Whilst some types of stoma are permanent, others are considered ‘temporary’ in nature and there may be an option to have it reversed/closed.
Whether to have your stoma reversed or not is a decision some ostomates may face. It is an individual decision and there are a lot of factors to consider. The decision will initially be led by your surgeon as to whether this is surgically possible for you, the potential success of reversal and the likelihood of acceptable bowel function, before deciding whether you are suitable for a stoma reversal or not. Most people who have a reversal do have a successful outcome, yet there are those who experience problems and, in some cases, have their stoma reformed.
We are all different and adapt in various ways to living with a stoma. For some ostomates, having stoma surgery saved their life and although it is hard decision, they may not want to go through more complex surgery to have it reversed. Yet for others they may struggle to adapt to life with a stoma or have a stoma that is difficult to manage, making living with a stoma on a day-to-day basis more challenging and they are counting the days down until their potential reversal surgery. It is hugely beneficial to speak with other ostomates who have gone through reversal procedure to see how they coped post- operatively. Some may tell you they had a positive outcome and others may have experienced problems. Talking it through will help you come to a decision of your own.
Who is offered a reversal?
You could be considered for a reversal of your temporary stoma if you have enough rectum left, have good anal sphincter muscle control, no active disease in your bowel, and are generally in good health to cope with more surgery.
It is important to note for various reasons, that not everyone who can have a reversal, decides to go ahead with reversal surgery. Also, those who have what was initially deemed a temporary stoma, may end up keeping it, as reversal may not be possible further down the line. These are both discussions to have with your surgeon.
When would reversal be offered?
The timing of your reversal is important. The optimum time is usually between 3-12months following your initial surgery. This is to ensure you have good muscle tone and that your bowel is in a healthy state for surgery. If your surgery was for bowel cancer, a reversal is not usually offered until chemotherapy has been completed and the bowel has had chance to recover afterwards (usually about 6 weeks after the end of treatment)
Reversal of your stoma will only be offered if your surgeon is confident that you will regain enough bowel control following surgery. You may have some tests done to check that your bowel has healed enough and that your anal sphincter muscles are in good working order:
- Rectal examination to check the strength of your sphincter muscles and the strength of your bowel control
- CT Scan to confirm there is no active disease that could compromise your reversal
- An enema to check there are no leaks with the join in your bowel
- Flexible sigmoidoscopy or for patients with an ileoanal pouch, a pouchoscopy to see how well your bowel/pouch has healed.
Surgery for reversal
The procedure to reverse your stoma is usually technically less demanding than original stoma surgery. This does depend on whether you have any complications such as a hernia, which can be repaired at the same time. Surgery still comes with risks and your surgeon will discuss your reversal surgery and any possible risks with you. You will also see your Stoma Care Nurse who will support you with more information about any potential complications following surgery.
What to expect following a stoma reversal
Expectations can differ depending on each hospital protocol for reversals. Following surgery, you may be advised to stick to liquids only, so that your bowel can rest and then start a soft diet, low in fibre for the following 1-2 days. Moving around as much as possible will help your bowel to be active and helps your general recovery. After 3-5 days depending on your recovery and whether you have had your bowels opened or passed flatus, you will be allowed home. With an enhanced recovery programme, the length of stay in hospital could be less and you may be sent home much sooner if all is well.
Common problems following reversal surgery
Your bowel habits may be a bit erratic for some time after the surgery. You may experience loose motions or even constipation, a feeling of urgency, some discomfort/pain when passing motions, sore skin from the back passage, incomplete emptying, and some degree of incontinence for up to a few months following surgery.
If these symptoms persist it is important to speak to your surgeon or specialist nurse, as there are things that can be done to help.
Complications of reversal surgery:
- Ileus (temporary paralysis of the bowel) – sometimes the bowel is slow to start working after surgery. Disturbances to your body’s salt balance or certain pain medication can increase the risk of this happening.
- Bowel obstruction/blockage – this can happen at a later stage which is due to a physical blockage or problems with adhesions (scar tissue)
- Anastomotic leak (the breakdown of the join in your bowel)- if this occurs you may be given antibiotics and may even have to have further surgery to form a temporary loop ileostomy, to rest the bowel and protect the join whilst it heals. On occasions abscesses can form which again can be treated with antibiotics and drainage of the abscess
- Urinary and sexual dysfunction – this may be affected only temporarily. The risk of this being higher for those ostomates having surgery to reconnect an end colostomy as the nerves controlling these functions lie in this area.
- Some individuals may suffer with pain following reversal surgery.
- There are other risks too and these include infection or complications from the surgery itself
It may take some time to get back to a normal, healthy diet. Whilst your bowel is feeling fragile it is a good idea to limit any foods which could irritate the gut. These are food such as:
- Acidic fruits such as citrus fruits like oranges, lemons, grapefruit, strawberries
- Wind inducing vegetables such as broccoli, beans, cabbage, sprouts or onions
- Spicy foods
- Fizzy drinks, especially beer or larger
After a loose bowel movement, it is important to keep your skin free from irritation and soreness. Washing the area with warm water and patting dry afterwards, will help keep it clean. Application of a good barrier cream will help protect your skin and minimise any skin problems.
How you may feel about reversal surgery
It may be of benefit to ask important questions about stoma reversal surgery from both your surgeon and stoma care nurse before you go ahead. Be realistic about how you will feel going through another surgery and the possibility of experiencing a period of disrupted bowel dysfunction. Talk to people who have been through this journey to get a real feeling of how it could be for you. Your stoma nurse could arrange this for you. On occasions a stoma can improve your quality of life and you may not want to go ahead with a reversal for many reasons. It is a very personal decision.