months to a year after.

During the period of healing and waiting for the appropriate time for a reversal, the anal and rectal sphincter muscles lose tone while not in use. Rectal capacity is decreased. As a result, once reversed, fecal urgency occurs. It is difficult to hold on to the stool. It is recommended for you to go to the bathroom as soon as you feel the urge to move your bowels (BM). This will lessen the number of accidents or fecal incontinence episodes.

What happens after Stoma Reversal?

If your temporary stoma was an ileostomy, you may have frequent loose stools. This worsens the situation. The first few weeks after the reversal, it can become a struggle to remain continent. Many patients wear adult briefs during this time. Frequent loose stools and the inability to hold them cause frequent incontinent episodes that irritate the perirectal skin. This is quite painful. Perineal cleansers such as ConvaTec’s Sensi-Care Perineal Cleanser or McKesson’s MSA Rinse Free Perineal Wash help alleviate pain with cleaning. Once clean, it is a good idea to apply a skin barrier ointment such as Coloplast’s Baza Clear Moisture Barrier Ointment or Medline’s Soothe & Cool Moisture Barrier Ointment. This will reduce burning caused by moisture/stool coming in contact with the skin so frequently. Some will need to take Imodium to slow down the motility (the speed at which waste travels through the intestinal tract) of the GI tract, while others need to add fiber to bulk up the stool. Some will require both. These interventions often become part of a daily regimen for life.

 

Tips to Help After Reversal

  1. During the time you are diverted with the ostomy, you can do pelvic floor exercises such as Kegels to help keep the pelvic muscles toned. Once reversed, continue doing them.
  2. After surgery eat small meals 4-6 times a day rather than 3 larger meals
  3. Drink plenty of fluids to maintain hydration.
  4. You will be on a low fiber diet for a few weeks after surgery but certain foods will naturally thicken the stool without adding fiber. These include rice, pasta, potato, bagels, pretzels, peanut butter, tapioca, yogurt and cheese.
  5. Foods that can worsen or loosen the stool are carbonated beverages, alcohol, caffeine, high fiber vegetables, spicy or fatty foods.

Risks of Stoma Surgery

Every surgery has risks and benefits associated Risks of Surgery with it. These include:

  1. Post-operative ileus - This is when the peristalsis (the wave-like motion that pushes food through the digestive tract) stops. This is a side effect of anesthesia and narcotic pain medications. Bowel rest (no food intake) and walking help stimulate the bowel to function again. 
  2. Bowel obstruction 
  3. Anastomotic leak - This is a failure of the reconnected intestine. This causes infection (peritonitis) from bowel contents within the abdominal cavity. 
  4. Hernia at the incision or previous stoma site. You will have activity restrictions for 4-8 weeks after reversal surgery. 
  5. DVT (deep vein thrombosis or blood clot). 
  6. PE (pulmonary embolism) is a blood clot from the DVT travels to the lungs). This can be fatal without treatment. 
  7. Post-operative pneumonia

Once healed from your reversal surgery, at some point you will resume a normal diet. Remember, your digestive tract has been altered and shortened. Foods that never caused digestive problems may react differently with these new changes. If you continue to struggle with irregular BMs, consider keeping a food diary of what you eat and the effects that occur. This will help you find the source of negative side effects. Those foods can be eliminated, allowing a more regular bowel pattern. Good luck!

 

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