Rectal Bowel Resections
LAR: Low Anterior Resection
Proctectomy with Colo-anal Anastomosis
Proctectomy with Colonic J Pouch
The rectum is the lower part of your large intestine where your body stores stool. The anus is the opening of the rectum through which stool passes out of your body. These surgeries will remove all or part of your rectum.
Low anterior resection: Only the part of the rectum with the tumor is removed with no effect on the anus. Part of your rectum may remain and the colon is attached to it. Your bowels will move in the usual way. If you had chemo or radiation before surgery, you may have a (temporary) ostomy while the bowel heals. If a very low resection is required in order to get beyond the tumor, then one of the following types of re-connections may be done.
Proctectomy with colo-anal anastomosis. The rectum is removed and the colon is attached to the anal canal. Urgency with bowel movements is common.
Proctectomy with Colonic J Pouch. The rectum is removed and a small pouch is created inside of you. The pouch is made out of a part of your colon. This small pouch inside you slows down stool as it moves thru. You will have less frequency with bowel movements than with the colo-anal anastomosis in the first 1-2 years after surgery. You may have a temporary ostomy while the bowel heals. A second operation closes the ostomy.
Abdominoperineal Resection: All of the rectum and anus (including the anal muscles) are removed. This is done in cases where the tumor is located in a very low location. In this case, a permanent colostomy is required where the colon is brought up to the skin on the left side of the abdomen.
Getting Ready for Surgery
You will begin bowel prep two days before surgery. We will talk to you about the details. If you smoke, you need to quit. Smoking delays wound healing. We can help you with your efforts to quit smoking.
After Surgery
Pain
Expect to have pain after surgery. You will have pain pills to help ease the pain.
Wound Care
Your incisions are easy to care for. You may be able to shower 3 days after surgery.
Check daily for signs of infection.
- Increasing redness or warmth
- Pus-like drainage
- Excess bleeding
- Excess swelling
- Temperature by mouth above 100.4°F, for two readings taken 4 hours apart
- Pain not controlled by your pain pills
Diet
The time it takes for the bowel to start working again varies. It may take from 2-3 days or even up to a week. You will start on clear liquids and advance to a regular diet with low fiber. If you have an ostomy, you will follow an ostomy diet. At your first follow-up visit with your doctor, we will adjust your diet.
Bowel Movements
Expect to have frequent loose bowel movements after surgery. You will need to wear a special cream on your skin to protect it. These will persist for a variable amount of time. They may require changes to your diet or adding fiber to bulk the stool and slow it down.
If you have an ostomy, care will be discussed with you in detail. We want you to be comfortable and confident with this care at home. A home health nurse may see you at home to help you with your ostomy care if needed.
Activity
- You will be walking with help soon after surgery.
- Plan to take 4 walks a day, this helps you regain your strength.
- Nothing more strenuous than walking until it is okayed by your doctor.
- No driving on narcotic pain pills.
- You will have a lifting restriction, we will discuss the details with you.
- Avoid all tobacco products including second hand smoke.
What to Watch for After Surgery
Dehydration can occur if your stool output is greater than what you eat or drink. You must drink extra water and fluids (8 to10 eight-ounce glasses) for the first few weeks. Call your doctor if you have:
- Increased thirst
- Dry mouth and skin
- Weight loss of more than 3 pounds overnight
- Fatigue
- Feel dizzy when you stand up
A Bowel Obstruction is a blockage. This can be caused by food, scar tissue, hernia or a twisted or kinked bowel. You may need surgery if it is a complete blockage. A partial blockage is treated by resting the bowel until it opens. Call you doctor if you have:
- Tender and bloated stomach
- Cramping
- Nausea or vomiting
- Temperature of 99º F by mouth or higher
- Unable to pass gas or stool
- Decreased or no ostomy output
Follow Up
2 weeks after surgery you will see your doctor. You may have a rectal exam at this visit. We will assess your diet, stool output and make changes as needed. Bring your list of questions.
6-8 weeks after surgery, if you have an ostomy, you will have a barium enema to check healing. This test helps us to decide when you may be ready for the ostomy ‘takedown’ or closure. If you will have chemotherapy after surgery you will keep the ostomy until after your treatment is completed.
When to Call the Doctor
- Incision(s) are more red or warm to touch
- Pus-like drainage
- Excess swelling or bleeding
- Temperature (by mouth) above 100.4º F for 2 readings taken 4 hours apart
- Pain not controlled with pain pills
- Bloating
- Nausea or vomiting
- Constipation
- Dehydration
- Skin problems
Phone Numbers
Digestive Health Center: (608) 890-5000.
After hours, weekends or holidays this number will be answered by the paging operator. Ask for the doctor on call or ask for Dr. Harms, Heise, Kennedy, or Foley. Leave your name and phone number with area code. The doctor will call you back.
If you live out of the area, call (800) 342-9900
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 04/24/2013
Copyright © 11/16/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7120
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