Long -term function after colorectal resectionMedical editor Arild Nesbakken MD
Professor of Surgery
Oslo University Hospital
After colon resection
- For right-sided hemicolectomy the stools may be more frequent and the consistency softer, but this is rarely of clinical significance.
- For subtotal and total colectomy as well as ileorectal anastomosis, the patient's stools get much looser than previously, the frequency is typically five times per day. Treatment with Imodium and possibly bulk-forming laxatives are relevant.
After rectal resection
- Protracted urinary retention due to damage of the autonomic innervation of the detrusor muscle of the bladder occurs in up to 5%. In rare occasions this becomes a permanent damage. Treatment with CIC (clean intermittent catheterization) is relevant. The ideal is to start early after surgery if the catheter removal on the fifth day led to urinary retention.
- Impotence/reduced potency occurs in 25-50% of the patients, more frequent the longer distally the tumor was located. The reason is damage of the parasympathetic nervous system, most often by dissection anterolateral blistered /prostate, or by damage to the nerve roots S2-S5 on the pelvic wall. Remedies for erectile dysfunction may be attempted.
- Retrograde or reduced ejaculation occurs in a few patients; this is caused by damage to the sympathetic nervous system at the pelvic entrance (The sympathetic hypogastric nerve).
- Patients who manage to administer a well-functioning end colostomy have as good a quality of life as patients with low colorectal anastomosis.
Feces function/low anterior rectal syndrome (LARS)
After colorectal anastomosis the capacity and compliance of neo-rectum is reduced, the interaction between neo-rectum and the distal rectal mucosa / sphincter muscles are changed and sensibility in the distal rectal mucosa is often changed with reduced sensibility.
This leads to the following changes:
- Frequency - The patient has usually 3-5 bowel emptying per day.
- Urgency - the urge to defecate is coming faster than before. This may be a social problem.
- Incontinence - Light incontinence/soiling is relatively common.
- Fragmentation - Patients rarely manage to complete emptying of the intestine when visiting the toilet, but have to go back one or several times to achieve complete emptying.
All these symptoms are most problematic during the first year and will gradually become better, but the end result is similar to what is mentioned above. All symptoms increases if the patient has had an anastomosis leakage. This will always heal with fibrosis, and the capacity/compliance is greatly reduced.