Diet after Lower Anterior Resection (Rectal Cancer)

[ColleenC]

Hi everyone,

At the end of November 2016 I had a lower anterior resection to remove a cancerous tumour. The surgery went very well and I did not require an ostomy bag. My tumour was a T2 tumour and therefore I did not require chemotherapy but I did do short course radiation prior to surgery. Three weeks after surgery my small intestine looped down into my pelvis causing an obstruction. The doctors were able to resolve this without surgery however I was put on a low residue diet. After three weeks on the low residue diet I started to have extreme pain again and I ended up going back into the hospital a few more times because the pain was unmanageable. On my final visit they determined that the low residue diet had severely constipated me and I was told to slowly put fibre back into my diet along with 1 teaspoon of metamucil before bed. Slowly things are getting better but I have days where I have several (probably 20 to 30) small bowel movements all day. I understand that eventually my bowel movements will start to cluster and that I can achieve this with my diet. I have had some days when my bowel movements cluster to the morning and the evening which I think is very manageable. I know that I have to learn to live with my new normal however I am hoping that my new normal will involve my bowel movements clustering to one or two times a day. I also have difficulty with urgency, my rectum is now only 1 inch, and I am still very nervous about going anywhere that does not have a toilet near by.

I was wondering if anyone who has been through this would be willing to share with me what worked for them and what didn't. I am journaling my food to help determine what times of food I can and can't eat but I can't seem to make a connection between my good days and my bad days. Any advice you can give me would be greatly appreciated. Thanks!

[ozziej]

Hi Colleen
Sorry that you're having a hard time. If you read my signature you will see that I too am now without a rectum. Unlike many who have loose stool, mine has always tended towards constipation. I'm nearly 2 years out from reversal. It does get better with time but I have certainly felt frustrated and teary at times. I too kept a food/poop diary but like you i never really made a reliable connection. To be honest, i truly believe that time is the thing that makes the most difference. You are only 3 months out and at your stage i too had many days with 20 to 30 toilet stops, even though I had well formed stool. Most days now are between 4 and 6 BMs with very good days being one or two. However I still get the odd day when everything goes crazy and I'm tied to the toilet. The things I've found helpful are: keeping to a very regular dietary pattern including time of eating as well as what I eat; eating plenty of fibrous foods; drinking plenty of water; walking every day, especially after meals; drinking hot drinks if I want to stimulate the bowel to go; resisting every urge to go until i absolutely have to. This encourages the colon tissue to learn to stretch and act as a neo rectum (never as good as the old one but it is much better now than it was at 3 months). I take 1 Dulcolax and 1 Sennekot every evening. The urgency is also much better but still not as good as pre op. My understanding is that my new rectum will never fully be able to relicate the old one due to different tissue and nerve types.
It is very much a trial and error process. For example, in the early days i couldn't eat tomatoes but now they are no problem. And if I really want a clean out i just eat chocolate ice cream and it does the trick nicely You will find what works for you. There is a very good reversal thread on this forum that has lots of tips and ideas. Hang in there and keep posting as we are here to help each other.

[ColleenC]

Ozzie,

Thanks you so much for your reply! I know that I am not alone but sometimes I feel that way. It is such a relief to hear from someone who has been through this. I tend towards the constipation side of things as well. Although I have several BMs a day there are well formed and sometimes difficult to pass. I have spoken to some people who have had colo-rectal cancer but they were all dealing with loose stool so their approach to dealing with this is very different than what I need. I also went to a support group however it was the same thing. All the participants were dealing with loose stool so the focus was on how to bulk their stool up.

I will have to try and see if the chocolate ice cream works for me. That would be a tasty thing to help clean me out. Thank you for all your suggestions and sharing your experience. I will try them out and also I will try to be patient. I am glad to hear that time does help.

Colleen

[ozziej]

Hi Colleen
I thought it might be helpful if I described my diet. You might like to try it and see if it works for you. I make my own breakfast cereal: rolled oats mixed with cinnamon and orange juice then toasted in the oven. Then mix this with All Bran and chopped dried apples and apricots. I use soy milk with the cereal as cow's milk seems to make me more constipated. Never been much of a lunch eater so usually just one large apple. Dinner is often a stir fry of some kind. I use very little meat as large quantities seem to contribute to clustering. I then load up on vegetables: so far i can tolerate broccoli, zucchini, squash, eggplant, red capsicum, baby spinach, mushrooms, baby tomatoes and most importantly avocado. I read somewhere that avocado helps keep the stool slippery so easier to pass. I have experimented with spices and can tolerate curry paste. I have a glass of red wine with my dinner and about three or four decaf coffees each morning. The rest of the day i drink water and lots of camomile tea.
Something i have found helpful is when sitting on the loo if i think I've finished i stand and wait for a while. If I feel another 'contraction ' i sit down again and am often able to pass some more.
Another thing I've noticed is that the 'urgency' is often not real urgency. Where once that painful feeling would have meant get to the toilet asap, post rectum it just seems to mean that the stool has reached the neo rectal area. It's as though the whole peristalsis thing has gone from autopilot to something I'm now very conscious of. I find that if i breathe through a 'contraction' it will often pass.
I have rattled on but i hope some of this info might be helpful.
Cheers

[ColleenC]

Hi Ozzie,

That is very helpful. Thank you! I actually just bought an avocado today because I also read that it may be helpful. I am glad to hear that it is for you. I used to take a fish oil supplement before my surgery, which is also supposed to make the stool slippery, but I can't tolerate it post surgery.

It is interesting to hear that hear that I am not alone with the false urgency. I often feel as if I have to run to the bathroom and I get to the toilet and nothing! Thanks for your strategies. It is just such a strange thing to get used to.

Thanks again,
Colleen