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Life After Surgery: Part I

Ileal J-Pouch anal anastomosis surgery eliminates the need for a permanent ostomy and the concern of many people about their body image. Not surprisingly, satisfaction with this procedure has been high. However, it will take time, patience—as well as trial and error—to adjust to this lifestyle change.

In the following article, we will talk about what you may expect after the ileostomy has been reversed.

Anal/Pouch Bleeding
Don't be afraid if you experience a small amount of bleeding around the anal area. This is normal and is usually caused by irritation at the suture line (your stitches).

Diarrhea
The frequency and consistency of bowel movements varies from patient to patient. Usually the first bowel movement occurs two to three days after the operation. To ease the discomfort from your incision, press a pillow against your abdomen.

What You Should Do
After you go home, it is important that you continue to exercise your anal muscles. You also should begin to try to hold back your bowel movement a bit to stretch the pouch.

Remember: The stronger the muscle, as the pouch stretches, the better control you will have.

Bowel Frequency & Urgency
After surgery, when stools begin to fill the J-pouch, you can expect to feel urgency and frequency. It is not uncommon to have 10 to 20 bowel movements in a 24-hour period before you have started to eat solid food and are started on constipating medication.

When you go home and begin to eat a more normal diet, the bowel movements will thicken and decrease in volume. You may feel discouraged at the number of bowel movements you have during the day. You may even have to get up more than once a night.

Over time, the number of bowel movements will decrease. There also are steps you can take to help slow the frequency.

What You Should Do

  • Call your doctor if you have more than six to seven stools a day. He or she will prescribe medication to help decrease the diarrhea and increase the bulk.
  • Thin or watery stools are difficult to hold. Bulking agents (i.e., Citrucel), antidiarrheal medicines (i.e., Imodium, Lomotil, codeine), and change in diet—eating binding foods such as rice—can often resolve this.

Incontinence
It is normal to have some incontinence and/or leakage. Over time, this will resolve as the pouch stretches.

Nighttime incontinence is the most common, and you should be prepared for this. If you need added protection, pressed cotton makeup removal pads are the most absorbent. Place one of these in front of the anal area. Be sure to change the pad each time you urinate or have a bowel movement.

You may find that it is difficult to tell the difference between gas and stool. This can be a frustrating experience. Be patient with yourself, you will gradually learn to tell the difference again.

Remember: It is not uncommon for it to take about six to eight months to be able to tell the difference between gas and stool.

Skin Care
It is very important to keep the anal area free from irritation and itching. An irritated anal area is more likely to send confusing signals and trigger more incontinence.

What You Should Do

  • Examine your skin and notify your surgeon's office if you see any rashes.
  • Do not wipe the anal area with harsh toilet paper. Instead, use baby wipes, which are more suited for delicate skin.
  • Be sure to rinse the anal area with warm water and pat dry. Early on, in some cases, using a hair drier on a low setting is the least irritating way to dry the area after bathing.
  • Wearing cotton underwear will allow air to get to the area so that your skin will not get too moist.
  • Your surgeon may recommend some soothing ointments. There are many products that might be helpful (i.e., Calmoseptine or Criticaid).

Remember: Continue to follow this skin care routine for two to three months after surgery—by which time the number of bowel movements should have decreased.

Everyone who has had this procedure should be sure to carefully follow the advice of your surgeon and nurse. Don't be shy to ask for help when you need it. If you have any questions, your healthcare team is just a phone call away.

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