A colostomy reversal is a surgical procedure designed to restore the natural passage of stool through the rectum, effectively closing a temporary colostomy. The surgery involves reconnecting the two ends of the colon that were previously separated at the stoma site. The goal is to restore the continuity of the digestive tract and eliminate the need for an external appliance. This process requires the body to adapt to a new normal, involving a distinct recovery timeline and functional adjustments.
Immediate Post-Operative Recovery
The first few days following a colostomy reversal focus on managing pain, monitoring the surgical site, and encouraging early mobility. Pain management is typically addressed with prescription medications initially, transitioning to over-the-counter options. Reducing opioid use quickly is important, as these can slow down the return of normal bowel function.
The incision where the stoma was closed requires careful attention to prevent infection. Observe the wound site daily for signs of complications like increased redness, swelling, warmth, or unusual discharge. Early ambulation is encouraged to stimulate circulation and promote healing. Heavy lifting (over five to ten pounds) must be avoided for at least six weeks to reduce the risk of a hernia developing at the surgical site.
Restoring Bowel Function
Restoring bowel function begins with a period of rest for the digestive system. Immediately after surgery, patients are often kept NPO or given only clear liquids to allow the reconnected bowel segments time to heal. The return of peristalsis is closely monitored, with the passage of gas often being the first positive sign that the colon is “waking up.”
Once the bowel shows signs of activity, the diet slowly progresses to a soft, low-residue diet. The first bowel movement typically occurs within two to four days, and the stool is often very loose, watery, and frequent because the diverted colon segment may be temporarily deconditioned and unable to absorb water efficiently.
Managing this early phase often involves temporary use of anti-diarrheal medications, such as loperamide, to slow transit time and help solidify the stool. A low-fiber, low-residue diet is maintained initially, focusing on easily digestible foods. Fiber must be reintroduced gradually, as too much too soon can exacerbate frequency and discomfort.
Managing Long-Term Bowel Changes
Months after the reversal, a “new normal” for bowel function takes shape, which may differ significantly from pre-surgery habits. Common long-term challenges include increased stool frequency, a strong and sudden urge to defecate (urgency), and the sensation of not completely emptying the bowel. Mild fecal incontinence or difficulty distinguishing between gas and stool may also persist, especially in the first year.
Rehabilitation strategies address these changes, starting with adjustments to diet and hydration. Favoring soluble fiber to bulk up the stool can help regulate bowel movements and reduce liquid output.
Strengthening the pelvic floor muscles is key to long-term recovery. Pelvic floor muscle exercises (Kegels) help improve the tone and control of the anal sphincter, which is crucial for managing urgency and preventing leakage. For those with persistent difficulty, specialized physical therapy involving biofeedback may be recommended to retrain the muscles and nerves responsible for bowel control.
Potential Post-Reversal Complications and Warning Signs
While most recoveries proceed smoothly, awareness of serious complications that require immediate medical attention is necessary. One serious risk is an anastomotic leak, which occurs if the surgical connection between the two bowel ends does not heal properly. Symptoms include severe and worsening abdominal pain, a persistent high fever, and signs of sepsis.
Other potential complications include a surgical site infection at the closed stoma site, presenting as increasing pain, foul-smelling discharge, or significant swelling. A bowel obstruction can also occur, often caused by scar tissue or adhesions, leading to symptoms like persistent vomiting, severe cramping, and the inability to pass gas or stool. Any sudden, uncontrolled pain or inability to tolerate food should be reported to the surgical team without delay.