You might need to have surgery to remove part of your bowel if it’s been affected by disease, such as bowel cancer or diverticular disease. You might also need to have an operation if you have inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis. The exact procedure you have will depend on what condition you have and how much of your bowel is affected.
An operation to remove part of your bowel is called a colectomy. Types of this kind of surgery include:
- total colectomy – an operation to remove all of your large bowel
- proctocolectomy – your surgeon will remove your large bowel and back passage (rectum )
- hemicolectomy – an operation to remove either the left or right side of your large bowel
- sigmoid colectomy – surgery to remove the part of your bowel that’s closest to your back passage
- proctectomy – an operation to remove your back passage
Your surgeon will talk with you about the most appropriate procedure for you.
Your care may not be quite as we describe here as it will be designed to meet your individual needs. But you’ll meet the surgeon carrying out your procedure beforehand to discuss what will be involved.
You’ll need to stay in hospital for between two and nine days if you have bowel surgery.
You may go to a pre-assessment clinic a few days before your operation for routine tests. Your surgeon will explain how to prepare for your operation. If you smoke, it’s highly likely that you’ll be asked to make a real effort to stop. This is because as well as the many other problems it can cause, smoking increases your risk of getting a chest and wound infection. This may mean it takes you longer to recover.
You may need to follow a special diet for a day or two before your operation and take laxatives on the day or the day before. Or you may need to have a bowel washout (enema). This involves having a liquid injected into your back passage (rectum) to flush out anything that is still in your bowel.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand exactly what will happen. You might find it helpful to prepare some questions to ask about the risks, benefits and alternatives to the procedure. This will help you to feel really well informed about what is going to happen so you can give your consent for it to go ahead. You’ll be asked to sign a consent form before the operation.
You’ll have bowel surgery under general anaesthesia. This means you’ll be asleep during your operation. An anaesthetic can make you sick so it’s important that you don’t eat or drink anything for six hours before your operation. Follow your anaesthetist or surgeon’s advice. If you have any questions, just ask.
You may need to wear compression stockings to keep your blood flowing in your legs. And you may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.
There are two main ways you can have bowel surgery.
- In keyhole (laparoscopic) surgery, your surgeon will make small cuts in your tummy (abdomen). They do the operation by putting small instruments and a tube-like telescopic camera through these. Images from the camera are shown on a monitor so your surgeon can see what they are doing. People often recover more quickly from this type of surgery.
- In open surgery, your surgeon will make a single, large cut into your tummy to reach your bowel.
Your surgeon will remove the diseased parts of your bowel and may join the two healthy ends together using stitches or staples. This is called an anastomosis.
It’s possible that your surgeon will bring the healthy ends of your bowel through your abdominal wall and onto the surface of your skin. This will make a stoma, which is an artificial opening on your tummy. This is where waste products will leave your body if the end of your bowel has to be removed. You’ll need to wear a bag over your stoma to collect the waste from your bowel.
Having a stoma can have a big effect on you. If your surgeon thinks it’s likely you’ll need a stoma, they’ll arrange for you to see a specialist stoma nurse before your operation. They will give you information about living with a stoma and can help you decide on the best position for the opening.
A stoma can either be temporary or permanent, depending on the type of surgery you have and how much bowel your surgeon removes. The type of surgery you have will also determine the size and shape of your stoma, as well as where it is. The procedure is called a colostomy if it involves your large bowel and an ileostomy if it’s done from your small bowel. To find out more about stomas, read our FAQ: How will a colostomy or ileostomy bag affect my life?
You might have some discomfort as the anaesthetic wears off. But you’ll be offered pain relief as you need it.
You may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes (a drain) running out from your tummy to drain fluid into another bag. These are usually removed after a few days.
You’ll have a drip inserted into a vein in your hand or arm to give you fluids. You can eat and drink again as soon as you feel able to. If you have any diarrhoea or constipation, your doctor or nurse will help you to deal with this.
To help prevent deep vein thrombosis (DVT), you’ll have a daily injection of an anti-clotting medicine (such as heparin). You’ll also need to wear compression stockings to help keep your blood flowing well. Try to get out of bed and move around as soon as possible. This will help prevent chest infections and blood clots forming in your legs.
You’ll be able to go home a few days after surgery but exactly when will be different for everyone. It’ll depend on what operation you had and how well you’re recovering. You’ll usually need to have gone to the toilet and be able to eat (even if it’s just a liquid diet) before you can leave. You will also need to be up and about and able to walk.
Before you go home, your nurse will give you some advice on how to care for your healing wounds and stoma, if you have one.
If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. To try to prevent constipation, make sure you drink enough fluid and don’t take painkillers that contain opiates (such as co-codamol).
You may be able to return to work anything from one to six weeks after your operation but follow your surgeon’s advice. Ask them about when you can get back to exercise, heavy lifting and driving too.
As with every procedure, there are some risks associated with bowel surgery. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. The possible side-effects of bowel surgery include:
- pain and discomfort in your tummy (abdomen)
- changes in your bowel movements, such as constipation or diarrhoea
Complications are when problems occur during or after your surgery. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing DVT.
Complications of bowel surgery include the following.
- Leaking of the new join in your bowel. This is known as an anastomatic leak and can cause pain in your tummy.
- An infection. Your wound may become swollen, red and tender to touch. Contact your hospital if you develop these symptoms.
- Bands of scar tissue (adhesions). These can develop after surgery and may cause your tissues or organs to stick together. If you have adhesions, you may have pain in your tummy; they can also block your bowel.
- Nerve damage. If nerves are damaged during surgery, this can lead to loss of sensation. This could affect your sex life or how well you can control your bladder.
- Temporary paralysis of your bowel. Sometimes your bowel may be slow to recover from the surgery and won’t contract as usual. This is known as an ileus and may cause you to feel bloated, be sick or have problems with your bowel movements. Your hospital team will give you fluids to help you recover.