Bowel surgery

There are lots of types of bowel surgery. This information is about surgery to remove all or part of your large bowel (colon). This is called a bowel resection. You might need this type of surgery if you have a bowel condition such as bowel cancer, diverticular disease, Crohn’s disease or ulcerative colitis.

Types of bowel surgery

The exact procedure you have will depend on the reason why you’re having surgery and how much of your bowel is affected. The procedures are named differently depending on what section of bowel is removed. They include:

• total colectomy – all of your large bowel removed
• proctocolectomy – your large bowel and back passage (rectum) removed
• panproctocolectomy – your anus, large bowel and back passage removed
• hemicolectomy – either the left or right side of your large bowel removed
• sigmoid colectomy – the part of your bowel that’s closest to your back passage removed
• transverse colectomy – the middle part of your large bowel removed
• proctectomy – all or part of your back passage (rectum) removed

Some of these types are shown in the illustrations below. Your surgeon will talk with you about the most appropriate procedure for you.

Preparing for bowel surgery

If your doctor recommends surgery, they’ll go through exactly what to expect with you. This will include what will happen before, during and after your procedure, and the risks and benefits involved. Do ask your doctor if you have any questions or need any more explanation about the procedure. You’ll be asked to sign a consent form before the procedure, so it’s important that you feel fully informed.

Getting ready for surgery

You’ll be assessed before your operation to check that you’re fit for surgery. This will often happen at a preoperative assessment clinic. They’ll also explain how to prepare for your operation. For example, if you smoke, you’ll be asked to stop because smoking increases your risk of infections and other complications after surgery. The nurse or doctor will check what medicines you’re taking and advise if you should stop taking any of them before surgery.

Sometimes, you may be asked to take laxatives on the day of your surgery or the night before, to clear out your bowel. Or you may need to have an enema – a small amount of liquid medicine is inserted into your back passage (rectum) to help you to empty your bowel.

Bowel resection usually involves a hospital stay of between three and nine days, so it’s important that you make any necessary preparations for this.

On the day

You’ll have bowel resection surgery under [PC1] , which means you’ll be asleep during your operation. You’ll be given clear instructions about when to stop eating and drinking before your anaesthetic. You may be given a special, carbohydrate-rich drink to have the night before your surgery and again a few hours beforehand.

When you come into hospital, a member of the surgical team will talk you through what will happen and answer any questions you may have. They’ll check that you’re well and still happy to go ahead. You may be asked to wear compression stockings and you may be given an injection of an anti-clotting medicine called heparin. This helps to prevent blood clots forming in the veins in your legs. You may also have an antibiotic injection before your operation to reduce your risk of infection.

What happens during bowel surgery?

Bowel resection surgery involves removing the diseased parts of your bowel and, if possible, joining the two healthy ends together using stitches or staples. This is called an anastomosis.

Sometimes, your surgeon may need to bring the healthy end of your bowel through your abdominal wall and onto the surface of your skin. This is called a stoma. If the operation involves your large bowel, it’s called a colostomy; if it involves your small bowel, it’s called an ileostomy. The waste from your bowel passes out of the stoma, and is collected in a bag that you wear over the stoma. A stoma can either be temporary or permanent, depending on the type of surgery you have and how much bowel your surgeon removes.

If your surgeon thinks you may need a stoma, they’ll arrange for you to see a specialist stoma nurse before your operation. Our FAQs explain in more detail how a colostomy may affect your everyday life.

If you’re having a proctocolectomy to remove all your large bowel and back passage, your surgeon may create a ‘pouch’ from the end of your small bowel. This can store the waste from your bowel and allow you to pass waste (poo) through your anus.

Ways to have surgery

There are two main ways you can have bowel surgery: keyhole (laparoscopic) and open surgery.

• In keyhole surgery, your surgeon inserts instruments and a tube-like telescopic camera through small cuts (‘ports’) in your abdomen. They then remove the appropriate section of bowel through a larger cut. Images from the camera are shown on a monitor so your surgeon can see what they are doing.
• In open surgery, your surgeon will make a single, large cut into your tummy to reach your bowel and remove the affected section.

People often recover more quickly from keyhole surgery, don’t have to stay in hospital for so long and may have less pain afterwards. Not everyone can have keyhole surgery though – it depends on your circumstances. Sometimes your surgeon will need to switch from keyhole to open surgery during the operation. They’ll talk to you about the possibility of this happening, and what it will mean, before your surgery.

A newer type of surgery that uses robotics is being used in some hospitals for surgery on the back passage (rectum). This is a new technique that’s still under investigation, so it’s not available everywhere yet.

What to expect after bowel surgery

You’ll spend the first few hours after your operation in a special recovery unit, before being transferred to a ward or other unit. You might have some discomfort as the anaesthetic wears off, but you’ll be offered pain relief as you need it. The two most common types of pain relief you may have are patient-controlled analgesia and an . In patient-controlled analgesia, morphine is delivered directly into a cannula or drip. In an epidural, a pain-relieving medicine is injected into the space that surrounds your spinal cord (the epidural space).

At first, you’ll have a catheter to drain urine from your bladder into a bag. You may also have fine tubes (drains) running out from your tummy to drain fluid into another bag. These are usually removed after a few days. You’ll have a drip in your hand or arm to give you fluids. This can usually be removed after a day or so. You’ll be encouraged to eat and drink as soon as you feel ready. Read our FAQ on what to eat after bowel surgery for more information.

To help prevent , you’ll have a daily injection of an anti-clotting medicine and be asked to keep wearing compression stockings. You’ll also be encouraged to get out of bed and move around as soon as possible. You may be shown exercises you can do while sitting or lying down too, including breathing exercises to clear your lungs.

You’ll be able to go home a few days after surgery but exactly when will be different for everyone. It’ll depend on the type of surgery you had and how well you’re recovering. Before you go home, your nurse will give you some advice on how to care for your healing wounds and  if you have one. If you have a stoma, you’ll be given the details of a stoma nurse you can contact once you get home, if you need to.

Recovering from bowel surgery

It usually takes at least six weeks to start feeling that you’re back to normal after bowel surgery. You should avoid heavy lifting and strenuous exercise for longer than this though.

You might continue to have some pain and discomfort from your surgery for a while. You may be prescribed some painkillers to take home, but you can also take , such as paracetamol or ibuprofen if you need to. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

It can take a while for your bowel to settle down after surgery. Your doctor may suggest some changes to your diet while your bowel is recovering. For more information, read our FAQ on what to eat after bowel surgery.

It’s common to feel tired while you’re recovering and to need to sleep and rest more than usual. It’s important to take time to rest. But do try to get up and move around as much as you can, and keep up any exercises you’ve been given by your physiotherapist. This can help you to feel better and get your strength back as well as reduce your risk of complications.

Complications of bowel surgery

Complications are problems that can happen during or after your surgery. The possible complications of any operation include an unexpected reaction to the anaesthetic or developing a chest infection afterwards. Complications may also include excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT).

Specific complications of bowel surgery include the following.

• Leaking of the new join in your bowel (an anastomotic leak). This can cause severe abdominal pain, and you may feel very unwell with a high temperature. You may need to be admitted to hospital for further treatment and surgery if you have an anastomotic leak.
• A wound infection. Your wound may become swollen, red and tender to touch. You might have a high temperature too, and feel sick. Contact your hospital if you develop these symptoms.
• Bands of scar tissue (adhesions). These can develop after surgery and may cause your tissues or organs to stick together. Adhesions can cause ongoing pain in your tummy, and they can also block your bowel. You might be able to have a procedure to break them up.
• Temporary paralysis of your bowel (ileus). It takes time for your bowel to start working again as normal. You may feel bloated, be sick or have problems with your bowel movements. If this isn’t getting any better after a few days, your hospital team will give you fluids to help you recover.
• Nerve damage. If nerves in your pelvic area are damaged during surgery, this can lead to loss of sensation. This could affect your sex life or how well you can control your bladder. For more information, see our FAQ on bowel surgery and your sex life.