An ileostomy reversal, sometimes called a “takedown,” restores the natural path of digestion by reconnecting the small intestine to the colon or rectum. This operation closes the temporary opening, or stoma, on the abdomen created during a previous surgery. While the reversal is often viewed as a final step toward recovery, it marks the beginning of a new phase of physical adjustment. This guide offers a realistic overview of the recovery experience, focusing on the immediate post-operative period and the longer-term adjustments to bowel function and daily life.
The First Week of Recovery
The immediate post-operative phase focuses on healing the surgical site and ensuring the newly connected bowel begins to function. Most patients spend one to three days in the hospital following the reversal, which is generally a shorter stay than the initial surgery. Pain management progresses from intravenous to oral pain relievers as the initial soreness subsides.
Caring for the incision where the stoma was located is a primary focus upon discharge. The wound is typically small and may be left open to heal from the bottom up, requiring daily dressing changes for four to six weeks. Mobilization is encouraged almost immediately after surgery; gentle walking helps stimulate the bowel and prevent complications like blood clots.
Oral intake begins slowly, starting with clear liquids and gradually advancing to a soft or low-fiber diet as the bowel wakes up. The return of peristalsis, indicated by passing gas, is a positive sign that digestive function is resuming. Patients are usually discharged once they are tolerating a diet and their bowel function has restarted.
Adjusting to New Bowel Function
The body requires significant time to adapt to the return of waste material to the lower gastrointestinal tract. The colon’s primary role is to absorb water from the stool, a function that was dormant while the ileostomy was active. Because the small intestine output is liquid, initial bowel movements after reversal will be loose and numerous, often occurring up to 10 to 20 times a day.
This high frequency and urgency are normal, as the colon and rectum must re-learn to store and regulate waste. Over the first few weeks to months, frequency will decrease and consistency should thicken as the remaining colon begins to absorb more fluid. This process can take up to six months or even a year to stabilize into a predictable pattern.
Dietary changes can significantly aid this transition, starting with a low-residue diet of simple, easily digestible foods. Patients should temporarily avoid high-fiber foods, such as raw fruits and vegetables, and gas-producing items like carbonated drinks, beans, and broccoli. Hydration and electrolyte intake remain important, especially with frequent, loose stools, to prevent dehydration.
Strengthening the pelvic floor muscles through exercises, such as Kegels, can help regain bowel control and manage urgency. These exercises are beneficial because the muscles and nerves controlling the anus may be weakened or uncoordinated after disuse. Anti-diarrheal medications, like loperamide, may be prescribed to slow the transit time of stool, allowing for better water absorption.
Essential Perianal Skin Care
The skin around the anus is unprepared for the frequent, highly acidic stool that passes after an ileostomy reversal. The digestive enzymes and bile salts in the liquid output can quickly cause irritation, redness, and pain, a condition sometimes called ileostomy reversal-associated diarrhea (IRA-D). Protecting the skin is paramount because the lack of a protective mucosal barrier makes the tissue vulnerable.
Gentle cleansing after every bowel movement is necessary, using a soft cloth or a peri-bottle with warm water instead of harsh toilet paper. Avoid scrubbing the area; gently pat or air-dry the skin instead. Soaking the area in a warm sitz bath several times a day can be soothing and help reduce inflammation.
Applying a thick, protective barrier ointment is fundamental to preventing irritation. Products containing zinc oxide, like diaper rash creams, are effective because they create a physical barrier between the skin and the corrosive stool. These creams should be applied liberally to the entire perianal area, forming a protective layer that is only gently wiped away during cleansing.
Monitoring Progress and Long-Term Recovery
Full recovery from an ileostomy reversal is a gradual process, typically taking six to eight weeks to regain energy and strength. Light activities, such as walking, are encouraged immediately. Patients should avoid heavy lifting (objects heavier than 10 pounds) for the first six weeks to prevent a hernia at the surgical site. Driving can usually be resumed once a person can safely perform an emergency stop without pain, which often takes about six weeks.
Close monitoring for specific warning signs is necessary to catch potential complications early. Immediate contact with a healthcare provider is warranted for symptoms that could indicate an infection, a bowel obstruction, or require urgent medical attention:
- A fever above 101°F.
- Persistent nausea or vomiting.
- The inability to pass gas or stool.
- Severe, escalating abdominal pain.
- Signs of dehydration, such as extreme thirst or dark urine.
Regular follow-up appointments with the surgical team and a wound, ostomy, and continence (WOC) nurse are scheduled to monitor the healing of the stoma site and manage the adjustment of bowel function. While the most significant improvements occur in the first few months, the bowel may continue to refine its function for up to a year.