An ostomy reversal is an operation to reverse an existing colostomy or ileostomy. You might have an ostomy if you’re recovering from an injury or disease in your bowel that prevented you from using it normally. After your bowel has recovered, you might be a candidate for ostomy reversal surgery.After colostomy reversal surgery, your body needs time to heal and adjust to the return of typical bowel function.Colostomy reversal surgery requires more care and attention in comparison with colostomy surgery. since your colon is connected and is functional it is therefore crucial to give proper attention to the diet you are going to consume. For instance, consuming any food that is hard to digest will worsen the condition.That is why the right diet is necessary as it will not only help in healing but also promote bowel functionality. Eating appropriate foods can help prevent complications such as infections, bowel obstructions, and nutritional deficiencies. Moreover, a well-planned diet can reduce the chances of common post-surgery symptoms like diarrhea, constipation, and bloating, making your recovery more comfortable.
Understanding Colostomy and its Reversal
When a colostomy is created, part of the colon is brought through the abdominal wall to form an opening on the belly called a stoma. This is often done to let the bowel heal after illness or surgery. Once healing has taken place, the colostomy can sometimes be reversed.
A colostomy is a surgical procedure that involves creating an opening in the abdominal wall through which a portion of the colon (large intestine) is brought to the surface of the skin. This opening is called a stoma. The end of the colon is then attached to the stoma, allowing waste (feces) to leave the body through this new opening rather than through the rectum and anus. Colostomy can be temporary and permanent. temporary colostomy is performed when the colon is infected and healing time is required by the colon. Whereas permanent colostomy is performed when part of colon is removed completely.
Colostomy reversal, also known as colostomy takedown or colostomy closure, is a surgical procedure designed to reverse a temporary colostomy. During this surgery, the section of the intestine that was brought outside the abdomen is brought inside the abdomen and is connected back to the rest of the intestine. Colostomy reversal surgery is performed in temporary colostomy where purpose of stoma formation is to give healing time to colon. conditions such as diverticulitis, Crohn’s disease and colorectal cancer requires temporary colostomy.
Who is Eligible for Stoma Reversal?
You can be considered for a stoma reversal if you have enough rectum left intact (unless you are having J Pouch surgery in which, a new rectal reservoir will be created from your small bowel), have good anal sphincter muscle control, don’t have any active disease in your bowel or rectum and are generally in good health to get through the surgery. The timing of you reversal will be carefully considered, you won’t be able to undergo the surgery if you are receiving chemotherapy. The optimum time for reversal is between 3 and 12 months following stoma surgery. This is to ensure that you still have good muscle tone and that you bowel is in a good healthy state for surgery.
Read also: Eating After Ileostomy Reversal
Types of Colostomy Reversal Surgery
There are two main types of colostomy reversal surgery.
- Loop colostomy reversal. A loop colostomy brings a loop of bowel with two openings to the skin surface. Reversal of a loop colostomy, often called a stomal closure, is usually straightforward since both ends of the bowel are already close together. The surgeon detaches the loop from the abdominal wall and reconnects the bowel before returning it inside.
- End colostomy reversal. An end colostomy has only one opening. The other end of the colon or rectum is closed inside the abdomen. This end is called the colon stump or rectal stump. Reversal of an end colostomy is often called a stoma takedown or Hartmann reversal. This procedure is more complex than a loop colostomy reversal. This is because the surgeon must reopen the prior scar, locate the internal colon or rectal stump and reconnect it to the colostomy end.
The Surgical Procedure
The procedure to reverse your stoma is usually technically less demanding than the original stoma surgery although this will depend on whether you have any complications such as a hernia, which can be repaired at the same time. A straightforward stoma reversal will take around 1-2 hours to perform under a general anaesthetic. The operation can be performed either laparoscopically (via keyhole) or as an open surgery. Your surgeon will discuss with you which is the most appropriate option for you.
Colostomy reversal surgery can be performed using either an open or a minimally invasive laparoscopic approach.
- Open colostomy reversal. Open surgery involves making a long incision in the belly. This approach gives the surgeon full access to the bowel and surrounding structures. Open surgery typically requires a longer hospital stay and recovery time.
- Minimally invasive colostomy reversal. This technique is done laparoscopically, which means that several small incisions are used. A camera is used to see inside the abdomen, while specialized tools are used to reconnect the bowel. This type of surgery offers advantages such as fewer complications, less pain and a shorter hospital stay.
Post-Surgery Expectations
For the first 24 hours after surgery you will be advised to stick to liquids only to allow the bowel to rest. After 1-2 days you can then start on a soft diet. You will be encouraged to move around as much as possible to encourage activity back into your bowel and aid your recovery. The average hospital stay ins between three to five days, you will be allowed to leave hospital once you have opened your bowels and are not experiencing any complications.
Once you are discharged home, it is common to feel tired and weak following the surgery. Regular short walks can help you to regain your energy and get you back on your feet. You will need to avoid any heavy lifting for around 6-8 weeks and you can drive again once you are confident that you can do an emergency stop. Again, for most people this will be around the 6-8 weeks post op mark.
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Your bowel habits may be erratic for some time following surgery. You may experience loose motions or constipation, urgency, pain when passing motions, sore skin around the back passage, incomplete emptying and a degree of incontinence for up to a few months following surgery.
The Importance of Diet After Colostomy Reversal
For proper healing and smooth transition, diet is extremely important after colostomy reversal surgery as after surgery your bowel needs time to heal and function properly: here are some of the reasons why diet is important after colostomy reversal surgery
- Supports Healing:A balanced diet provides essential nutrients such as proteins, vitamins, and minerals that are crucial for tissue repair and overall recovery. Adequate nutrition helps the body rebuild and restore the intestinal tract and surrounding tissues after surgery.
- Regulates Bowel Movements:After colostomy reversal, your bowel needs time to adjust to its new function. A well-planned diet helps regulate bowel movements, preventing issues like constipation and diarrhea.
- Reduces Complications:Certain foods can irritate the digestive system or cause blockages, especially in the initial stages of recovery. By following dietary guidelines, you can minimize the risk of complications such as bowel obstructions, infections, or excessive gas and bloating.
- Enhances Comfort:Eating easy-to-digest foods in small, frequent meals can significantly enhance comfort during the recovery period.
Dietary Recommendations After Colostomy Reversal
Following your stoma reversal there are some things you can do to help control your symptoms following stoma surgery.
After colostomy reversal surgery, your body needs time to heal and adjust to the return of typical bowel function. At first, your diet is usually fluids and soft, low-fiber meals. It is typical to have frequent or urgent passing of stool and loose stools after reversal. This can last for weeks or months as your bowel adjusts.
Initial Stage: Low-Residue Diet
The goal of starting with low residue diet is to Minimize bowel movements and reduce irritation. Keep an on-low residue diet for the first few weeks after surgery.
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Foods to Include:
- White bread
- Refined cereals
- White rice
- Lean meat
- Poultry
Bland foods are low in fiber and easy on the digestive system. The digestive system can tolerate bland foods better than fatty or spicy foods. Bland foods are also less acidic, causing less stomach upset. People who have had a colostomy should cook their foods rather than eat them raw, as raw foods are more difficult to digest.
- broth
- tofu
- white pasta
- beets
- beans
- spinach
- carrots
- eggs
- lean proteins
- fruit juice
Those recovering from a colostomy may begin with a clear liquid diet before moving on to solid foods. Doctors often recommend liquid diets to those with complications of the digestive system.
- clear fruit juices, with no pulp
- broths
- sports drinks
- gelatin
- water
- decaffeinated tea or coffee
Gradually Introducing Fiber
The purpose of incorporating fiber in your diet is to promote regular movements without causing any strain. Be cautious to introduce food slowly and observe the response of your body
Foods to Include:
- Oatmeal
- Peeled apples
- Bananas
- Carrots
- Squash
Mashed potatoes, bananas, jelly sweets and marshmallow are good for firming up loose stools.
Importance of Hydration
It is really very important, especially after colostomy reversal surgery to maintain hydration status. Drink plenty of water and other drinks. You can enjoy herbal teas, clear broth, or herbal solutions
Clinical dietitians recommend 6-8 glasses of fluid per day, but this will vary between people. After any kind of bowel surgery, a person’s ability to absorb water is weaker. Therefore, adequate hydration is a necessary part of healing.
If you are suffering from wind or cramps fennel or peppermint tea can help ease the pain and trapped wind.
Incorporating Protein and Healthy Fats
Lean protein is extremely important in quick healing and recovery as it helps in tissue repair and overall recovery of the patient. chicken, fish and eggs are the best sources of lean protein.
When it comes to healing, how can one forget about fats? Fats provide energy and support the cellular repair system. the best sources of fat are olive oil, nuts, and avocado.
Food Options to Include
Food options for people recovering from a colostomy include:
- non-fat or low-fat skimmed milk
- lactose-free dairy products
- yogurt
- cheese
- lean animal proteins
- small amounts of nut butter or nuts
- low-fiber carbohydrates, such as white pasta or bread
- well-cooked vegetables without skin
- lettuce
- pulp-free fruit juice
- peeled or canned fruit
- the contents of thick-skinned fruits, such as watermelon or honeydew melon
Quick and Simple Meal Ideas
While menu options might be limited, there are a few quick and simple meal ideas that work well for those recovering from a colostomy.
- Jam or jelly on white toast: Jelly or jam contains pectin, and white toast is low in fiber.
- White rice with canned or cooked vegetables: Both canned or cooked vegetables are low in fiber yet can still provide a person with nutrients. Vegetable ideas include carrots, asparagus tips, or skinned zucchini.
- Low-fat yogurt with banana: Slice a banana and add it to low-fat yogurt. The yogurt is a good source of protein, and the banana will boost potassium levels. It is also a complex carbohydrate, which can help people stay full for longer.
Foods to Avoid After Colostomy Reversal
After a colostomy, people may wish to avoid foods that exacerbate or inflame the colon.
- Avoid using high-fiber foods initially right after the surgical procedure. The reason is that fiber-rich foods cause bowel irritation and increase stool bulk.
- Do not use gas-producing food as it leads to discomfort and bloating such as Beans, Carbonated drinks and cruciferous vegetables.
- Avoid using spicy and fried food as it can cause irritation in the digestive tract
- Some people have tendency to develop temporary lactose intolerance. in such individuals, it is strictly recommended to avoid using dairy products after colostomy reversal surgery.
Fizzy drinks, alcohol, caffeine high fibre vegetables, spicy foods and fatty foods are more likely to cause diarrhoea so it is worth limiting those at the beginning of your recovery.
After a colostomy, people may wish to avoid foods that exacerbate or inflame the colon. People may find that it is best to avoid:
- all high-fiber foods
- carbonated drinks
- high-fat or fried foods
- raw fruits with the skin
- raw vegetables
- whole grains
- fried poultry and fish
- legumes
- high-fat dairy
- spicy foods
All of these foods can damage the colon as it recovers after surgery. A person should avoid them until a doctor or registered dietitian advises otherwise.
Beverages to Avoid
After a colostomy surgery, the type of fluids a person drinks will also affect their colon.
It is important to avoid carbonated and caffeinated beverages, which tend to cause irritation, gas, and bloating, leading to discomfort. Decaffeinated tea and coffee are both safe to drink.
People in recovery should avoid alcohol post-colostomy or introduce it very gradually. They should always talk with their doctor before drinking alcohol after having this procedure. For many people, alcoholic beverages cause diarrhea, gas, and odor. This is especially the case with beer, which is high in yeast content and hops.
Foods That Cause Odor
An upset stomach can often lead to passing odorous gas. To minimize odors, people should avoid:
- alcohol
- broccoli
- brussels sprouts
- cabbage
- carbonated drinks
- corn
- dried beans
- eggs
- fish
- garlic
- grapes
- leeks
- milk and dairy products
- onions
- peanuts
- prunes
Additional Tips for a Smooth Recovery
Eat Small and Frequent Meals: Eat small meals often. It will be easier on the digestive system and nutrients can be absorbed easily. For instance, instead of three large meals in a day, why not take 6 small meals?
Chew Food Thoroughly: A person should eat slowly and chew their food thoroughly. It will aid in digestion and reduce strain on the bowel.
Avoid vegetable that increases flatulence such as cabbage and onions
Do not take alcohol or fizzy drinks before completely healing
Monitor Your Progress:
- After colostomy reversal surgery keep a strict eye on your body’s response which it produces by consuming different types of food items. Remember you are the only one who knows your body very well. So after consuming anything observe the following points:
- Check the consistency of stool. it is ideal to have a soft and well-formed stool. If the stool consistency is too runny then there is a problem somewhere in your diet.
- Check the frequency of bowel emptying. Once your colon is healed completely your bowel movement will gradually become regular.
- Keep and strict check on the signs and symptoms of bloating or diarrhea. if you consume anything that causes diarrhea, quickly adjust your diet accordingly.
Protect your skin - you may find it easier to use unfragranced wet wipes to clean up after each bowel movement. A barrier cream such as zinc, castor oil, Sudocrem, Cavilon or Vaseline can help you to prevent getting chapped and sore skin
Retrain your bowel - your rectum and pelvic floor muscles are likely to be weaker than before your stoma surgery. This will be because they have been inactive for some time. Pelvic floor exercises can help to strengthen and tone these muscles, which will help you gain better control
Constipation Relief: People may experience constipation after colostomy surgery as a result of cutting out fiber. However, they may find relief with the following methods:
- increased fluids
- stool softeners
- probiotic supplements, with medical approval
Empty your ostomy bag when it gets to be one-third full.
Possible Complications After Colostomy Reversal
All surgeries carry a degree of risk. Below are some side effects and risks that are associated with a stoma reversal. Your surgeon will explain any potential complications in details with you during your pre-assessment.
After colostomy reversal, the most common complications are wound infection, bowel leakage at the connection, slow bowel recovery and hernia at the stoma site. While many issues are minor and improve with time, some complications can be serious and may require another operation.
- Ileus - where the bowel stops working temporarily
- Anastomotic leak - the new join in the bowel can come apart and leak into the abdominal cavity
- Bowel obstruction/ adhesions - due to scar tissue forming in the bowel
- Risk of hernia
- Chest infection
- UTI
- Blood clots
- Infection
Adapting to Life After Ostomy: FAQs
Many questions may run through your mind as you plan your first ventures outside of your home.
If you've been given the OK from your doctor to resume your regular diet, eat what you like. Just as some foods gave you gas before your surgery, you'll likely experience gas with certain foods now that you have an ostomy. Certain foods are more likely to cause gas, diarrhea, constipation, incomplete digestion or urine odor. If you're unsure how foods will affect you, consider trying them at home, one at a time, before eating them in public.
Unless your favorite hobby is a contact sport with lots of potential for injury, you'll be free to go back to the activities you enjoy after you heal from ostomy surgery. Check with your doctor before you begin lifting weights after your surgery. You may need to wait for your surgical incision to heal before lifting weights, to reduce your risk of complications. If you're nervous that running, swimming or other athletic activity will loosen your ostomy bag and cause a leak, use a special belt or binder to hold your ostomy bag in place.
You'll need time after your surgery to heal and recover, but you can eventually go back to work. Once your doctor says you're ready, consider going back to work.
It's up to you to decide who to tell about your ostomy surgery. It may make sense to tell the people closest to you. These people may be worried about your recovery, and explaining your ostomy may ease their fears.
As you get used to your ostomy, you'll figure out tips and ways to keep the bag concealed and the noises to a minimum. Most people won't notice your ostomy unless you tell them about it.
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