Post-Op

 

When you wake up, the ileostomy will be gone. Again, there are several tubes that will be in place following this operation:

  • IV lines--to receive fluids and medicines until you start eating (usually 3-5 days)
  • Foley catheter--a urine tube to collect urine into a bag, so that an accurate account of your urine can be monitored (3 or 4 days)

In addition, you may have:

  • Nasogastric (NG) tube--a tube that goes through the nose into your stomach, to prevent nausea until bowel functions begin to return (usually 2-3 days)

You will be given pain medicines as needed. Most patients have the Patient Controlled Analgesia (PCA) pump to control their own pain medication. The recovery period is usually shorter for this operation. A patient stays in the hospital for 3 to 7 days with the average of 4 days.

You will begin to have bowel movements 2 to 5 days after this operation. Initially the movements are liquid and may occur 10 or more times a day. As you eat solid food, the bowel movements become more firm and the frequency decreases. Occasionally you may need medication to slow down or thicken the bowel movements. You will be given a clinic appointment to see your surgeon in 10 days to 2 weeks after this operation.

In summary, most patients have IPAA performed in two stages. The first stage is removal of the colon and formation of the ileal pouch with temporary ileostomy. The second stage consists of taking down the ileostomy and restoring continence. IPAA may be performed in one stage if the surgeon feels it is technically safe. When IPAA is performed in three stages, it is usually done because of the severity of your disease. Your actual case can be discussed with your surgeon.

Returning to Normal

Returning to normal may take a few weeks or months, depending on your body's healing power. Most patients feel much better after their diseased bowel is removed. They begin to gain back lost weight, eat better and have more energy.

Bowel Habits

Every person develops their own bowel habits. Just as everyone with a normal colon has their own bowel habits, you will develop yours over the first year after your operation. Just after your operation you may be having 6 to 10 bowel movements a day. As the pouch matures most patients have an average of 4 to 7 bowel movements per day. You will be asked to try and hold the urge to have a bowel movement so that the pouch can stretch over time. Bowel movements become predictable and controllable. They will have the consistency of a thick paste, like peanut butter. You will be given a medication, an antidiarrheal, to help slow the bowel motility such as Imodium or Lomotil. Over time you will be able to reduce the need for these medicines. Often patients find that they take antidiarrheals before going on a trip or before an important meeting, so that their bowel function can be delayed for a period of time.

Diet

Most patients are concerned about what they can eat after IPAA. There is no special diet for a patient that has undergone the pullthrough operation. There are some foods which may cause difficulty, such as an increase in the number of bowel movements, anal irritation and/or increased gas. A diet guide can be found on the last page of the pamphlet. Most patients can tolerate a variety of foods without difficulty. It is best to add foods to your diet gradually. You will then be able to know how specific foods affect your bowel movements. Also remember to drink plenty of fluids everyday.

Driving a Car

As you begin to feel stronger and are no longer taking pain medication, you will be permitted to drive. Do not drive if you are taking any kind of pain medicine or medicine that impairs your judgment. You should not drive until you discuss this with your surgeon, at your first follow-up visit.

Work

Most patients feel strong enough to return to work in 3 to 6 weeks following the initial operation. If you do work that requires you to lift or bend then you should be placed on restricted work duty until advised differently by your surgeon. After the final operation, it may be 2 to 6 weeks until you feel strong enough to work, and you will be limited as to the amount of lifting you may do. If you need a letter or work excuse to be sent to your employer, please let your surgeon or the GI Surgery nurse know.

Activity and Exercise

Patients begin to feel like doing some activities within 1 or 2 weeks following IPAA. It is a good idea to do light exercise such as walking, but do not do any strenuous activity or exercise for 6 or 8 weeks following your operation. You should not lift anything heavier than 8 pounds (a gallon of milk) for 6 weeks. You should avoid putting pressure on your abdominal muscles. After the final operation and you have been released from the surgeons care, you will be permitted unrestricted activity.

Sexual Relations

To allow healing to occur, physicians advise no intercourse for 4 to 6 weeks after IPAA. Surgery that involves removal of the rectum can change sexual function. Potential problems with sexual function such as the inability to have an erection or ejaculate rarely occur. The utmost care is taken during the operation to ensure that complications do not arise. These issues should be discussed with your surgeon. Women can and have had children after undergoing IPAA.

Potential Problems

As with any major operation, there is the possibility of complications. Some potential short-term complications which may arise shortly after the operation are:

  • Infection--infections can occur with any operation. Every step is taken to ensure that this does not take place. The colon is full of bacteria. You are given a bowel preparation prior to the operation in order to clean the bacteria out as much as possible. It is very important for you to follow the bowel preparation closely so that the chance of infection can be reduced.  
  • Wound infection-- These infections are usually superficial or on the surface, and can be treated by draining or opening the wound, and with antibiotics.
  • Blood loss--a modest amount of blood can be lost during this operation. If your physical condition permits, you will be asked to give a unit of your own blood prior to IPAA in case you need blood after your operation.
  • Leaks--Leaks are usually found along suture lines. The most common sites to leak are in the newly formed pouch and at the attachment of the pouch to the anus. A temporary ileostomy is often used to reduce the risk of abscess in the event of a small leak.

Long term complications that may arrise months or years after your operation include:

  • Intestinal Obstruction--Blockage of the intestines by scar tissue, called adhesions, may occur following any abdominal operation. There is a 10-15% chance that this will occur over a lifetime. If an obstruction occurs then about half the time it will resolve on its own and half the time an operation will be necessary to relieve the blockage.
  • Hernia-- A hernia is a protrusion of tissue through a weak spot in your incision. They may occur after any type of operation. Patients who are overweight, who have been on high dose steroids or other immunosuppressive medications and have a wound infection following the operation have a higher risk of developing a hernia. An operation is necessary to repair the hernia.
  • Pouchitis--Inflammation of the pouch. It occurs more commonly in patients with ulcerative colitis and rarely in familial polyposis. Symptoms of pouchitis include: an increase in stool frequency, watery diarrhea, blood in your stools, low grade fever, and urgency. You may feel as though you have the flu or that the ulcerative colitis has reoccurred. This occurs in about 30% of all ulcerative colitis patients. It is most controlled with antibiotics and can occur once or many times. About 10% of patients have chronic pouchitis and require a low dose of antibiotics regularly. Rarely, patients have pouchitis that can not be controlled, and in these cases the pouch may need to be removed. This occurs in only 1-2% of patients and means a permanent ileostomy will be needed. No one knows why pouchitis occurs.

Conclusion

Most patients feel much better following this operation. They have more energy and are free from the worry of having to know where the restroom is everywhere they go. The procedure makes bowel movements predictable. You are able to enjoy a more active lifestyle. Patients can participate in any activity--sports, camping, hiking, travel, swimming, etc.

 

The surgeons here at UNC Hospitals have been performing this procedure for many years. They have much experience in all aspects of the care regarding patients with ulcerative colitis and familial polyposis. We encourage you to speak to patients who have had this operation. We are glad to give you the names of previous patients who are willing to talk to potential patients.

 

There are many support groups in which patients can come involved. There are chapters of the Crohn's and Colitis Foundation (1-800-932-2423) as well as information and newsgroups (alt.support.crohns-colitis and alt.support.ostomy) on the internet. You will always be supported by the GI Surgery team at UNC. You can call them with any concerns or questions.

 

This information has been provided to help patients understand ileal pouch anal anastomosis. You should talk with your physician about any medical advise dealing with your medical diagnosis. The percentages presented in this booklet are representative of national research experience.

Written by the GI Surgery section of the University of North Carolina at Chapel Hill

Diet Guide

Gas Producing Foods:

Milk
Dried beans and peas
Strong cheese (Roquefort, Blue)
Melons
Asparagus
Onions
Nuts
Beer
Carbonated drinks
Broccoli
Cabbage
Cauliflower

Foods That May Increase Output or Cause Diarrhea:

Green leafy vegetables
Caffeinated drinks
Spicy foods
Raw fruit
Broccoli
Beans
Chocolate
Beer

Foods That May Cause Irritation:

Popcorn
Spicy foods
Nuts
Coconut
Raw vegetables
Foods with seeds
Oriental vegetables

Foods That May Decrease Output or Control Diarrhea:

American or Swiss cheese
Low fat Cottage cheese
White rice
Tapioca
Creamy peanut butter
Bananas