How do I get treatment

For London Colorectal please telephone:

  • +44 (0) 20 7403 6061

For Gastroenterology please call:

  • +44 (0) 20 7234 2292

 

Patient Advice following an ileo-anal Pouch Formation

An ileo-anal pouch is formed in order to allow the ileum, which is the small bowel, to act in a similar way to the rectum (to store faecal matter).This prevents a permanent ileostomy.The pouch is formed by folding the ileum back on its self and creating a bag like structure. This is then sutured or stapled together down the joins and attached to the anus. The pouch can be formed over a 1, 2 or 3 stage operation. However a stage 3 operation is more common. This is usually done due to the whole of the colon (large bowel) being removed due to Ulcerative Colitis or Familial adenomatous polyposis. The first stage within the 3 would involve removing the whole colon, leaving the rectum in place and forming an end Ileostomy. The second stage is where the Ileo-anal pouch is formed but in order to allow this to heal a temporary loop Ileostomy is formed. The final operation is where the Ileostomy is reversed and natural bowel function is restored via the pouch.

Bowel Function

After you have had your Ileostomy reversed (Stage 3 of the procedure), natural bowel function is now going through the pouch. Once your bowels do start to work you may find that your bowel motion is very loose and more frequent in nature. This will be more so in the initial stages and is normal and will improve with time. However if it becomes a problem or doesn't improve your specialist can prescribe medication to help thicken and slow down your stool. On average you will empty your pouch approximately 4-8 times during a 24hr period and the stool should be a porridge like consistency. If you do have frequent bowel motions this may result in you having sore skin around your anal area. Barrier creams such as Sudocrem can help to relieve this. In order to be in the idea position to open your bowels, it is advised that you sit on the toilet with you feet on a small foot stool. This encourages complete emptying.

Pouchitis

This is where the pouch can become inflamed. This doesn’t usually occur until the pouch has been established if at all for a few months (if at all) and commonly presents with increased pouch activity, discomfort and possible bleeding. This is effectively treated with antibiotics.

Medications

It is not unusual to still have some discomfort/pain after you have been discharged and you will have been discharged with some pain relief medication. It is important to carry on taking these as prescribed and gradually wean yourself off them. Your body will tell you if are over doing things or if you require more pain relief. Contact your GP or specialist if pain becomes worse.

Diet

Ensure you try and eat a sensible diet with plenty of fluids, fresh fruit and vegetables. Following bowel surgery it may take a few weeks for your appetite to return. It is important to ensure you drink plenty of fluids but and taking regular, smaller portions of food. It is worth remembering that all individuals are different and some foods can have an effect on a persons bowel function. It is important that you are aware of the types of food that may cause problems however don’t rule them out as they may not cause a problem for you or not enough of one to stop you enjoying certain foods. It’s all about trial and error.

Sutures and Wound care.

Your wound will have been closed with either Dermabond, abdominal clips or sutures.

If you have Dermabond to your wound, this will take a few weeks to disappear. Ensure that you don't rub at the wound in order to remove the glue like substance. This acts like a water proof protection to your wound.

If you have abdominal clips in place, these remain in place for 10-14 days. If you have gone home before the removal date, it can be arranged for you to attend your practice nurse or for you to return to outpatients in order to have clips removed.

If you have sutures in place, these usually stay in place for 7-10 days. Again if you have been discharged prior to this it can be arranged for you to have them removed as above.

Your wound is best left exposed unless there is a reason for a dressing still to be required. The nurse will advise you on dressing changes prior to discharge home. If it is felt that District Nurse/ Practice Nurse input is required then a referral will be sent prior to you leaving hospital.
If your wound becomes inflamed, swollen or painful or if there is evidence of the wound weeping, this could be a sign of a wound infection; you may also have signs of a fever. If you have any of these signs or symptoms please ensure you contact your GP or Consultant as antibiotics may be required.

Bathing/Showering

You can bath and shower as normal once you are at home, however ensure that you don't rub yourself across the wound area with or without perfumed lotion/potions. Bubble bath or highly scented soaps etc can cause irritation to the wound. Ensure you dry yourself well, patting your wound sites gently. Do not use talcum powder as this can cause irritation. If you have a sore anal area due to frequent bowel motions then ensure you clean and dry the area well by just patting and not rubbing. Apply a barrier cream such as Sudocrem to this area each time you have a bowel motion. Moist toilet tissues are also advisable.

Driving

It is recommended not to drive a car during the early weeks following surgery. Before stating to drive again you should test to see that you are happy to perform an emergency stop. It is important that you contact your insurance company to ensure that your insurance covers you to drive after surgery of this nature. Even as a passenger you are at risk as the seat belt crosses over the very area you are trying to protect. It would advisable to place a thin cushion or towel between yourself and the seat belt to act as protection in the initial weeks until you feel more secure.

Exercise

Ensure you allow yourself recovery time following the initial surgery. You will feel tired for the first few weeks which is only natural. You should ensure you avoid activities that could cause undue abdominal discomfort and risk of developing a hernia around the wound site for the first 4-6weeks post operatively. Remember to listen to your own body and not to over do it. The physiotherapist will advise you on recommended exercises. Walking is a good place to start with exercising and can be gently built up. Pelvic floor exercises are advisable as this will encourage control and improve the sphincter muscles in the anal canal.

Household Duties

As your abdominal muscles start to heal after surgery they will be very weak and even everyday movements can cause possible pressure and the possibility of a hernia. The sort of movements that can cause the most discomfort following surgery are bending, stretching and lifting. It is important that family and friends help out if possible as you should try not to do any heavy lifting for approximately 6 weeks. It is not unusual to feel tired and insecure when you first go home. It can be quite frustrating relying upon others to help with everyday activities however it is important to allow time for healing.

Sexual Relationships

After surgery, while you are recovering and learning to adapt, you may not experience any sexual feelings for days, weeks or even months. It is important that you don't expect too much of yourself, ensure you are patient and kind to yourself and your partner. Once you have rested, healed and become more reassured, your sexual desires will return. Your surgeon will have explained the small possibility of problems following lower pelvic surgery, however these are usually temporary. It is important that you talk to your partner and allow yourself time to recover.

Returning to Work

The time at which you can return to work depends on the type of surgery you have had and what your job entails. It is important that you feel completely better and stronger in yourself. It is worth discussing with your employer as to whether working part time initially may be advisable.

Follow up Appointment

You will be advised to make an appointment with your Consultant through his secretary after you have been discharged. This will usually be within the first 2 weeks however you will be advised if this should be any different.