Bowel Surgery

When doctors say "bowels", they are referring to the last three feet or so of the digestive tract. This is part of the digestive tract looks and performs differently from the small bowel. Surgery performed on the small bowel is, in fact, not common, and is done for different reasons than large bowel surgery.

If Bowel Surgery is due to Cancer or Polyps

Large bowel surgery is done for several reasons. One may be that you might have a polyp on your colon. A polyp on the colon is usually a lesion on a stalk that is coming from the inner lining of the colon.

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When there is a polyp on the colon, the doctor removes it, usually through a colonoscopy, and checks it for cancer. This kind of bowel surgery is minor. There is very little bleeding and you can tell if you have cancer on the polyp within a few hours or days.

If there is cancer on the polyp or if there is an obvious lesion of cancer on the colon, the bowel surgery is much more involved. Sometimes the doctor has to remove a small segment of the colon. This is the small part of the colon on either side of the cancerous polyp and sometimes involves removing nearby lymph nodes.

If your cancer is severe, a "partial colectomy" is done. This is when a larger segment of the colon is removed during bowel surgery. The bowel surgery puts the two ends of the colon together, making a much smaller large bowel. This is usually performed if there are larger cancerous lesions.

If you have Ulcerative Colitis

Total colectomies, or surgeries removing the entire colon, are sometimes done if a person has ulcerative colitis. This is an inflammatory disease of the colon that has a high risk of colon cancer. Because of the high risk of colon cancer, bowel surgery is done:

• to remove the entire colon to prevent cancer from happening.
• and to reduce symptoms of ulcerative colitis.

Without bowel surgery, there is a high risk of colon cancer and the individual has significant diarrhea and cramping pain from the disease.

Sometimes it is not possible to return the ends of the colon back together and a stoma must be placed. A stoma is an artificial opening or hole placed on the outer abdominal wall. Stool passes through the stoma and into a bag that sticks to the abdominal wall.

Stomas are sometimes placed after cancer surgery and, if everything goes well, the stoma can be reversed and the ends of the colon can be connected back together again. A stoma involving the colon is called a colostomy and it puts out relatively solid stool.

If you have Diverticulitis or Diverticulosis

Bowel surgery is sometimes done for diverticulitis or diverticulosis. These are conditions where out-pockets of the colon form. They form when you have constipation often or if you have it by heredity.

Diverticulosis means you just have the out-pockets in the colon but they are not infected or blocked. They are only removed by bowel surgery if there have been more than two episodes of diverticulitis in the past and doctors want to get rid of the entire crop of diverticuli.

If you have infection and abscess formation in the diverticuli, you have diverticulitis. This is a painful condition that can cause fever and bowel changes. Bowel surgery is necessary to remove the infected diverticulum and to clean out infection and abscess formation. The doctors may perform a partial colectomy at the same time and you may need a colostomy in severe cases.

Dealing with Bowel Surgery

Bowel surgery is not simple surgery. You will:

• Need to have your colon cleaned out before the surgery, if at all possible, so that stool does not get into the abdominal cavity.
• You will not be able to eat the night before surgery and sometimes even the entire day before surgery.
• After surgery, you will have enough pain so pain medication will be necessary.

Unfortunately, pain medication slows the function of the gut so that it takes awhile to have a bowel movement.

You must drink clear liquids after bowel surgery until the bowel begins to rumble. Then you can eat full liquids and finally regular surgical soft food. It takes four to seven days to recover enough to eat regular food after you have had bowel surgery. Fortunately, most people tolerate this just fine and eventually can gradually return to their normal lives.

Written by Christine Traxler

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