A stoma can be either permanent or temporary. A temporary stoma can be reversed after several weeks to months once the bowel has had time to heal and recover from any treatment, for example, from chemotherapy. Reversing a stoma involves re-joining the piece of bowel that is your stoma with either your rectum, colon or your small bowel and then closing the stoma site. After your initial stoma surgery your surgeon will have discussed whether reversal is an option for you depending on the type of surgery and the reason it was performed.
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 generally in good health to get through more surgery.
It is important to note, for various reasons, not everyone who can have a reversal, decides to go ahead with reversal surgery. Also, those who have a planned temporary stoma may end up keeping it as a permanent stoma, as reversal may not be possible. 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 the 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 also 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.
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 nurse, as there are things that can be done to help.
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 stomach and bowel. These are food such as:
- Acidic fruits such as 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 to 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 do not want to go ahead with a reversal for many reasons. It is a very personal decision.