Fecal diversion surgery involves creating a new path for stool to exit the body, bypassing parts of the intestine that are diseased, injured, or need time to heal. This procedure redirects digestive waste from its usual route through the rectum and anus to an opening on the abdomen. The primary purpose is to allow a segment of the bowel to rest and recover, or to manage conditions where normal bowel function is not possible.
Understanding Fecal Diversion
Fecal diversion surgery is performed for various reasons, allowing the bowel to heal or managing conditions where normal function is not possible. Common reasons include severe inflammatory bowel disease (Crohn’s disease or ulcerative colitis), bowel obstructions, or trauma to the digestive tract. It is also used for colorectal cancer that obstructs the bowel, or to aid healing after certain surgical procedures like rectal cancer surgery.
There are two main types of fecal diversions: colostomy and ileostomy. A colostomy reroutes the large intestine (colon) to the abdominal opening, usually on the lower left abdomen. Stool from a colostomy can range from soft to firm. An ileostomy connects the small intestine (ileum) to a stoma, typically resulting in looser or liquid stool.
Fecal diversions can be either temporary or permanent. A temporary diversion allows a section of the bowel to rest and heal from injury, infection, or surgery. These are often in place for a few months, after which another surgery can reconnect the bowel. Permanent diversions are necessary when the lower part of the rectum or anus is removed, or when bowel damage or disease is extensive and not expected to heal.
The Surgical Procedure
Before fecal diversion surgery, patients undergo preparation, including an assessment of their fitness. This involves laboratory work and a discussion of risks and benefits with the surgeon. Patients receive prophylactic antibiotics to minimize infection risk and laxatives to clear the bowel. Fasting for 8-12 hours before surgery is also required.
During the operation, performed via open or laparoscopic surgery, a stoma is created. Laparoscopic surgery involves small abdominal incisions for instruments and a camera. The surgeon brings a portion of the intestine through the abdominal wall and secures it to the skin, forming the stoma. For a loop colostomy or ileostomy, a loop of the intestine is brought out and partially opened, sometimes supported by a plastic rod for several days.
In the immediate post-operative period, patients remain in the hospital for a few days. Pain management is provided, and early ambulation is encouraged to prevent complications like blood clots. Patients initially start on a liquid diet, progressing to a soft diet as bowel function returns. A stoma care nurse will provide education on managing the stoma and changing the pouch before discharge.
Living with a Fecal Diversion
Adjusting to life with a fecal diversion involves learning practical stoma care. This includes regularly emptying the pouch when it is about one-third to half full and changing the pouching system every 3 to 7 days. Proper skin care around the stoma (peristomal skin) is important to prevent irritation and ensure a secure pouch seal.
Dietary adjustments are important with a fecal diversion. Most individuals can return to a regular diet, but it is important to introduce foods gradually and observe their effects on stoma output. Some foods may cause increased gas, diarrhea, or blockage, especially for ileostomy patients. Chewing food thoroughly and maintaining adequate hydration can help manage digestion.
Lifestyle adaptations include clothing choices and physical activity. Modern ostomy systems are discreet, allowing individuals to wear most types of clothing. Physical activity like walking, swimming, or yoga is encouraged, ensuring the pouch is secure and emptied before exercise. Many people with diversions continue to work, play sports, and travel, leading active and fulfilling lives.
Adjusting to a fecal diversion involves important emotional and psychological aspects. Feelings of uncertainty, fear, and changes in body image are common. Seeking support from friends, family, and specialized support groups can provide emotional relief and practical advice. Cultivating a positive mindset and embracing self-acceptance are important steps in adapting to changes and regaining confidence.
Reversal and Long-Term Outlook
For individuals with temporary fecal diversions, a stoma reversal procedure is an option. Reversal criteria include complete healing of the original bowel surgery site without leaks and no active infection or inflammation. The anal nerves and muscles must also be functional for bowel control, and the patient’s overall health suitable for another surgery. Most temporary colostomies are reversed within a few months, typically 3 to 6 months, allowing the bowel to fully heal.
The reversal procedure involves reconnecting the two ends of the bowel and closing the stoma opening. After reversal, patients spend a few days in the hospital, initially on a liquid diet until bowel function returns. Full recovery can take six to eight weeks, with energy and strength gradually returning and dietary intake broadening. Bowel movements resume through the anus, though initially they may be frequent and liquid, gradually becoming more formed.
For both temporary and permanent diversions, the long-term outlook for quality of life is positive. Many individuals with ostomies lead active, healthy lives, returning to work and social activities. Potential challenges include managing peristomal skin irritation, occasional pouch leaks, and adapting to changes in body image. Ongoing medical follow-up with healthcare providers and ostomy nurses helps manage complications and ensure continued well-being.