Post-Colon Cancer Complications: Adhesions and Bowel Incontinence Solutions

Q: Post-Colon Cancer Complications: Adhesions and Bowel Incontinence Solutions

Hello, Sir：<br>Question 1： Regarding new technologies, it would be better to consult a surgeon for more clarity.<br>Question 2： Postoperative adhesions are often caused by previous abdominal surgeries, pelvic inflammatory disease due to infections, or even as a result of chemothe

Postoperative intestinal adhesions after colorectal cancer surgery?

Hello, Doctor.
My father was diagnosed with stage II colon cancer four years ago.
He initially underwent chemotherapy to shrink the tumor before having surgery to preserve his anus, which unfortunately resulted in fecal incontinence.
However, subsequent tests showed no issues.
Recently, he was hospitalized for seven days due to severe intestinal adhesions and subsequently underwent surgery to remove part of the necrotic tissue.
I have a few questions:
1.
Besides physical rehabilitation techniques, are there any new surgical methods available to improve the quality of life for patients experiencing fecal incontinence after colon cancer surgery?
2.
Could the intestinal adhesions be a result of the previous chemotherapy or the surgery?
3.
After the surgery for the adhesions, the doctor mentioned that my father's small intestine is only 120 cm long (normal is about 300 cm), but he did not know why it is so short.
Could this be one of the reasons for his fecal incontinence? What can family members do to help the patient enhance nutrient absorption given the short length of the small intestine?
I apologize for asking so many questions, and I greatly appreciate Director Lai taking the time to respond! Thank you!

Zi, 30~39 year old female. Ask Date: 2016/02/03

Dr. Lai Yicheng reply Oncology

Hello, Sir:
Question 1: Regarding new technologies, it would be better to consult a surgeon for more clarity.
Question 2: Postoperative adhesions are often caused by previous abdominal surgeries, pelvic inflammatory disease due to infections, or even as a result of chemotherapy, radiation therapy, or electrical therapy.
Generally, patients develop adhesions mainly due to undergoing laparotomy, which can lead to pain, reduced mobility, and the effects of anesthesia.
In the case of laparoscopic surgery, bleeding and clot formation can occur postoperatively, leading to adhesions.
Typically, when organs are removed, surrounding tissues may exhibit a non-bacterial inflammatory response.
Additionally, pelvic inflammatory infections can lead to the presence of pus, all of which can contribute to the development of intestinal adhesions.
Question 3: The patient is advised to eat small, frequent meals consisting of soft foods such as congee and steamed eggs.
It is recommended to supplement with a nutrient-rich drink like Ensure between breakfast and main meals to aid intestinal absorption.
A light diet is suggested, avoiding irritating foods.
If bloating occurs, it is advisable to reduce the intake of gas-producing foods and beverages, such as legumes, potatoes, and sweet potatoes.
(1) A low-fat, low-residue diet is recommended, including oil-free white bread and crackers.
(2) Foods high in oxalates, such as chocolate, spinach, sweet potatoes, plums, strawberries, and grapes, should be avoided to prevent hyperoxaluria.
(3) It is best to avoid caffeinated beverages, smoking, and alcohol.
Fruit juices can be consumed but should be diluted with an equal amount of water.
Balanced nutritional supplements that aid intestinal absorption, such as Ensure, can be taken between main meals.
Changhua Hospital cares about you.
Director Lai Yi-Cheng, Department of Radiation Oncology

Reply Date: 2016/02/03

More Info

Post-colon cancer complications, particularly bowel incontinence and adhesions, can significantly impact a patient's quality of life. Your father's situation, having undergone treatment for stage II colon cancer and subsequently facing complications, is not uncommon. Let's address your questions one by one.

1. Improving Bowel Incontinence: Bowel incontinence after colorectal surgery can be distressing. While physical rehabilitation techniques, such as pelvic floor exercises, are commonly recommended, there are also newer surgical options available. One such option is the implantation of a sacral nerve stimulator, which can help regulate bowel function by stimulating the nerves that control bowel movements. Additionally, some patients may benefit from procedures like colostomy or ileostomy reversal if appropriate. It's essential to have a thorough discussion with a colorectal surgeon who specializes in these conditions to explore the best options tailored to your father's needs.

2. Causes of Adhesions: Adhesions can form after any abdominal surgery, including those for cancer treatment. They are fibrous bands of scar tissue that can develop between organs and tissues, often as a result of the healing process. While chemotherapy itself is not a direct cause of adhesions, the surgical procedure is a significant factor. The manipulation of tissues during surgery can lead to inflammation and subsequent adhesion formation. It's crucial to monitor for symptoms of bowel obstruction, which can occur due to these adhesions.

3. Shortened Small Intestine: A small intestine length of 120 cm is indeed shorter than the average length of approximately 300 cm. This shortening can be a result of previous surgeries, especially if portions of the intestine were removed due to cancer or complications. A shorter small intestine can lead to malabsorption issues, which may contribute to bowel incontinence and other gastrointestinal symptoms. To support your father's nutritional needs, consider the following strategies:
- Frequent, Small Meals: Encourage him to eat smaller, more frequent meals rather than large ones to ease digestion.

- Nutrient-Dense Foods: Focus on foods that are high in calories and nutrients, such as avocados, nuts, and smoothies, to ensure he gets adequate nutrition despite the reduced absorption capacity.

- Hydration: Ensure he stays well-hydrated, as this can help with digestion and overall health.

- Consult a Dietitian: A registered dietitian can provide personalized dietary recommendations based on his specific needs and conditions.

In summary, your father's post-operative complications are complex and require a multidisciplinary approach for management. Engaging with healthcare professionals, including surgeons, gastroenterologists, and dietitians, will be crucial in addressing his needs effectively. It's essential to maintain open communication with his medical team to explore all available options for improving his quality of life. Thank you for your thoughtful questions, and I wish your father the best in his recovery journey.

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