Helping elderly after bowel surgery
Dealing with Bowel Surgery
For the majority of patients who are told they have bowel cancer, surgery will be an important part of their treatment and still provides the best possible chance of curing the disease
Changes in bowel habit are caused by a change in the length and shape of your colon once a tumour has been removed
Other problems are caused by changes in the shape and ability of the bowel to hold the poo (faeces) once it reaches the end of the bowel, especially if the rectum has been removed or damaged in some way by surgery or radiotherapy treatment.
Small nerves that help to control the movement of the bowel and the muscles of the anus and bladder can be affected during surgery and this can cause problems with leaking of urine and soiling
This may only be a short term issue for you, but in some cases, it can become a longer term problem and may need professional help and treatment to manage and treat effectively
Pelvic floor exercises, relaxation, regular activity and avoiding sitting still for long periods can all help to improve the strength and control of the muscles in the abdomen and pelvis
A controlled diet and taking medicines to change the consistency of the poo (faeces) can also help to make bowel movements more predictable and comfortable to manage.
Regaining Bowel Control Post-Surgery
Faecal incontinence (leaking faeces from the bottom) is much more common than people think, but it is not something that is talked about openly
However there are continence nurses and doctors who specialise in helping people to overcome problems with their bowel control and your ageing parent can ask their GP for a referral to this service
There are exercises which may help your parent regain control. There are also some medicines which may help, if necessary
How the bottom works
There are two rings of muscle wrapped around the anus, called ‘sphincters’
When a stool (faeces, poo) comes into the rectum one of the muscles relaxes and allows the stool to enter the anus
Sensitive nerve endings in the anus can tell someone if it is gas or stool waiting to come out
If it is stool, they squeeze the second muscle to stop it from coming straight out. The squeezing moves the stool back into the rectum, where it waits until they get to the toilet
Your parent may not be able to squeeze enough to hang on if their muscles are weak, or have been damaged by surgery, or they do not squeeze in the correct order, or the nerve supply to the muscles is damaged
There are many different reasons why your ageing parent might develop bowel leakage, or incontinence following treatment for bowel cancer. For example, surgery which involves removing part of the bowel, shortening it or changing its shape, will affect its normal working pattern
It can also change how sensitive the nerve endings around the bowel area are, or in rare cases, cause damage to the anus – the sphincter muscle, which forms the entry into the rectum (back passage)
Chemotherapy treatments can also cause side effects in the bowel and these can take some time to settle down again.
In a few cases, radiotherapy treatments can also cause short term and longer term changes to the way you are used to your bowel working.
Whatever the reason, having a problem controlling your bowels can be upsetting. If your elderly relative has had the distressing experience of a bowel accident in public, they will be acutely aware of the feeling of any pressure or filling sensation in their rectum (back passage), which might mean they will need to find a toilet quickly. It is a natural reaction to try and prevent an accident by either tensing muscles and holding breath, or rushing to find a toilet. A better course of action is to sit, or stand still, breathe deeply and contract the anal sphincter until the urge passes.
Most people find that their emotions have an influence on their bowels
If your parent is worried, or anxious, it can lead to more frequent, more urgent, and looser bowel actions. If they panic when their bowel is full, this can cause the sense of urgency to become even stronger. Their rectum, sphincter muscles and confidence need retraining to help them overcome this problem
Learning to control the sphincter
Exercises can strengthen these muscles, so that they give support again. This will improve bowel control and improve, or stop, leakage of gas, or stool. Like any other muscles in the body, the more they are used and exercised, the stronger they will be. Your parent should try to:
1. Imagine that the sphincter muscle is a lift. When you squeeze as tightly as you can, your lift goes up to the fourth floor. But you cannot hold it there for very long and it will not get you safely to the toilet, as the muscle will get tired very quickly. So now squeeze more gently and take your lift only up to the second floor. Feel how much longer you can hold it than at the maximum squeeze. You may not be able to do this at first. If the urge is too strong, start by trying to delay bowel emptying once you are sitting on the toilet. See how long you can wait until you really have to let go.
2. Sit on the toilet and hold on for as long as you can before opening your bowels. If you can only manage a few seconds, don’t worry, it will become easier with practice. You might find it easier if you try to relax and concentrate on breathing very calmly. It may be helpful to take something to read.
3. Once you are able to delay opening your bowels for a few minutes, the unpleasant urge to go then disappears. Get up and leave the toilet. Return a few minutes later when there is no urge and try to open your bowels. Gradually you will find that you can increase the distance and time away from the toilet. The more you practise this and the sphincter exercises below, the sooner it will happen. Eventually you should find that you are regaining control of your bowels. The longer you can hold on, the more fluid is absorbed from the stools and so the firmer and less urgent they become. When you have some successes, you will become more confident. The less you panic, the easier it is to make the urge go away.
Specific Sphincter Exercises
1. Sit, stand or lie with knees slightly apart. Now imagine that you are trying to stop yourself passing wind from your bowel. To do this, you must squeeze the muscle around your back passage. Try squeezing and lifting that muscle as tightly as you can, as if you are really worried that you are about to leak. You should be able to feel the muscle move. Your buttocks, tummy and legs should not move much at all. You should be aware of the skin around your back passage tightening and being pulled up and away from your chair. You should not need to hold your breath when you tighten these muscles.
2. Tighten and pull up the sphincter muscles as tightly as you can. Hold for at least five seconds and then relax for at least 10 seconds. Repeat at least five times. This will work on the strength of your muscles.
3. Pull the muscles up to about half of their maximum squeeze. See how long you can hold this. Then relax for at least 10 seconds. Repeat at least five times. This will work on the endurance or staying power of your muscles.
4. Pull up the muscles as quickly and tightly as you can, then relax, and then pull up again. See how many times you can do this before you get tired. Try for at least five quick pull-ups. Do these exercises at least 10 times every day. As the muscles get stronger, you will find that you can hold for longer than five seconds, and that you can do more pull-ups each time without the muscles getting tired. Remember that you cannot hold your tightest squeeze for very long, so it is better to use a gentle squeeze that you can hold for longer. Your control will gradually improve. You may need to exercise regularly for several months before the muscles gain their full strength and continue to exercise to maintain your bowel control
The Beating Bowel Cancer Nurse Helpline offers support to patients, their families and carers and answer questions and concerns
Anyone who is worried about any aspect of the disease – whether it’s about symptoms and you don’t know what to do, if your ageing parent has been diagnosed, or have questions about treatment options – then please call our confidential helpline, open from 9am to 5.30pm Monday to Thursday and from 9am to 4pm on Friday: Tel. 08450 719301 (low call rate)
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