Bowel function after surgery for rectal cancer

After surgery for bowel cancer, the way your bowel works may change. You may:

  • poo more than usual
  • have difficulty controlling when you poo
  • pass more wind than before
  • have a sore bottom.

It may take a few weeks or months for these changes to settle.

Tell your surgeon or nurse if you are having problems. They may give 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.
  • Avoid foods that cause problems until your bowel function improves.
  • Try to relax and manage any stress you are feeling.
  • Try to keep to a healthy weight.

If you keep having trouble finding things you can eat, ask to see a dietitian for advice.

Problems with bowel control can affect your confidence, but there are things you can do to cope. Some organisations have toilet cards that you can order. These may get you access to a toilet more quickly when you are out.

Bowel function after surgery

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 recognise 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 poo several times a day (more frequent)
  • feeling that you can’t wait when you need to poo (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 is not 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 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 one to two 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 is 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, you may want to get advice from a dietitian.

Treatment such as anti-diarrhoeal medicine may help you to manage your bowel symptoms better, which may allow you to eat a wider range of foods.

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 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.

I went through some funny times getting my body to accept foods. There were days when I was on the loo more than I’d want to be. And there would be other times when I was constipated. But it doesn’t stop me going out that day, getting on with my business and enjoying my life.

Anita


Anti-diarrhoea 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 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.


Coping with bowel changes

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.

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. 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.

Our information on managing weight gain after cancer treatment and healthy eating and cancer have more information.


Going out

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.

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.

Back to Surgery explained

If you have a stoma

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