When your doctor tells you that you need to have colon surgery, it's normal to feel a lot of fear and anxiety. When you hear a name like "proctocolectomy," it can seem even more complicated. But don't worry. This is a life-saving surgery that can help you live a better life by relieving your current symptoms. We'll talk about everything in a simple way that you can understand.
What exactly is Proctocolectomy?
Simply put, a proctocolectomy is the surgical removal of your colon and the last part of your rectum.
Let's explain this a little more. The large intestine is a long tube-like part of our digestive system. It has three main parts:
1. Colon: This is the largest part. It absorbs water from the waste products left over from the food we eat and turns them into a solid form, called stool.
2. Rectum (the last part of the anus): This is the short part after the colon. It is where stool is temporarily stored before it is expelled.
3. Anus: The opening through which feces exit the body.
So, in a proctocolectomy, both the colon and the rectum are removed, or part of them. "Procto" means the rectum. "Colectomy" means the removal of the colon.
Why do you need to have this kind of surgery?
There are several reasons why such a major surgery may be performed. The main reason is that the disease in the intestine prevents that part of the body from functioning properly or that the disease is life-threatening.
| Medical condition | A simple explanation |
|---|---|
| Inflammatory Bowel Diseases | If the inside of the intestine is continuously injured and inflamed due to conditions such as Ulcerative Colitis and Crohn's disease , surgery may be necessary if the condition cannot be controlled with medication. |
| Colorectal cancer and precancerous conditions | To stop the spread of colon cancer cells or in conditions such as Familial Adenomatous Polyposis (FAP) , which is a hereditary condition that causes hundreds of polyps that are more likely to turn cancerous. |
| Other reasons | Complications such as death of intestinal tissue due to loss of blood supply (ischemia), severe constipation, severe injuries to the intestine, or diverticulitis . |
How do you defecate after surgery?
This is the biggest question that many people have. When the colon and rectum are removed, the normal path for stool to pass out is lost. How do you then defecate? The answer to this depends on the type of proctocolectomy you have. Your doctor will determine the most appropriate method based on your medical condition.
There are several main methods:
1. Ileostomy procedure
This involves connecting the last part of your small intestine, called the ileum, to a small opening (stoma) made in the skin of your abdomen. An ostomy bag is then attached to the opening to collect stool. This can be permanent or temporary . Temporary is only done until your body heals. This can be changed later with another surgery.
2. Ileoanal Pouch (creation of an internal pouch)
This is a very interesting procedure. It is also called a Restorative Proctocolectomy. A part of your small intestine (ileum) is taken and a small pouch is created from it. Think of it as a new part of your body that can temporarily hold your stool, just like your rectum. Then, the pouch is reconnected to your anus. After this procedure, you will be able to go to the toilet and defecate normally after a while. The most common procedure for this is called a J-pouch .
3. Subtotal Proctocolectomy (sparing a portion)
In this, a portion of the large intestine is left behind. If it is possible to do so, the remaining part of the intestine can be reconnected to the anus or the rest of the rectum (anastomosis). However, sometimes, a temporary opening in the abdomen may need to be made and a stool bag (colostomy) inserted until the connection site heals.
The most important thing is that your doctor will discuss with you which of these methods is best for you. So, discuss any questions or concerns you have with your doctor.
What happens before, during, and after surgery
Before surgery
If it's not an emergency surgery, you'll have time to prepare.
- A few weeks before: Your doctor will explain the surgery to you, its risks, and your options.
- Two weeks before: If you are taking blood thinners, you will be told to stop or reduce them. You will be advised to eat a high-fiber diet and drink plenty of water.
- 24 hours before: You will be given a bowel prep to completely clean your intestines. You will also be told to eat only liquids for the day. You may also be given antibiotics to prevent infection after surgery.
During surgery
You will be put to sleep under anesthesia, so you won't feel anything. The surgery can be done in two main ways:
- Open Surgery: The traditional method, performed through a large incision in the abdomen.
- Laparoscopic Surgery: Also known as "keyhole" surgery, this is done by making a few small incisions in the abdomen and inserting a camera and delicate instruments through them. This method results in faster recovery and less pain.
The surgeon then carefully removes the diseased part of the intestine and performs the necessary procedures (ileostomy, pouch, or re-connection) as discussed earlier.
After surgery
You will need to stay in the hospital for about a week. During this time, you will be gradually transitioned from liquid to solid foods. If you have an ostomy (bag), a specially trained nurse (WOCN - Wound Ostomy Continence Nurse) will teach you how to use it and keep your skin clean.
What are the possible complications?
As with any surgery, there are some risks and complications that can occur, but most of the time these are temporary.
| Type of complication | Description |
|---|---|
| Common complications of surgery | Reactions to anesthesia, internal bleeding, infections, intestinal obstruction, etc. |
| Complications related to ostomy (bag) | Skin infections around the stoma, the stoma sinking in or protruding out. A condition called phantom rectum can also occur. This is when you feel like you need to defecate even though your rectum is removed. This will decrease over time. |
| Complications related to the Ileoanal Pouch (internal pouch) | Pouchitis , anastomotic leak, and early fecal incontinence. Many of these are treatable. |
What are the emergencies that require seeing a doctor?
If you experience any of the following symptoms after your surgery, call your doctor immediately or go to the hospital's Emergency Department (ETU) .
- Bloating, stomach pain, nausea, and constipation (these may be signs of intestinal obstruction).
- Severe abdominal pain, fever, pus draining from the incision (these are signs of infection).
Don't forget, if you feel anything unusual, don't ignore it. It's safest to seek medical advice.
Take-Home Message
- Although a proctocolectomy is a major surgery, it can cure life-threatening conditions and allow you to live a more comfortable life.
- There are different ways to defecate after surgery. Some people have to live with an ostomy bag, while others have other options that allow them to defecate normally. Your doctor will decide what is best for you.
- It takes time to heal. You can return to normal life in a few months. It is very important to be patient and follow your doctor's instructions during this time.
- Feel free to discuss all your fears, doubts, and questions with your doctor. It will give you great mental strength.
- Although living with an ostomy bag can be a challenge at first, once you get used to it, you can continue to function normally. There are many devices and methods available today to help with this.
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