Constant diarrhoea and nausea

Hi Curls and a warm welcome to the forum.

Pleased to see you’re through your surgery and are back at home and I hope things have settled a little more in the last few days.

It is still very early days at the moment and bowels are notoriously unhappy after being handled. It is likely to take a while to settle down and for you to find your new normal, but meantime I know how exhausting and demoralising.

There are a few things for you to be aware of as you’ve had a right hemicolectomy and quite often these are not flagged up by the medical team.

One of the jobs of your colon is to absorb excess liquid so the stool becomes more solid. As your colon is shortened due to the surgery, there won’t be as much colon to absorb the excess liquid hence watery stools and diarrhoea. Also, the transit time through your colon is shortened which means less time for salts and nutrients to be absorbed; this is one of the reasons ‘Dioralyte’ has been recommended.

People who have had a right hemicolectomy have a higher chance of Bile Acid Malabsorption (BAM). This is due to the terminal ileum being resected where bile acids (which help with the digestion of fat) are reabsorbed before entering the large bowel. As they can’t (or not as much can) be reabsorbed, this leads to more entering the large bowel where it becomes an irritant causing frequent bowel movements, loose or liquid stools, faecal urgency, faecal incontinence and nocturnal defaecation.

*BAM is a lifelong condition but it can be treated with bile acid sequestrants (which bind bile acids) and by following a low fat diet.

Another complication due to ileal resection is the chance of Small Intestine Bacterial Overgrowth (SIBO) which can cause your symptoms.

Both BAM and SIBO can lead to deficiencies in vitamins or minerals.

It is often suggested that your diet after colon surgery is ‘beige’, foods that can easily be digested and absorbed, typically lower fibre and often higher in fat and this can cause issues if you have BAM*.

I would strongly suggest keeping a detailed food diary (I know it’s a bore) but is really helpful in helping you to pinpoint what food/s in your diet might be upsetting your digestion.

I’d also recommend reading this thread in case you do have BAM – I sincerely hope you don’t.
https://community.macmillan.org.uk/cancer_types/bowel-colon-rectum-cancer-forum/f/general/309619/a-call-to-arms-about-diarrhoea-and-incontinence-after-right-hemicolectomy-and-bile-acid-malabsorption 

Please let us know how you are getting on.

Very best wishes,

Net77 x

Some good advice above. I had a left (not right) hemicolectomy in March and didn't feel great for a few weeks after I left hospital. The diarrhoea was so prolific that I temporarily wore incontinence pants for a while just to give me confidence when leaving the house. I remember when leaving the hospital I (exaggeratingly) joked that I could row myself home on my sea of diarrhoea!! I also felt nausea with regard to eating and was so weak - it was a difficult time.

BUT the good news is that it all settled down in a few weeks and now I feel so much better than before and am eternally grateful to my surgeon for saving me (emergency surgery) and allowing me to enjoy life again. I feel normal now though am still going through chemo, so am getting a few minor side effects.

Hopefully it will settle down for you. All the best.

Hi Curls

I am 5 weeks post right hemicolectomy and have suffered with constipation for the last 3 weeks which then turned to diarrhoea. I have been on a cocktail of Lactulose and Movicol. The only advice I can give to sort out the diarrhoea is to eat a very bland diet, toast, biscuits, mash potatoes, chicken and gravy, yoghurt, no fruit or veg,  for a few days to slow things down. Once your bowels settle then you should be able to sleep better and feel better. 

Hi sorry to hear your having troubles after your op. This happens to lots of people, please look for my blog on here called a call to arms bile malabsorption it might help.