For those individuals who are wondering why the placement of a temporary ileostomy, Ann (Aqx99) has expressed the reasoning and rationale.
Aqx99 wrote:It was explained to me that the tissue was so fragile after chemoradiation that the temporary ileostomy was needed to allow for proper healing. It's also why I took daily Miralax before my surgery, because even pushing too hard for a bowel movement could have torn my rectum.
Radiation has adverse effects on the soft and connective tissues of the pelvic cavity as well as the remaining rectum and it’s dense muscular layers. Radiation tends to thin the collagen component of tissue, making soft and connective tissues more frail and fragile. This heightens the risk that carefully placed sutures will not hold - causing failure of the anastamosis. Failure of the anastomosis with incomplete healing where there is no temporary ileostomy would lend to leakage of fecal material and bacteria into the abdominal and pelvic cavities with resultant peritonitis and possible systemic sepsis.
It is the adverse effects of radiation for rectal cancer that warrant placement of a temporary ileostomy. The location of the rectal tumor in reference to the anal verge is not a primary deciding factor of whether a temporary ileostomy is placed. It is the Health or lack of health of the soft/connective tissues post radiation that is the deciding factor for the surgeon at the time of the LAR or ultraLAR. A surgeon may make the call for no ileostomy if the pelvic tissues are patent with little/no radiation after effects. But this is a small minority. The potential of a life-threatening sepsis if the anastamois were to fail due to tissue fragility generally takes precedence lending the majority of surgeons to place a temporary ileostomy as a measure of safety.
As people have noted in their individual experiences, the length of time for healing of the anastomosis can vary. Individuals where the pelvic tissues are relatively unscathed by the radiation may have their temporary ileostomies reversed earlier than 6 months. People have different rates of healing. Healing of the anastamosis is tested prior to scheduling of the reversal. A barium study of the resting rectum is performed using fluoroscopy imaging, often referred to as the “leak test.” Barium is infused into the rectum and visualed on fluoroscopy. If no barium leaks into the pelvis the anastomosis is considered sufficiently healed and the reversal scheduled.
While a temporary ileostomy can be frustrating and exhausting, it’s placement is necessitated by the adverse effects of radiation on soft and connective tissue. The transient inconveniences of a temporary ileostomy are far less than the pain and tragedy of a failed anastomosis and sequela of systemic sepsis.
I have a permanent ileostomy. In the 6 years that I have had an ostomy, my stoma has become routine and a part of me - just as my hands and feet are a part of me. Keeping a sense of humor and levity are helpful when you have a stoma sharing space on your abdomen.
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.