Most people have changes in how their bowel works after treatment for bowel cancer.
You may have one or more of the following changes:
- needing to poo several times a day (more frequent)
- feeling that you can’t wait when you need to poo (urgency)
- diarrhoea or constipation
- feeling bloated or passing a lot of wind
- having a sore bottom.
If you have had rectal surgery, other effects may include:
- losing control over when your bowels open (incontinence)
- difficulty telling the difference between wind or stools.
These effects usually improve over time. Tell your surgeon or specialist nurse if you are having problems, or if your bowel is not settling into a routine. They can give you advice, prescribe medicines or refer you to a continence specialist nurse or dietitian.
After a local resection
If you had a local resection, your bowel will usually recover quite quickly.
After surgery to remove more of the bowel
The bowel will take longer to recover after a larger operation, such as
- TME surgery
- removing all or part of the colon (colectomy)
- abdominal-perineal resection for anal or rectal cancer.
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 recognise as normal for you.
If you had radiotherapy to the pelvis or chemoradiation, this will also affect your bowel. It can take time to adapt to changes in your bowel habit.
After surgery, you may notice certain foods upset your bowel. High-fibre foods, such as fruit and vegetables, may make your stools loose and make you go to the toilet more often. Tell your doctor or nurse if this happens, as they can give you medicine to help.
It sometimes takes months for bowel movements to get back to normal. Some people may find their bowel is permanently more active than it was before. They may have to eat carefully to control their bowel movements. Your stoma nurse will give you advice about this.
There are things you can do to help you cope with changes to your bowel function:
Eating at regular times to encourage regular bowel function
If you have a poor appetite, it may be easier to eat several small meals a day, rather than one or two large meals. Drink at least 1 to 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
This will help your body to heal after surgery. But you should still try to eat a wide range of different food types for a healthy, well-balanced diet.
Keeping a diary of what you eat and how it affects you
Keeping a daily diary can help you remember which foods are causing you problems. This means you are aware of what to avoid in your diet. As your bowel settles, try to gradually reintroduce foods that caused you problems.You may find they no longer affect your bowel.
Choosing specific foods that can help with diarrhoea
You should choose low-fibre foods such as white bread and pasta instead of wholemeal. Eat fewer leafy green vegetables, cook vegetables well and peel fruit.
Finding treatments that help you to manage bowel symptoms
This might include things like as anti-diarrhoea medicine. Having these treatments may allow you to eat a wider range of foods.
If you continue to be limited in what you can eat, you may want to get advice from a dietitian.
Your doctor or specialist nurse may recommend you take anti-diarrhoea 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 a syrup, 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 is safe to take loperamide for as long as you need it, but you should discuss this with your doctor.
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 or oil, and fennel or mint tea may help.
Our information about eating problems and cancer has more about common eating difficulties after cancer. It explains why they happen and offers some practical tips for managing them.
It may take time for your bowel function to settle. In the meantime, there are things that can help you feel more confident and in control.
Protect your skin
If you poo frequently or it is loose after surgery, the skin around your bottom may become sore. These tips may help:
- Keep the skin around your back passage clean and dry.
- Use unperfumed wet wipes, as they are softer on your skin than toilet paper.
- Use absorbent pads and barrier creams (such as Cavilon® or Sudocrem®) to help protect your skin.
- Wear cotton underwear, which allows your skin to breathe.
Your emotions can affect your bowel. Anxiety and stressful situations can make poo 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 is 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. Pelvic floor muscles are 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 is especially important to keep to a healthy weight if you have bowel control problems. Your GP can advise you on what a healthy weight is for you.
If your bowel habit isn’t predictable, you may feel worried about going out, especially to somewhere new. Planning ahead so that you are prepared can help you feel more confident.
Finding a toilet in a hurry
Carrying a Just Can’t Wait card may help you to get access to a toilet more quickly when you are out. It states that the card holder has a medical condition that requires urgent access to a toilet. You can get a card from the Bladder and Bowel Community.
You can use disabled toilets too. These often offer more privacy, have a wash basin and more space if you need to change.
The National Key Scheme offers people with a disability access to about 9,000 locked public toilets across the UK. You can buy a key from Disability Rights UK. They can also send you details of where the toilets are.
Macmillan also has a toilet card for people who have problems with bowel or bladder control. It gives you urgent access to a toilet when out in public. You can get one by phoning our support line on 0808 808 00 00 or you can order one at be.macmillan.org.uk
Carry a bag with supplies
Pack a bag with things you may need when you go out. This will make you feel more confident and help you to cope if an accident happens.
You may want to include:
- wet wipes
- barrier cream, such as Cavilon® or Sudocrem®
- loperamide (anti-diarrhoea tablets), if you have bowel control problems
- pads and spare underwear
- stoma supplies if you have a stoma
- a change of clothing
- a sealable bag.