How long after takedown to begin step one of bowel training?

[wifeandmom]

My ileostomy takedown was Thursday, Dec. 23. My colon had been "off-line" for a year and two days. First poop after the surgery was Saturday evening. Got to go home on Sunday (yeah!!!!). Since then, it's been .... an interesting learning experience. Stools are usually completely liquid. Depending on the time of day/night, I can usually get to the bathroom in time. Keeping the food bland: bagels, chicken and rice, pasta, Activia.

I know I need to call my surgeon in the morning and make sure it's okay, but in your experience is this too early or not to begin the MD Anderson "Changing Loose Stools to Formed Stools" part of the training?

Also, I'm curious how other have handled getting enough liquids in. If I understand correctly, it's better to wait an hour after eating before drinking. Does that mean it's better not to drink for an hour before eating as well?

Thank you for your continuing support! As I think I said in a previous post, this is a lonely process. Even with loving family around, there really is nothing they can do regarding the management of this particular phase of our recovery.

[stexcanuck]

MDA says take no more than 8 oz water with your meals, then take soluble fibre supplement with only 2 oz water with no other fluids for an hour, and then for bowel training says take a cup of hot liquid after your main meal..... I am in need of clarification as well! Isn't this a roller coaster? You are not alone, if that makes it any easier.

[SoCalSaz]

I know what you mean, it can be a lonely process. I find it's some consolation in the bad moments if I can remember to tell myself "this, too, shall pass" and "I am not the only person who's ever gone through this." Also, I try to remember to breathe slowly and deeply through my nose... it can also be calming during the rough, painful patches.

As far as beginning bowel management (which I believe is actually a distinct process from bowel training, which I think they advise to begin later), my reading of the Anderson protocol is that you should be on Imodium (or Lomotil) first to get things under control (or at least somewhat under control!) before moving on to adding fiber to the mix. At that point, you can gradually increase the fiber upward while decreasing the anti-diarrhea medication.

The issue of liquid intake has been a little tricky in my book, especially as I tend to flip very easily back and forth between diarrhea and constipation. In those first few weeks, I did avoid liquid before a meal as much as after a meal... this worked OK for a few weeks, but then I think it started to make me constipated, so I stopped being quite so strict with my liquid intake and that helped (at least till I went on chemo, which has made everything a bit unpredictable again!).

Of course, my tendency toward constipation may not apply to you -- my tumor was quite high, at the rectosigmoid juncture, so my surgeon was able to retain about half my rectum, and my digestive system in general has had a tendency toward constipation for years, so what has worked (or not) for me may be different from you. It's all a bit of trial and error, which I know I realized intellectually going into this, but have found difficult to accept emotionally sometimes!

[Surroundedbylove]

My surgeon didn't want me on Imodium for at least two weeks post surgery and he wanted me on Immodium prior to starting bowel management. I think you can do the food parts of bowel management earlier - oatmeal, soluble fiber, etc. - just not the supplements and drug parts.

Also, I noted the Activia comment. Recently there was a big fine against Dannon for the marketing of Activia. I suggest reading up on that. I don't think Activia is critical. Yogurt may be helpful but for other reasons than the probiotic claims of Activia. I'd actually suggest using a yogurt with no added sugar.

[wifeandmom]

Happy New Year! For anyone who wanted to follow along, here's how things have been going for the first week into my straight colo-anal anastomosis ileostomy reversal.

Following my update on Tuesday, I called the next day and spoke to the nurse in my surgeon's office who said it was time to begin the Immodium. She wanted me to take two pills before breakfast, lunch, and dinner, and another two before bed. She also wanted me to start with probiotics. And she recommended yogurt. Given the time that she and I spoke, there was only time for the pre-dinner Immodium, and the bedtime dose. Thursday was a mighty rocky day! Lots of abdominal pain (especially in the former stoma area, and in waves, which led me to believe that the pain was associated with progress of food through the area). The pain was accompanied by nausea which grew progressively worse during the day. Needless to day, I didn't take Immodium. I couldn't eat anything at all, and wasn't even able to keep down tea or Gatorade. Since calls to the surgeon's office went unreturned, we called the hospital (as instructed) and asked for the on-call doctor covering the colorectal surgical service. The young doctor was quite concerned about dehydration (we were, too). He suggested that I go back on the pain meds (I'd stopped taking them the day after I came home from the hospital), take some anti-nausea meds and try to just relax. I was able to fall asleep.

The next day, Friday, I was feeling a bit better. Stayed with the pain and anti-nausea meds, started ice chips, stayed away from Immodium. Things progressed well through the day. I was ultimately able to keep down some soup, Gatorade, and popsicles. Felt almost human again by New Year's Eve. This morning, I tried a half of a bagel, more Gatorade, water, then later some soup. I pooped a little bit a few times so we could rule out a blockage. By dinner time, it was time to try just one Immodium before dinner (per. doctor's orders) and then I was able to really enjoy cheese ravioli. Everything stayed down. The nausea is essentially gone. So one more Immodium before bed and I'm ready to see what tomorrow brings.

So, it's been just over a week and I've learned:
Immodium is really strong!
Dehydration is bad.
Baby wipes are good.
Take pain meds if I'm in pain.

If keeping up with these reports is helpful, I'll be happy to continue. If not, I can just wait til I have a question or a .... I don't know..... an unusual exerience.

Thank you again for the advice, suggestions, and encouragement!

[Surroundedbylove]

Take pain meds if I'm in pain.

If keeping up with these reports is helpful, I'll be happy to continue. If not, I can just wait til I have a question or a .... I don't know..... an unusual exerience.

Thank you again for the advice, suggestions, and encouragement!

I would suggest starting a thread for a Takedown Info - Straight Coloanal Anastomosis and include as the beginning post your background and info and then keep it up. BrownBagger's thread was very helpful and I know mine has helped many people too. Seeing the progression and the trial and error of one person through the entire thread is more helpful than separate posts - kind of a mini-blog on the topic.

Since you have the straight coloanal anastomosis, your experience may be slightly different than those of us with colonic j-pouches so you'll help others with connections like your's.

SBL

[SoCalSaz]

Imodium can really affect me strongly, too. When I started off post-takedown with the first suggested dose of 2, I was constipated for several days. I've learned now to start with 1, and sometimes even with just half of one (especially if I'm taking pain and/or anti-nausea meds), and then work my way up from there.

And yeah, watch out for the dehydration. I've ended up in ER once and nearly had to go a second time the other day from not being diligent about my fluid intake. It's hard to remember (at least for me) when I'm not following my usual routine of work, errands, etc., but it's definitely something to stay on top of.

Keep at it, just one day at a time, like you're doing!

[BrownBagger]

The pain meds are probably contributing to the constipation. I've never been constipated from Immodium, I don't think. Pain meds--plenty of times. You might want to experiment with Metamucil. Try a little when you take the pain pills. Just don't overdo it & be aware that it takes a few hours to kick in. Basically, it just lubes everything up so it slides out easier. Overdo it and you might have continence problems. Check with your doctor first--a phone call to the office is usually all it takes. The nurse with check with the doc and get back to you.

The thing you need to remember is that your body is trying to adapt to the new plumbing. It's going to take months, if not years, to settle into a "normal" routine. It should become manageable before long, but you'll be adapting to constant change (and improvement) over the next year--and probably longer. I'm 17 months post-reversal and it's still an adventure from time to time. Nothing bad--just different.

[stexcanuck]

I had my reversal 12/13. I went a week and a half after coming home letting the new plumbing run freely trying to ensure that it was fully functioning, and the tried immodium for the first time New Years Eve day. I took 2 tabs to start in the am, which pretty much immediately slowed things down, and then 1 12 hrs later so I could venture out for the 2nd time since coming home. This combined effect has allowed me to have a) a much longer transit time b) actually being able to feel stool coming along, and not rushing to the bathroom c) better formed stools, and d) actually being able to start using the push muscles.
I have not taken immodium since, as I actually was worried that I'd "stopped things up" for awhile as yesterday am I had a few small movements and then went all day without the urge, but then have resumed again this am. Thus, for me, 3 pills actually had a pretty long term effect, not eliminating movements, but definitely slowing them down and allowing some control back. I've not gotten into the training for a set time yet. I think that the best bet is to introduce the immodium in slowly, just like watching your trigger foods, and take on an "as needed" basis vs. a set time regimine. I am trying to get it figured out on the go as well, so I'm no expert by far, but this definitely has helped with the urgency issues without flipping me to contipation (so far, knock on wood!).
We're each individuals, so what works for one may not for the other, but I hope this helps. Good luck.