Bowel function after surgery

After rectal surgery, the way your bowel works may change. You may have more bowel motions than usual, have difficulty controlling when your bowels open or more wind than before. It may take a few weeks or months for these changes to settle. Tell your surgeon or nurse if you’re having problems. They may prescribe you medicines or suggest exercises you can do. These are called pelvic floor exercises and help strengthen muscles used for bowel control.

There are also things you can do to help yourself. Here are some tips:

  • Eat small meals at regular times of the day.
  • Drink plenty of water.
  • Try to relax and manage any stress you’re feeling.
  • Try to keep to a healthy weight.

If certain foods cause bowel problems, it’s best to avoid them. You can then start eating them again when your bowel function improves. If you keep having trouble finding things you can eat, ask to see a dietitian for advice.

Bowel changes

Most people have changes in how their bowel works after rectal surgery.

If you had a local resection, your bowel will usually recover quite quickly. After TME surgery, it will take longer. It could take several months for your bowel function to get into a regular pattern. It may never be the same as it was before the cancer. But in time, it should settle into a routine that you recognize as normal for you.

If you had radiotherapy or chemoradiation before or after rectal surgery, this will also affect your bowel. This could mean it takes longer to get back to a regular bowel habit.

After rectal surgery, you may experience one or more of the following changes:

  • needing to open your bowels several times a day (frequency)
  • feeling you can’t wait when you feel the need to open your bowels (urgency)
  • diarrhoea or constipation
  • losing control over when your bowels open (incontinence)
  • difficulty telling the difference between wind or stools
  • feeling bloated or passing a lot of wind
  • having a sore bottom.

These effects usually improve over time. Tell your surgeon or specialist nurse if you are having problems, or if your bowel isn’t settling into a routine. They can give you advice, prescribe medicines or refer you to a continence specialist nurse or dietitian.


Diet after bowel surgery

Eating at regular times helps to encourage a regular pattern for your bowel function. If your appetite isn’t good, it may be easier to eat several small meals a day, rather than one or two large meals. Drink at least 1–2 litres of fluid a day, especially if you have loose stools or diarrhoea.

Including high-protein foods such as fish, meat and eggs in your diet will help your body to heal after surgery.

It’s important to eat a wide range of different food types for a healthy, well-balanced diet. But, some foods may cause problems. Keeping a daily diary of what you eat and how this affects you can help.

If you have diarrhoea, choose low-fibre foods such as white bread and pasta instead of wholemeal. Eat fewer leafy green vegetables, cook vegetables well and peel fruit.

As your bowel settles, try to gradually reintroduce foods that caused you problems. You may find they no longer affect your bowel. If you continue to be limited in what you can eat, it’s definitely worth getting advice from a dietitian.

Wind

Some people have problems with excess wind or bloating after bowel surgery. Here are some tips:

  • Eat slowly and chew food well.
  • Be aware that beans, beer, chewing gum, fizzy drinks and onions can cause wind.
  • Peppermint capsules and oil, fennel and mint tea may help.

You may find our information on eating problems and cancer helpful.


Medicines

Your doctor or specialist nurse may recommend you take anti-diarrhoeal drugs. The most commonly used drug is loperamide (also called Imodium® or Diareze®). It slows down your bowel, making the stools more solid and less frequent.

Taking loperamide regularly, half an hour before meals, works well for some people. Loperamide is also available as asyrup, so you can adjust the dose as needed. It may take time to find the dose that works best for you. Your doctor may recommend you start with a low dose and increase this until it works for you.

It’s safe to take loperamide for as long as you need it, but you should discuss this with your doctor.


Managing stress

Your emotions can also affect your bowel. Anxiety and stressful situations can make bowel movements looser and more frequent. If you don’t feel in control of your bowel, this in itself can be stressful.

Learning how to relax may help your bowel to settle and will be good for your general health. Your doctor or specialist nurse can tell you about relaxation classes in your area. Some support groups also offer relaxation classes.


Pelvic floor exercises

There are exercises you can do to strengthen the muscles used for bowel control. There are two main groups of muscles that are important for bowel control: the sphincter muscles in the back passage (anus) and the pelvic floor muscles (also important for bladder control and sexual function).

Pelvic floor exercises may help if you have problems with leakage of wind or stool from your back passage. A colorectal or continence specialist can tell you if these exercises are likely to help you. They can teach you how to do them.

It can take at least 12 weeks of doing pelvic floor exercises three times a day to rebuild strength in these muscles. As your muscles improve, try doing the exercises while doing everyday jobs.


Keeping to a healthy weight

Being overweight puts pressure on your pelvic floor muscles. It’s especially important to keep to a healthy weight if you have bowel control problems. Your GP can advise you on what is a healthy weight for you.


Coping with ongoing bowel changes


Back to Surgery explained

What happens after surgery?

Your specialist nurse will help you recover after surgery and you’ll probably be ready to go home after 3–7 days.

If you have a stoma

Adjusting to a stoma takes time but most people manage well with support from their stoma care nurse.