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Friday, August 1, 2014
Following removal of part of the colon
My father was found to have Cancer of the colon. To get rid of it they cut out a large section of his colon/rectum and he had a colostomy bag for a while. However it was then considered that enough of the bowel was left for the operation to be reversed and the bag was removed. However since then he has been virtually incontinent. He passes large amounts of gas and has little control over the expolsion of fecaes, and has to get out of bed several times a night for trips to the bathroom. Is there anything diet wise which could help this situation? He has some medication which he takes to try and control the incontinance but this makes him plunge from the continual passing of feces one day, to constipation the next. There is never a happy medium and it has completely ruined his quality of life. He is in his 70s. Any advice would be greatly appreciated. Many thanks
There are many factors that must work together for a patient to achieve continence.
- First, the patient must be alert and able to sense rectal distension.
- Second, the rectum must be compliant, and be able to stretch to accommodate a stool bolus.
- Third, the stool should be bulky.
- Fourth, the sphincter muscle should be intact and functional.
If your father had the majority of his rectum removed, he will have difficulty with the "reservoir" function of the rectum, since the majority of the reservoir has been removed. If he had post-op radiation, the compliance, or ability of the reservoir to stretch, will be severely limited. As we age, all of our muscles become weaker, including the anal sphincter. All of these factors combined may be hindering his ability to be continent. A daily bowel regimen may improve upon things, but will take a great deal of perseverance and patience.
Consider consulting a colorectal surgeon to see if they have a wound/ostomy/continence nurse in the office who can offer you advice. It may mean a combination of bulk-forming agents, anti-diarrheal agents, and possibly even daily enemas.
Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati