Hi all
You may remember that I started this post Part 1 - waiting for reversal - I need to know at the end of September and now have this for you, Part 2 - the FAQs of having a stoma reversal and hope you will find it of interest and of help pre and post reversal.
Before I list the FAQs it only right that I thank the many stoma care specialist nurses that I am associated with for looking this over for accuracy also all my contacts involved in the manufacturing and supply of stoma products and to the Cancer Research, Bowel and Bladder UK and Chrohns and Colitis UK, the United Ostomy Associations of America and our own NHS for their helpful articles that helped me double check all the FAQs and not forgetting for suggesting a few of her personal "things to know" that she requested be included
FREQUENTLY ASKED QUESTIONS -
STOMA REVERSAL
Q. What is a stoma reversal?
A. Stoma reversal surgery involves rejoining the piece of bowel that is your stoma with either your colon or your small bowel and then closing the stoma site. Both a colostomy reversal and an ileostomy reversal are performed in the same manner.
Q. Is there an Alternative to surgery.
A. The alternative to this surgery is not having the stoma reversed and keeping the stoma. Around 1 in 12 patients who have had a planned temporary stoma for cancer of the rectum will keep a permanent stoma.
Q. What happens during a stoma reversal?
A.The stoma is cut away and the remaining parts of the colon/bowel are are attached by stitching together and placed back into your abdomen.
Q. I have a loop COLOSTOMY, can I have a reversal?
A. Yes, Reversing a loop colostomy is a relatively straightforward process
A cut (incision) is made around the stoma so the surgeon can access the inside of your abdomen.
The upper section of your colon is then reattached to the remaining section of your colon.
Q. I have an end COLOSTOMY can I have a reversal?
A. Yes, An end colostomy can be reversed, but involves making a larger incision so the surgeon can locate and reattach the two sections of colon.
It also takes longer to recover from this type of surgery and there's a greater risk of complications.
Q. I have a loop ILEOSTOMY , colostomy can I have a reversal?
A. Yes, Reversing a loop ileostomy is a relatively straightforward procedure that's carried out under general anaesthetic. A cut (incision) is made around the stoma and the section of small intestine is pulled out of the tummy (abdomen).
Q. I have an end ILEOSTOMY can I have a reversal?
A. If most of the large intestine (colon) has been sealed and left inside the abdomen, It's sometimes possible to reverse an end ileostomy
The area that had been divided to form the stoma is then stitched back together and placed back inside the abdomen
Q. I have a urostomy can I have a reversal?
A. No, As a urostomy is a surgical procedure which diverts the normal flow of urine from the kidneys and ureters into a specially created stoma the urine will continue to pass through the stoma, completely bypassing the bladder. The bladder may or may not be removed.
A urostomy is permanent.
Q. How long will I have to wait for my colostomy reversal?
A. A colostomy reversal will only be carried out when you're in good health and have fully recovered from the effects of the initial operation. This will usually be at least 12 weeks after the initial colostomy surgery.
The reversal may need to be delayed for longer if you need further treatment, such as chemotherapy, or you haven't recovered from the original operation.
But there's no time limit for having a reversal, and some people live with their colostomy for several years before it's reversed.
Q. How long will I have to wait for my ileostomy reversal?
A. The reversal operation will only be carried out when you're in good health and fully recovered from the effects of the original ileostomy operation.
This will usually be several weeks or months after the initial surgery, or sometimes even longer.
There's no time limit for having an ileostomy reversed, and some people may live with one for several years before it's reversed.
Q. How is a loop Colostomy reversal carried out.
A. Reversing a loop colostomy is a relatively straightforward process. A cut (incision) is made around the stoma so the surgeon can access the inside of your abdomen.
The upper section of your colon is then reattached to the remaining section of your colon.
Q. How is an End Colostomy reversal carried out.
A. It is carried out in the same way as a loop colostomy except that it involves the surgeon making a larger incision he can locate and reattach the two sections of colon.
It also takes longer to recover from this type of surgery and there's a greater risk of complications.
Q. How is a loop Ileostomy reversal carried out.
A. Reversing a loop ileostomy is a relatively straightforward procedure that's carried out under general anaesthetic.
A cut (incision) is made around the stoma and the section of small intestine is pulled out of the tummy (abdomen).
The area that had been divided to form the stoma is then stitched back together and placed back inside the abdomen.
Q. How is an End Ileostomy reversal carried out.
A. If most of the large intestine (colon) has been sealed and left inside the abdomen, it is possible to reverse an end ileostomy.
The surgeon will need to make a larger incision to locate and reattach the small and large intestines.
It therefore takes longer to recover from this type of surgery, and there's a greater risk of complications.
Q. How long will I be in hospital after my reversal?
A. If your hospital has an Enhanced Recovery programme where you could be discharged the day after your operation, As long as you are tolerating fluids and a light diet, are mobile, have passed urine and are reasonably comfortable on pain killing tablets then you can go home. The doctors may decide to keep you in longer if they think it necessary.
Q. Recovering from a colostomy and ileostomy reversal surgery.
A. It's likely to take some time before your bowel movements return to normal. Some people have constipation or diarrhoea, but this usually gets better with time.
If necessary, your GP can prescribe medication to relieve diarrhoea until things improve.
You may have a sore bottom after the reversal, but this should improve as you get used to passing stools through your anus again.
After every bowel movement, it may help if you:
Other possible problems include
The reversal operation is usually a smaller procedure than the initial colostomy/ileostomy procedure, but it still takes several weeks to fully recover.
Your bowel activity may never return to the way it was before you had the operation.
Q. Will I have any tests/examinations before the reversals.
A. A stoma reversal will only be offered if your surgeon is confident that you can regain enough bowel control following surgery.
You may have some tests before your surgery to check that your bowel has healed sufficiently and that your anal sphincter muscles are in good working order, including:
Q. What to eat after a colostomy/ileostomy reversal.
A. Once you are home you should gradually build up to a normal diet
Your digestive system may be sensitive after a stoma reversal. The main advice is to eat little and often until your appetite returns to normal and you feel able to return to a healthy balanced diet.
Certain foods are also more likely to irritate the gut.
Foods that contain fibre will be hard for your bowel to digest initially.
It may help to limit or avoid:
Q. Will I experience any Complications following reversal of my stoma.
A. Possible complications following surgery
As with any surgery, the operation to close your stoma has some risks which you need to be aware of. Your surgical team will take all possible steps to prevent them from happening.
General complications that can happen after surgery include:
move through the bloodstream and into the lungs causing a pulmonary embolism (PE). Whilst you are in hospital you will have an anti clotting injection daily and support socks to prevent this happening.
A hernia occurs when the bowel protrudes through the muscles of your abdomen causing a bulge beneath the skin. The hernia may reduce or increase in size when lying, sitting, or standing. Hernias occur at sites of potential weakness (the stoma reversal site or at the scar of the first operation). The risk of a hernia formation is small but is more likely in frail, older and overweight patients. It's also seen more frequently in those who have strained their bodies or have undertaken too much exercise in the first few weeks following surgery. Management includes supporting your hernia with a belt or binder. This helps with decreasing the protrusion and assists in maintaining a good posture. Most hernias appear over subsequent months, generally developing within the first two postoperative years. Surgical repair may be necessary.
Q. What are Pelvic Floor Exercises
A.Both men and women will benefit from Pelvic Floor Exercises
(click on the green text to open)
Q. Should I have a standby bag (grab and go) made up and what should I have in it?
A. It would be a good idea to have one or two handy in a place that you can easily put your hands on them. If you work have one at your workplace.
Remember you can still use disabled toilets with your NKS RADAR key, you should still carry your CAN'T WAIT TOILET CARD.
You can use any suitable bag that should contain pads, spare underwear, dry/moist (not perfumed) preferably biodegradable that can flushed wipes or Waterwipes sensitive baby wipes (not flushable), barrier cream, poo bags to put any soiled clothing in.
Q. When can I resume driving?
A. You can drive as soon as you are able to concentrate fully and can make an emergency stop without discomfort in your abdomen. A minimum of two weeks is suggested however it is advisable to check with your own insurance policy as some insurance companies state that you will not be covered for six weeks after any abdominal surgery.
Q. When I can I return to work?
A. You can return to work when you feel ready to. However you may be surprised at how tired you feel after this operation, so it is advisable to consider returning to work on a part-time basis for a few weeks. If you have a physically demanding job or involves heavy lifting, it is preferable not to consider going back to work for six weeks, and to request lighter duties if possible. This will initially allow you to build up your stamina and strength for normal duties.
Q. Caring for yourself at home?
A. Having had surgery on your abdomen, you are advised not to lift for the first six weeks. It is important that you do not do any heavy lifting (no heavier than a half-filled kettle) for at least two weeks following the operation, and build up gradually. The concern is that if you put too much stress on your abdominal muscles, you may cause a permanent weakness, which may lead to a hernia in the old stoma site.
Q. Coping with bowel problems when I get home?
A. Your bowel habits may be erratic for some time following surgery. You may experience
Following your stoma reversal there are some things you can do to help control your symptoms and regain your bowel control following stoma surgery.
After each bowel movement.
Q. What should I do if I have an urgent feeling of needing the toilet?
A. The obvious reaction is to make a dash to the nearest toilet and hope that you can make it without having an accident en route. Nurses recommend that you stay put and control the feeling with your sphincter muscles until the urge passes then go to the toilet. (See doing you Pelvic Floor Exercises)
Q. Are there any risks and side effects of stoma reversal surgery.
A. All surgeries carry a degree of risk. Below are some side effects and risks that are associated with a stoma reversal. Your surgeon should explain any potential complications in detail with you during your pre-assessment.
Q. When can I resume sexual intimacy
A. The anxiety and all the stress your body has been through with this operation often reduces your sex drive. This is quite normal and in time it should return. It is important that you and your partner share time talking about your feelings, being close and enjoy being intimate without necessarily having penetrative sex. Once your body feels fitter and more relaxed, you may feel more confident resuming your usual sexual activity again. If you do experience any problems in having sex with your partner, please do discuss this with your doctor.
Q. What can I do with any supplies that I have left.
A. As hospitals and supply companies are unable to take supplies of pouches back you can send them to;
full postal address;
Jacob’s Well Appeal
Jacob’s Well Yard
Swinemoor Lane
Beverley
HU17 0JX
Telephone 01482 881162
email; office@jacobswellappeal.org
full postal address
Hospices of Hope
11 High Street
Otford
Kent
TN14 5PG
UK
Telephone: 01959 525110
Send small parcels of supplies to the above address indicating that the parcel contains medical supplies.
You can find a list of the nearest drop point to you here: https://droppoint.org/hospices-of-hope
Note Scottish shops DO NOT accept medical supplies
That's my take on the subject, if you want to have something included that helped you in your recovery let me know and I'll add it to the list.
Hopefully it will be of help to many in the future.
Ian
The BODACH October 2019
