Having bowel surgery due to cancer can be very distressing. Not knowing what to expect afterwards can be even more distressing. I wrote this blog because I’ve had clients express that they had no idea what they were going to experience following surgery. Many had no idea physiotherapy was even an option to help them with some of the side effects of surgery.

If you are having surgery or know someone who is battling colon cancer and might have surgery, please share this blog with them.

So here are 7 things you need to know following colorectal cancer surgery.

  1. Fecal Incontinence: this is the leaking of stool at inappropriate times and places. 90% of patient having bowel surgery will experience a change in their bowel habits, which includes incontinence (2, 3). Many will see improvement over 6-12 months but many patients report this problem as having an impact on the health quality of life (4).
  2. Gas Incontinence: is the inability to hold gas. You may find that you produce more gas than before as well (1).
  3. Fecal Urgency/Frequency: after surgery you will notice an increase in the number of visits to the bathroom. This can be anywhere from 1-15 or more times a day. Others experience what is called clustering, where you have a number of bowel movements in a short period of time (1). Usually this is accompanied by an increase sense of urgency, meaning the strong urge to go and the feeling that you cannot hold it. This can be very distressing and disrupting to your work activities, social activities and just day to day activities.
  4. Scar Tissue: with any surgery there is always scar tissue. Scar tissue can become a problem when it sticks to other tissue. It can make it difficult to move, can decrease blood flow to the area and can disrupt organ function. See our previous blog on scar tissue.
  5. Sexual Dysfunction: For women this could mean painful intercourse, decreased libido, and choice to withdraw especially with colostomy bag. For men it can be difficult getting an erection, difficulty or inability to achieve orgasm, decreased libido and decreased sensation to the area (5).
  6. Urinary Incontinence: leaking urine when you don’t want to leak urine. Most often caused by weakness in the pelvic floor muscles and/or could also result from nerve damage (5).
  7. Dermatitis: This means a breakdown of the skin around the anus. With the increase in loose bowel movements, you may find yourself wiping a lot. This can cause redness, pain, anal fissures (open wounds) (5).

5 ways Physiotherapy can help

  1. Pelvic floor muscle training: a pelvic floor physiotherapist can teach you how to properly contract the muscles that hold your urine, stool and gas in. Ideally we would teach you prior to surgery so that you can start the exercises right away to regain control of your bladder and bowels sooner. Otherwise one would have to wait 6-8 weeks after surgery to get an appointment. The tissue needs that time to heal. In order to correctly identify and teach these exercises, an internal examination through the vagina or anus needs to be performed. Make sure the therapist is qualified to perform this assessment (1, 4).
  2. Rectal Balloon training. This is where a rectal balloon is inserted to the rectum and attached to a syringe which pumps air into the balloon to inflate it.. It is used to train the rectum to tolerate larger amounts of stool, which thereby decreases urgency and frequency. The balloon can also be used to train fast muscle contraction in response to rectal filling, which can be helpful to hold the stool, when you get a sudden urge to defecate (1,4).
  3. Massage techniques: Pelvic floor physiotherapists that are trained in bowel dysfunction have a variety of techniques to massage the muscle, fascia and organs which can be useful after surgery and radiation due to build up of scar tissue and possibly adhesions. The various techniques can be taught to patients to do at home to improve movement, function and pain.
  4. Electrical stimulation/biofeedback: For those with moderate to severe muscle weakness or decreased sensation, a device can be used with a probe to help improve muscle strength, awareness and sensation.
  5. Education: Treatment always includes education such as; how to reduce stress on the pelvic floor, toilet positions, skin care techniques, self management at home, lifestyle changes, exercise programs and referrals to other professionals if needed.

To get you started: check out our free YouTube video on how to better use the toilet. https://www.youtube.com/watch?v=PcIziFdKf5A

References:

  1. Visser et al. 2014. Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: A systematic Review. Ann Coloproctol 30(3): 109-114.
  2. Scott, Kelly, M. 2014. Pelvic floor rehabilitation in the treatment of fecal incontinence. Clin Colon Rectal Surg 27: 99-105.
  3. Bols et al. 2007. A randomized physiotherapy trial in patients with fecal incontinence: design of the PhysioFIT-study. BMC Public Health 7:355-365.
  4. Maris et al. 2012. Treatment options to improve anorectal function following rectal resection: a systematic review.
  5. Australian Government Department of Health and Ageing. 2013. Improving bowel function after bowel surgery: Practical Advice. Accessed on October 1, 2016 from: http://www.bladderbowel.gov.au/assets/doc/ImproveBowelAfterSurgery.html#18
Bowel Surgery and Cancer