What is Proctocolectomy

Proctocolectomy is surgery to remove the rectum and all or part of the colon. The colon is also called the large intestine. This surgery may be done to treat severe inflammatory bowel disease or cancer.

After a proctocolectomy, stool (feces) will no longer be able to leave your body in the usual way. Instead, stool will pass through a permanent or temporary opening (stoma) in your abdomen and into a drainage bag (ileostomy bag) outside your body.

In some cases, the stoma will be temporary, and an internal pouch will also be created in your intestine to collect stool before it exits your body.

The internal pouch will be made from part of your small intestine and will be attached to your anus. After the pouch is allowed to heal for about 12 weeks, waste will be able to pass through the pouch and exit your anus.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Tenderness while in a sitting position. This will decrease over time.
• The bowel being slow to begin working (ileus), causing swelling in the abdomen or vomiting.
• Blockage or scar tissue in the remaining intestine.
• Inflammation of the internal pouch (pouchitis), if one is created.
• Damage to nerves that control erections in men and bladder emptying in both men and women.
• Reduced absorption of nutrients in your intestine. This can result in vitamin deficiencies.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• In the weeks leading up to surgery, drink at least 6–8 glasses of water a day.
• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• In the weeks leading up to surgery, eat a high-fiber diet.
• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.
• In the days before surgery, you may need to take laxatives or enemas to empty your bowels (bowel prep).

General instructions

• Plan to have someone take you home from the hospital or clinic.
• Ask your health care provider how your surgical site will be marked or identified.
• You may have an exam or testing. This may include blood tests, urine tests, or imaging tests such as an X-ray or MRI.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins. Medicines and fluids will be given to you through this tube.
• You will be given a medicine to make you fall asleep (general anesthetic).
• The surgeon may use either a laparoscopic or open technique for this surgery.
  • In the laparoscopic technique, the surgery will be done through small incisions in the abdomen. A thin, lighted tube with a tiny camera on the end (laparoscope) will be inserted into one of the incisions. Tools that are needed for the procedure will be put through the other incisions. This technique allows for a faster recovery time.
  • In the open technique, the surgery will be done through one large incision in the abdomen. Sometimes a surgery that starts as a laparoscopic surgery must be converted to an open surgery.
• Your rectum and colon will be removed. Lymph nodes may be removed as well.
• Then your surgeon will create a stoma in the abdomen for stool to go through as it leaves your body.
• The end of your small intestine will be pulled through the stoma and attached to the skin (ileostomy). The ileostomy may be temporary or permanent.
  • If the ileostomy is temporary, the surgeon will also create an internal pouch (ileoanal reservoir) to take the place of the large intestine. The internal pouch will be made from part of your small intestine and will be attached to your anus. When the pouch heals, waste will be able to pass through the pouch and exit your anus. At that time, a procedure will be done to reverse the ileostomy.
• An ostomy pouch will be attached to your stoma.
• Stitches (sutures) or skin glue will be used to close the incisions.
• The stoma will be covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may continue to receive fluids and medicines through an IV tube for a couple days. Tubes (catheters) will be attached to your bladder and abdomen for drainage of urine and other body fluids.
• You will be given pain medicine as needed.
• You will begin eating and drinking a soft, liquid diet. You will be encouraged to move around as soon as possible.
• You will be taught how to care for your ileostomy bag and stoma.

Proctocolectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain in the abdominal or rectal area, especially when coughing or sneezing.
• Soreness in the rectal area when sitting.
• Redness or swelling around the opening (stoma) in your abdomen.
• A small amount of blood in your stool.
• Drainage or leaking of stool or mucus.
• A feeling that you need to have a bowel movement for a few days after the procedure.
• Temporary sexual dysfunction in men.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Stoma and incision care

• Keep your stoma and the surrounding skin clean and dry.
• Follow instructions from your health care provider about how to take care of your incision and stoma areas. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision and stoma areas every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Follow instructions from your health care provider about changing and cleaning your ostomy pouch.
• Keep supplies to care for your stoma and ostomy pouch with you at all times.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions. This may include:
  • Eating a soft diet.
  • Eating three snacks and three small meals each day, instead of three large meals.
  • Avoiding greasy foods and foods that cause gas.
• Drink enough fluid to keep your urine clear or pale yellow.

Activity

• Rest as needed while the stoma area heals.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Move around as much as possible. Gradually increase your daily activity. Movement is good for recovery and healing.
• Avoid contact sports and activities that require a lot of energy (are strenuous) for as long as told by your health care provider.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that it is safe.
• Do not drive or use heavy machinery until your health care provider approves.

General instructions

• Follow instructions from your health care provider about how to empty or change the ostomy pouch.
• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Wear loose-fitting clothing.
• To reduce the pain when you sneeze or cough, try pressing gently with your palm on the incision area.
• Sit on a soft, foam pillow for comfort. Do not sit for long periods of time.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have pain in your abdomen that does not go away or gets worse.
• You have swelling in your abdomen.
• You have severe diarrhea.
• You have trouble urinating.
• You feel nauseous or you vomit.
• You have not had a bowel movement in several days.
• You have black or tarry stools.
• There is blood in your stool, beyond what is expected for the first few days.
• The skin around the incision is breaking apart.
• You have more redness, swelling, or pain around your stoma or incision.
• You have more fluid or blood coming from your stoma or incision.
• Your stoma or incision feels warm to the touch.
• You have pus or a bad smell coming from your stoma or incision.
• You feel unusual pressure in your rectal area.

Get help right away if:

• You are short of breath.
• You have red, painful, or swollen areas in one or both legs.
• You have chest pain.
• You have a fever.