Bowel Habits After Rectal Cancer Surgery: What to Expect

Frequent bowel movements?

Hello Doctor: My father underwent surgery for rectal cancer over a year ago, and all subsequent follow-ups have been normal.
However, his bowel movements are still irregular, ranging from once to several times a day, sometimes affecting his sleep.
Despite eating five meals a day, he is still unable to gain weight.
Is this a normal phenomenon? He is currently taking oral chemotherapy medication, UFT; could this also be affecting him? Thank you for your time and assistance.

Raymond, 30~39 year old female. Ask Date: 2017/12/25

Dr. Ke Fangxu reply Surgery

It is normal for patients who have undergone rectal cancer surgery, which involves the removal of a significant portion of the rectum, to experience frequent bowel movements.
Oral medications can be used to manage the frequency of bowel movements, with a target of around three times a day.
Please ask the surgeon to prescribe medications for your father.
There are also maintenance treatments available post-surgery, such as the use of capsules, which generally have fewer side effects; however, some patients may experience a decreased appetite.
If he can manage to eat five meals a day, that should not be a problem.
The inability to gain weight may also be related to whether there was weight loss prior to surgery.
If there was no weight loss before the surgery, then there is no need to intentionally increase weight post-surgery.

Reply Date: 2017/12/25

More Info

After undergoing rectal cancer surgery, it is not uncommon for patients to experience changes in bowel habits. Your father's situation, where he has variable bowel movements ranging from once to several times a day, is a phenomenon that many patients encounter post-surgery. This variability can be attributed to several factors, including the surgical procedure itself, changes in diet, and the effects of any medications he may be taking, such as oral chemotherapy.

Understanding Bowel Changes Post-Surgery
1. Surgical Impact: Rectal surgery can alter the anatomy and function of the bowel. The removal of a portion of the rectum may lead to changes in how the bowel stores and expels stool. This can result in increased frequency of bowel movements, urgency, or even incontinence in some cases. The nerves that control bowel function may also be affected, leading to altered sensations and control.

2. Dietary Factors: Post-surgery, dietary changes are often necessary. A high-fiber diet is generally recommended to help regulate bowel movements and prevent constipation. However, some patients may find that certain foods can exacerbate diarrhea or lead to gas and bloating, which can further complicate bowel habits. It’s essential to monitor which foods seem to trigger these symptoms and adjust the diet accordingly.

3. Medications: The oral chemotherapy medication, such as the one your father is taking, can also influence bowel habits. Chemotherapy can cause gastrointestinal side effects, including diarrhea, constipation, and changes in appetite. It’s crucial to discuss these side effects with his healthcare provider, as they may need to adjust the medication or provide supportive care to manage these symptoms.

4. Sleep and Quality of Life: The impact of frequent bowel movements on sleep and overall quality of life cannot be understated. If your father is waking up multiple times at night to use the bathroom, this can lead to fatigue and affect his ability to maintain a healthy weight. It may be beneficial to establish a routine that includes a regular eating schedule, which can help regulate bowel movements.

What to Expect and When to Seek Help
While some variability in bowel habits can be expected, it is essential to keep an open line of communication with his healthcare team. If your father experiences any of the following, it may warrant further evaluation:
- Significant Changes: A sudden increase in the frequency of bowel movements or a change in the consistency of stool (e.g., persistent diarrhea or constipation).

- Blood in Stool: Any presence of blood should be reported immediately, as it could indicate complications.

- Severe Abdominal Pain: This could suggest an obstruction or other serious issue.

- Weight Loss: If he continues to struggle with weight gain despite eating adequately, this should be addressed with his doctor.

Management Strategies
1. Dietary Adjustments: Consulting with a registered dietitian can provide personalized dietary recommendations that can help manage bowel habits effectively. They can suggest a balanced diet that includes adequate fiber while avoiding foods that may trigger symptoms.

2. Medication Review: Regularly reviewing medications with his healthcare provider can help identify any that may be contributing to bowel issues. Adjustments or additional medications may be necessary to manage side effects.

3. Bowel Training: Establishing a routine for bowel movements can help. This may include setting aside time after meals to use the bathroom, which can take advantage of the body's natural reflexes.

4. Hydration: Ensuring adequate fluid intake is crucial, especially if diarrhea is present, to prevent dehydration.

In summary, while it is common for bowel habits to be irregular after rectal cancer surgery, it is essential to monitor these changes closely and maintain communication with healthcare providers. With appropriate management strategies, many patients can achieve a more stable and comfortable bowel function, improving their overall quality of life.

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