Managing Colostomy Issues After Rectal Cancer Surgery: A Guide

Issues related to colostomy in rectal cancer?

My father, who is 62 years old, was diagnosed with rectal cancer about the size of a 50 NT dollar coin.
He underwent surgery around May 20, and there was no spread to the lymph nodes, so he did not receive radiation therapy.
The stoma was created at the anus, making it uncomfortable for him to sit, and he is unable to gain weight.
He also has urinary issues, leading to incontinence.
Which specialty should he consult to improve his condition? Are there any tests that need to be done now? Is it still possible to create a colostomy at the anal area? Currently, he needs to change his ostomy bag every 2 to 3 hours, which is very inconvenient.
We are unsure of what to do.
Thank you!

Lingling, 30~39 year old female. Ask Date: 2000/10/06

Dr. Li Junde reply Surgery

Dear Ms.
Ling,
I apologize for the delay in responding to your email due to the hospital's computer system update.
I would like to address your father's issue regarding postoperative urinary incontinence.
This can occur in some patients following rectal cancer surgery.
I recommend consulting with the original surgeon or a urologist to check for any additional urinary tract issues that may need to be addressed for improvement.
If rectal cancer is detected early and has not metastasized to the anal area, the preferred approach is still to manage it conservatively.
If your father is experiencing frequent bowel movements, dietary modifications may help, and normal patterns may return after some time.
However, if there is no improvement, please take him back to the original surgeon for further evaluation and treatment options.
Best regards.

Reply Date: 2000/10/06

More Info

Managing colostomy issues after rectal cancer surgery can be challenging, especially for patients like your father, who is experiencing discomfort and complications. Here’s a comprehensive guide to help you navigate this situation.

Understanding Colostomy
A colostomy is a surgical procedure that creates an opening (stoma) in the abdominal wall to allow stool to exit the body when the rectum or part of the colon has been removed or is not functioning properly. In your father's case, it seems that the colostomy was performed due to rectal cancer, and it is located near the anal area, which can indeed make sitting uncomfortable and complicate daily activities.

Common Issues with Colostomy
1. Skin Irritation: The area around the stoma can become irritated due to the adhesive used in colostomy bags or from stool leakage. It's essential to keep the skin clean and dry, and to use barrier creams if necessary.

2. Frequent Changes: Needing to change the colostomy bag every 2-3 hours can be inconvenient and may indicate that the bag is not fitting properly or that there is excessive output. This can be due to dietary choices, hydration levels, or other medical issues.

3. Dietary Concerns: Patients often experience changes in appetite and weight after surgery. It's important to maintain a balanced diet that includes adequate protein, fiber, and hydration. Consulting a dietitian who specializes in oncology can provide tailored dietary advice.

4. Urinary Issues: If your father is experiencing urinary incontinence or other urinary problems, this may require evaluation by a urologist. Sometimes, urinary issues can be related to the surgical procedure or the positioning of the colostomy.

Recommended Actions
1. Consult a Colorectal Surgeon: Since your father has undergone surgery for rectal cancer, it would be beneficial to follow up with his colorectal surgeon. They can assess the stoma, ensure it is functioning correctly, and discuss options for improving comfort and management.

2. Visit a Wound, Ostomy, and Continence Nurse (WOCN): These specialized nurses can provide invaluable support in managing colostomy care, including fitting the right type of bag, teaching proper skin care techniques, and addressing any complications.

3. Nutritional Assessment: A registered dietitian can help your father with meal planning to ensure he is getting enough nutrients to maintain his weight and health. They can also suggest foods that may help regulate stool output.

4. Urology Consultation: If urinary issues persist, a urologist can evaluate your father's urinary system and recommend treatments or interventions to improve his condition.

Colostomy Bag Management
- Choosing the Right Bag: There are various types of colostomy bags available, including one-piece and two-piece systems. A WOCN can help determine which type is best suited for your father’s needs.

- Changing the Bag: It’s essential to change the colostomy bag regularly to prevent skin irritation and odor. If the output is high, consider using a bag designed for high-output situations.

- Monitoring Output: Keeping track of the output can help identify any dietary issues or complications. If the output is consistently high, dietary adjustments may be necessary.

Conclusion
Managing a colostomy after rectal cancer surgery requires a multidisciplinary approach. By consulting with healthcare professionals such as colorectal surgeons, WOCNs, dietitians, and urologists, your father can receive comprehensive care tailored to his specific needs. It’s important to address any discomfort or complications promptly to improve his quality of life. Encourage open communication with his healthcare team to ensure all concerns are addressed effectively.

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