Ostomy reversal: What to expect
If you have a temporary ostomy, it’s likely that you will have it reversed at some point. In this procedure, the surgeon will move the stoma back into your abdomen and sew your intestines back together.
You will need several weeks to recover from your initial surgery, and you may need other treatments such as chemotherapy. In that case, your ostomy reversal surgery will be after you have finished chemo or if you’re in a good position to have take a chemo break. You also need to be well enough to tolerate the surgery. Many patients have their temporary ostomies reversed within 3 to 12 months of their initial surgery, but this can vary depending on your individual circumstances.
Before the procedure
Bowel prep, like before a colonoscopy or resection, is not usually required for ostomy reversal surgery. You will probably be told not to eat or drink anything for several hours before the procedure. Small sips of water to take your medication should be ok, but it is important to follow your surgeon’s instructions. You may be given antibiotics to take before the procedure to prevent infection. Chat with your surgeon about any vitamins, supplements or prescription medications that you are taking, as some of these may need to be discontinued for a period of time before or after surgery.
Before starting the surgery, you will receive anesthesia and have a fluid IV drip to keep you hydrated.
After the procedure
After the procedure, you will need to stay in the hospital until your bowels start working again. This may be anywhere from a day or two to a week or more if there are complications. After your bowels start working again and your team has determined that you are healing well, you will be sent home.
During your recovery, it is very important to follow the instructions of your surgeon regarding wound care, diet and exercise. It is a good idea to check your wound regularly for signs of infection and follow the wound care instructions given to you be your surgeon. If you notice increased pain, redness or swelling around the wound or any discharge of pus or fluid, call your team as these could be signs of infection. You will also be given pain meds to take at home. If you need a prescription refill, it is a good idea to call your team several days before running out so that you are not stuck without them. You will be scheduled for a follow-up visit with your surgeon where you can discuss any questions or concerns you have following your surgery.
What side effects might I experience?
Lower anterior resection syndrome (LARS)
This is probably the most common side effect that patients experience following ostomy reversal. LARS refers to a group of symptoms related to bowel function that patients may experience. These symptoms include:
- Increased frequency/urgency of stools
- Incontinence
- Clustering (needing to poop several times in a short span of time)
- Constipation
- Uncomfortable gas
- Abdominal pain
Your bowels have not been working for a period of time, so the nerves and muscles in the area may not be working properly. This can make it difficult to regulate bowel function.
Unfortunately, these symptoms are quite common, particularly in the first year or so following ostomy reversal surgery. Many patients report that they have a negative effect on their quality of life. Luckily, there are some things that you can do to help improve symptoms:
- Try pelvic floor physical therapy. Pelvic floor exercises can help strengthen the muscles in your pelvic floor. Many patients find that working with a pelvic floor therapist is extremely beneficial. The sooner after surgery you start therapy, the better. You should be able to request a referral from your surgeon or PCP.
- Make some diet changes. Modifying the amount and types of fiber in your diet can help improve symptoms. This can be different for each individual and may require a bit of trial and error to figure out what’s right for you. A dietician can also help with this. If you feel that would be helpful for you, ask for a referral from your oncologist or surgeon.
- Try medications. Immodium can help with diarrhea and Metamucil or Miralax can help with constipation.
- Drink water. Staying well-hydrated is crucial for regular bowel function. Aim to drink 8 to 10 glasses of water a day to keep things moving.
- Get moving. Gentle exercise can help stimulate the bowels and get things moving if you are experiencing constipation.
For more tips and tricks on regulating bowel function, read our Diet & Lifestyle section here.
Scar tissue
Scar tissue from surgical healing can cause difficulties with healing and bowel function. If you think this may be the case, speak with your surgeon, as they may be able to recommend physical therapy or scar tissue massage to help.
Hernias
A hernia happens when part of your bowel pokes through the cut made for your stoma. It is particularly important to avoid any heavy lifting post-surgery, as physical stress can cause hernias to form. Don’t lift anything more than 5 to 10 pounds until you are well healed. Just for reference, a jug of milk weighs around eight pounds!
Nerve damage
When you have surgery, nerve damage can happen. It can affect your bowel function, your ability to pee, or your ability to have sex. Connecting with a pelvic floor physical therapist soon after surgery can help you heal correctly. If you think you have nerve damage, chat with your team about physical therapy or medication options.
What should I eat and drink?
You’ll probably be advised to follow a low-residue, low-fiber diet in the initial weeks following your surgery. This means avoiding whole grains, beans, raw fruit and vegetables. White pasta, white bread, white rice, cheese, meat and well-cooked vegetables should be fine. Low-fiber foods are a bit easier to digest and will pass through your system more easily. Eating a low-residue diet will help your bowels to recover in the initial weeks following surgery. Try to include protein-rich foods at every meal to aid in wound healing. Avoid foods that can be hard on your stomach, like coffee, fried foods or spicy foods. Make sure to drink plenty of water, as this is also important for bowel function.
As mentioned above, you may find that your appetite is affected by the surgery. If you experience loss of appetite or taste changes, try eating small amounts of food throughout the day rather than large meals. Your appetite will likely return to normal after a couple weeks.
In the weeks and months following surgery, you will probably notice changes in bowel function and things may not work exactly as they did before. Adjusting the amount of fiber that you eat can help. It is a good idea to slowly introduce new foods to your diet every day or two, so that if you have any problems, you will know what caused them and you can cut back on that particular food. Starting a food diary can help you keep track of what you eat. Remember to take things slowly and listen to your body. A dietician can also be helpful in terms of advising you on what to eat following reversal surgery.
When should I call my doctor?
Although the risk of severe complications following ostomy surgery is low, it is important to know when to contact your care team. If you have any worrying symptoms, early reporting leads to earlier intervention and better outcomes in general. So if you feel that something is not right, it is always a good idea to call your doctor. If you experience any of the following, contact your team immediately:
- Increased abdominal pain, discomfort or bloating
- Difficulty breathing
- Persistent diarrhea
- Increasing pain when urinating
- High temperature
- Persistent nausea and vomiting
- Inability to eat or drink
- Unusual bleeding, redness or swelling
Want to learn more about ostomy reversal?
Join one of our COLONTOWN Facebook groups:
- In Stoma City you’ll find answers to your ostomy questions and lots of stories of ostomates living life to the fullest!
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