Proctectomy (not colectomy)
Abdominoperineal resection (also called APR). APR used to be the standard surgery for tumors of the lower rectum. Now, it is usually limited to large tumors that lie very low down in the rectum and affect the muscles of the anal sphincter. It requires 2 incisions. The surgeon makes one through your abdomen. The second goes around your anus in the perineum. This is the area surrounding your anus and genitals. During an APR, the surgeon removes your anus, rectum, and the surrounding muscles of the anal canal. Because the muscles of your anal sphincter are removed, you do not regain normal bowel function. That means you will need a colostomy. This creates an opening on your abdomen where waste can leave your body and collect in a bag.
I've been told to expect about 4 weeks of pain, with one week in the hospital. There will be some home nursing to aid with the stoma appliance.
So, again asking for any tips or knowledge on what to expect and what questions I should ask at the pre-surgical appointment (on te 5th).
Thanks,
Comments
-
Buck -
Re:
"During an APR, the surgeon removes your anus, rectum, and the
surrounding muscles of the anal canal. Because the muscles of
your anal sphincter are removed, you do not regain normal bowel function. "
That's the standard (if not verbatim) explanation. The only problem,
is that you can have "sphincter-saving surgery" with all types of
anal/rectal surgery, and doing so -will- make your life easier.
I spent over four years reading at that UOAA forum, and the information
they provide there can be of extremely great value to any ostomate.
In fact, the information there is invaluable to anyone about to have any
type of radical intestinal surgery.
There's a fella' from the UK (Terry G), that's very informed and can give you
some serious insight.
(UOAA sphincter-saving sample thread)
Best wishes,
John0 -
PS:
In your last thread regarding this, you said:
Re:
"No need to go over the ostomy portion"
Regardless if you already have an ostomy, or about to get one,
you really oughta' take some time now, and make sure they
will place it in a position that is correct for you.
There is a "four by four" rule that many colorectal surgeons use,
where the stoma is placed 4" to the side of the navel, and
4" below the waistline. That is usually the best spot, provided
you don't have any folds in the skin in that area.
The surgeon should have a nurse mark off the best spot for an
ostomy well in advance of the operation, even if an ostomy isn't
planned. I have an ostomy that wasn't planned, and many, many
thousands of others do as well..
That UOAA forum I gave you a link to, is well worth your time
to read at.
Good luck, and better health!
John0 -
OstomyJohn23 said:Buck -
Re:
"During an APR, the surgeon removes your anus, rectum, and the
surrounding muscles of the anal canal. Because the muscles of
your anal sphincter are removed, you do not regain normal bowel function. "
That's the standard (if not verbatim) explanation. The only problem,
is that you can have "sphincter-saving surgery" with all types of
anal/rectal surgery, and doing so -will- make your life easier.
I spent over four years reading at that UOAA forum, and the information
they provide there can be of extremely great value to any ostomate.
In fact, the information there is invaluable to anyone about to have any
type of radical intestinal surgery.
There's a fella' from the UK (Terry G), that's very informed and can give you
some serious insight.
(UOAA sphincter-saving sample thread)
Best wishes,
John
Thanks John,
Already bookmarked UOAA, and spent an hour with an ostomy nurse and expect to do it again before the surgery.
I am 6'4", about 250lbs, and a bit low waisted, so it looks like it will go above the belt line.0 -
Here is my story
I had similar surgery plus a hysterectomy March 2010.
I was on a morphine pump while in the hospital for pain management. The only real pain I had was when they messsed with the drains. Apparently one of them was very near a nerve. Once they started just emptying them and not clearing the tube I was ok.
I had to have a second surgery while there due to twisted bowel, so my stay went from the expected 1 week to 2. Someone else mentioned the pillow trick. My nurse took surgical tape and wrapped a pillow tightly. Holding it against surgical site was a help. At home I just used a decorative bed pillow.
They want you up and walking as soon a possible, and want output from the stoma. They bring you back to solid food slowly. The hospital food was more than I could stand to smell much less eat. I think some of that was the meds. If you have similar problem, perhaps someone can bring you in a favorite.
I can't say that the pain was bad even after going home with just pill meds. I stopped taking them within a week.
I found that it was very uncomfortable to lay in the bed. I spent the first few weeks in a recliner which kept me on my back with feet elevated.
Eat plenty of protein...meat, cheese, peanutbutter, etc. It promotes healing.
If you have any specific questions, ask away.
Marie who loves kitties0 -
Buck........I had exact same procedure.....Lovekitties said:Here is my story
I had similar surgery plus a hysterectomy March 2010.
I was on a morphine pump while in the hospital for pain management. The only real pain I had was when they messsed with the drains. Apparently one of them was very near a nerve. Once they started just emptying them and not clearing the tube I was ok.
I had to have a second surgery while there due to twisted bowel, so my stay went from the expected 1 week to 2. Someone else mentioned the pillow trick. My nurse took surgical tape and wrapped a pillow tightly. Holding it against surgical site was a help. At home I just used a decorative bed pillow.
They want you up and walking as soon a possible, and want output from the stoma. They bring you back to solid food slowly. The hospital food was more than I could stand to smell much less eat. I think some of that was the meds. If you have similar problem, perhaps someone can bring you in a favorite.
I can't say that the pain was bad even after going home with just pill meds. I stopped taking them within a week.
I found that it was very uncomfortable to lay in the bed. I spent the first few weeks in a recliner which kept me on my back with feet elevated.
Eat plenty of protein...meat, cheese, peanutbutter, etc. It promotes healing.
If you have any specific questions, ask away.
Marie who loves kitties
I had tumor to low to save rectum so there were 2 incisions made on each side of it and 5 holes in my stomach (laproscopically done) everything from inner spincter muscle , rectum, and I have an ostomy from my sigmoid. My tumor was low enough clear margins were not possible without the bag so poof, bag....As far as pain, you will want to elevate your tush to prevent any pressure being placed on it. I found that a pillow (when laying in bed) tucked as far up under the tush as possible with actually touching it is most comfortable...It will feel as though a pair of socks have been sewn up inside your tail but that is simply where they have to fold under and sew together. They most likely will leave a small drainage hole down there somewhere to allow healing fluid that the body secretes while its under mend to drain off so that pressure doesn't build up causing more pain. I had some buildup and it kept getting tougher and tougher to get relief until one day when I bent down to pick something up evidently it released and it looked as though I had peed in my pants , it was simply the fluid escaping and what a relief that was...Next,Standing up about 30 minutes at first then progressively got better as I went along... Sitting, forget it for a while, hurts like a mutha, I drove in 2 weeks holding my tail up off the seat with my other leg...not good, so I gave up and just laid around. I think I was down for 8 weeks total and went back to work after my post op chemo was done. If no chemo then most likely 6-8 weeks of off time then whatever you can handle...carefully...
I went in on a Tuesday and went home Friday...You have to be off Morphine, be able to urinate without a catheter, and your new bowel must function properly...so after the second day get rid of the morphine, and have them remove the catheter, and eat 5 cups of jello and I promise that your bowel will wake up...Don't let it scare the crap out of you. It will flutter like bumblebees but that tells ya it works...The next morning the ostomy nurse will come in and show you all the basics for taking care of your new butt...Its a piece of cake bud..aggravating some times but for the most part easy ..As I got off the morphine then came the script of Lortab...Use em, thats what they're for, pain and being uncomfortable. This will be a lengthy healing process but it will get to where you can sit for a while in a cushioned chair. Just take your time and deal with things as they come....Oh, and BTW, Viagra or Cialis takes care of any side effects you may have from surgery...
Issues with this type of surgery.....
(1) infection.....about 5% chance
(2) wound opening back up...10%
(3) Libido loss or inability to have an erection or ejaculation......50%
(4) Horse riding will be out of the question for hmmm...a year most likely...
If ya got any more questions about things just throw em out here or pm me and I will throw some answers back at ya...
1 more thing...the hospitals like to come in at all different hours of the night getting blood pressures , vitals , etc...Have a talk with them and instead of them coming in at all hours of the night ask them to all come in at one time and get it all...trust me you will sleep much better...also you will be getting heparin shots as well...Im thinking it is a blood thinner to prevent clots during recovery, simple taken behind the arm or in the stomach, never feel a thing..Thats it my friend.....Happy Trails to ya.......Buzz0 -
BuzzBuzzard said:Buck........I had exact same procedure.....
I had tumor to low to save rectum so there were 2 incisions made on each side of it and 5 holes in my stomach (laproscopically done) everything from inner spincter muscle , rectum, and I have an ostomy from my sigmoid. My tumor was low enough clear margins were not possible without the bag so poof, bag....As far as pain, you will want to elevate your tush to prevent any pressure being placed on it. I found that a pillow (when laying in bed) tucked as far up under the tush as possible with actually touching it is most comfortable...It will feel as though a pair of socks have been sewn up inside your tail but that is simply where they have to fold under and sew together. They most likely will leave a small drainage hole down there somewhere to allow healing fluid that the body secretes while its under mend to drain off so that pressure doesn't build up causing more pain. I had some buildup and it kept getting tougher and tougher to get relief until one day when I bent down to pick something up evidently it released and it looked as though I had peed in my pants , it was simply the fluid escaping and what a relief that was...Next,Standing up about 30 minutes at first then progressively got better as I went along... Sitting, forget it for a while, hurts like a mutha, I drove in 2 weeks holding my tail up off the seat with my other leg...not good, so I gave up and just laid around. I think I was down for 8 weeks total and went back to work after my post op chemo was done. If no chemo then most likely 6-8 weeks of off time then whatever you can handle...carefully...
I went in on a Tuesday and went home Friday...You have to be off Morphine, be able to urinate without a catheter, and your new bowel must function properly...so after the second day get rid of the morphine, and have them remove the catheter, and eat 5 cups of jello and I promise that your bowel will wake up...Don't let it scare the crap out of you. It will flutter like bumblebees but that tells ya it works...The next morning the ostomy nurse will come in and show you all the basics for taking care of your new butt...Its a piece of cake bud..aggravating some times but for the most part easy ..As I got off the morphine then came the script of Lortab...Use em, thats what they're for, pain and being uncomfortable. This will be a lengthy healing process but it will get to where you can sit for a while in a cushioned chair. Just take your time and deal with things as they come....Oh, and BTW, Viagra or Cialis takes care of any side effects you may have from surgery...
Issues with this type of surgery.....
(1) infection.....about 5% chance
(2) wound opening back up...10%
(3) Libido loss or inability to have an erection or ejaculation......50%
(4) Horse riding will be out of the question for hmmm...a year most likely...
If ya got any more questions about things just throw em out here or pm me and I will throw some answers back at ya...
1 more thing...the hospitals like to come in at all different hours of the night getting blood pressures , vitals , etc...Have a talk with them and instead of them coming in at all hours of the night ask them to all come in at one time and get it all...trust me you will sleep much better...also you will be getting heparin shots as well...Im thinking it is a blood thinner to prevent clots during recovery, simple taken behind the arm or in the stomach, never feel a thing..Thats it my friend.....Happy Trails to ya.......Buzz
I am so impressed with you. You just made a major life change sound so workable. You're amazing if no one has told you that.
Gail0 -
BuzzBuzzard said:Buck........I had exact same procedure.....
I had tumor to low to save rectum so there were 2 incisions made on each side of it and 5 holes in my stomach (laproscopically done) everything from inner spincter muscle , rectum, and I have an ostomy from my sigmoid. My tumor was low enough clear margins were not possible without the bag so poof, bag....As far as pain, you will want to elevate your tush to prevent any pressure being placed on it. I found that a pillow (when laying in bed) tucked as far up under the tush as possible with actually touching it is most comfortable...It will feel as though a pair of socks have been sewn up inside your tail but that is simply where they have to fold under and sew together. They most likely will leave a small drainage hole down there somewhere to allow healing fluid that the body secretes while its under mend to drain off so that pressure doesn't build up causing more pain. I had some buildup and it kept getting tougher and tougher to get relief until one day when I bent down to pick something up evidently it released and it looked as though I had peed in my pants , it was simply the fluid escaping and what a relief that was...Next,Standing up about 30 minutes at first then progressively got better as I went along... Sitting, forget it for a while, hurts like a mutha, I drove in 2 weeks holding my tail up off the seat with my other leg...not good, so I gave up and just laid around. I think I was down for 8 weeks total and went back to work after my post op chemo was done. If no chemo then most likely 6-8 weeks of off time then whatever you can handle...carefully...
I went in on a Tuesday and went home Friday...You have to be off Morphine, be able to urinate without a catheter, and your new bowel must function properly...so after the second day get rid of the morphine, and have them remove the catheter, and eat 5 cups of jello and I promise that your bowel will wake up...Don't let it scare the crap out of you. It will flutter like bumblebees but that tells ya it works...The next morning the ostomy nurse will come in and show you all the basics for taking care of your new butt...Its a piece of cake bud..aggravating some times but for the most part easy ..As I got off the morphine then came the script of Lortab...Use em, thats what they're for, pain and being uncomfortable. This will be a lengthy healing process but it will get to where you can sit for a while in a cushioned chair. Just take your time and deal with things as they come....Oh, and BTW, Viagra or Cialis takes care of any side effects you may have from surgery...
Issues with this type of surgery.....
(1) infection.....about 5% chance
(2) wound opening back up...10%
(3) Libido loss or inability to have an erection or ejaculation......50%
(4) Horse riding will be out of the question for hmmm...a year most likely...
If ya got any more questions about things just throw em out here or pm me and I will throw some answers back at ya...
1 more thing...the hospitals like to come in at all different hours of the night getting blood pressures , vitals , etc...Have a talk with them and instead of them coming in at all hours of the night ask them to all come in at one time and get it all...trust me you will sleep much better...also you will be getting heparin shots as well...Im thinking it is a blood thinner to prevent clots during recovery, simple taken behind the arm or in the stomach, never feel a thing..Thats it my friend.....Happy Trails to ya.......Buzz
Just what I was looking for! I may stay on the morphine a bit longer (like to think I'm a wimp) but I will try to remember the Jello trick!
I will have both the iPad and the laptop in the hospital, so I will try to keep in touch!0 -
1 more detail........or maybe 2Buckwirth said:Buzz
Just what I was looking for! I may stay on the morphine a bit longer (like to think I'm a wimp) but I will try to remember the Jello trick!
I will have both the iPad and the laptop in the hospital, so I will try to keep in touch!
remember, your intestine does not have any nerve tissue so it will not hurt at all. The stitches around the stoma will slightly but the arse will be the major malfunction...I will try and keep you abreast of anything else I come up with but right now thats the major milestone to get passed...it will mess with your mind as not having to sit down as we always did to take the daily "dump" that men are normally so proud of...I have the remedy for that as well...Simply, every so often, especially in the morning, when you go to urinate, drop the drawers and sit down as though its howdy doody time...LOL...I call it "phantom crapping" its something your body has involuntarily done all your life and by imitating that move even if there is no bowel there it somehow gives me the "mental" fix I need to help be ok with crapping in a sack....
and the only way to be completely ok with a bag, is to simply not try to hide it...its you now, and will always be a part of who you are now, you will win this battle but at a very small cost, a bag...so what...ya know ...at least I know when my arse is clean now and colonoscopies now are a breeze...I also fold my bag halfway up when I go out and it allows me to tuck my shirt in with little or no bulge...you will have accidents, but make light of them, laugh about it, might as well...let me ask you this ...you ever crapped in your shirt ? I have and it ain't fun trying to take it of when theres no buttons...but its doable.......ya see Buck, its tha little things in life that are so much fun. This is one that you learn as you go...... keep smilin' bud............Buzz0 -
Thank you Gail.......plh4gail said:Buzz
I am so impressed with you. You just made a major life change sound so workable. You're amazing if no one has told you that.
Gail
There is a little boy at Vandy Childrens Hospital that taught me a lot of things about being happy with whatever life throws at ya......and the thing is, he never said a word, he simply looked at me and smiled....now, to be able to do what he did, thats whats amazing, and I intend on doing just that no matter what happens in my life, be happy with what I have no matter where it takes me......and for you as well my dear, I really think that until we are faced with the reality of mortality then we never gain the insight of what our lives really mean to us. Use that insight we find to our advantage and try to make people understand just what they miss when they take life so for granted. Smile at them and tell them how beautiful they are as I will you, knowing that there is nothing to be embarrassed about but simply expressing to others what you always were afraid to say before. I view it as a second chance for me to do something with my life, no matter how long or short the duration is, but the enormity of laughter, love and memories that I can bring to people hearts and minds that will be forever etched as memories to be remembered long after Im gone. I want my children to hear of those things from others after I am gone as well so that they know their Dad tried to be the best he could be ....I wish this feeling for all of us....Love to you and yours as well Gail...............Buzz
sorry about hi jackin Buck.....just started rambling.....couldn't stop0 -
Its been since sept 22nd for me!!Buzzard said:1 more detail........or maybe 2
remember, your intestine does not have any nerve tissue so it will not hurt at all. The stitches around the stoma will slightly but the arse will be the major malfunction...I will try and keep you abreast of anything else I come up with but right now thats the major milestone to get passed...it will mess with your mind as not having to sit down as we always did to take the daily "dump" that men are normally so proud of...I have the remedy for that as well...Simply, every so often, especially in the morning, when you go to urinate, drop the drawers and sit down as though its howdy doody time...LOL...I call it "phantom crapping" its something your body has involuntarily done all your life and by imitating that move even if there is no bowel there it somehow gives me the "mental" fix I need to help be ok with crapping in a sack....
and the only way to be completely ok with a bag, is to simply not try to hide it...its you now, and will always be a part of who you are now, you will win this battle but at a very small cost, a bag...so what...ya know ...at least I know when my arse is clean now and colonoscopies now are a breeze...I also fold my bag halfway up when I go out and it allows me to tuck my shirt in with little or no bulge...you will have accidents, but make light of them, laugh about it, might as well...let me ask you this ...you ever crapped in your shirt ? I have and it ain't fun trying to take it of when theres no buttons...but its doable.......ya see Buck, its tha little things in life that are so much fun. This is one that you learn as you go...... keep smilin' bud............Buzz
Hey Buck,
I had the APR and now the colostemy. My butt still hurts and has since i started with Radiation and chemo back in June of 09. I am back to work, I'm driving Heck I even shoveled snow in the driveway today. I think everyone is different but it took a good 12 weeks befor i really started to feel better. I hope The Butt pain go's away some day soon. I stopped the pain meds Thought they might have been slowing down the healing??? We can all get through this together. Im on the mop up chemo now with my 3rd dose moved to tuesday this week same day as gail. I have a urudynamic study tomorrow to find out why I still need a cath to pee. They think its nerve damage from the surgery. That maybe something you want to talk to your surgeon about. Glad to answer any questions.
Tom0 -
Dear men....Buzzard said:Thank you Gail.......
There is a little boy at Vandy Childrens Hospital that taught me a lot of things about being happy with whatever life throws at ya......and the thing is, he never said a word, he simply looked at me and smiled....now, to be able to do what he did, thats whats amazing, and I intend on doing just that no matter what happens in my life, be happy with what I have no matter where it takes me......and for you as well my dear, I really think that until we are faced with the reality of mortality then we never gain the insight of what our lives really mean to us. Use that insight we find to our advantage and try to make people understand just what they miss when they take life so for granted. Smile at them and tell them how beautiful they are as I will you, knowing that there is nothing to be embarrassed about but simply expressing to others what you always were afraid to say before. I view it as a second chance for me to do something with my life, no matter how long or short the duration is, but the enormity of laughter, love and memories that I can bring to people hearts and minds that will be forever etched as memories to be remembered long after Im gone. I want my children to hear of those things from others after I am gone as well so that they know their Dad tried to be the best he could be ....I wish this feeling for all of us....Love to you and yours as well Gail...............Buzz
sorry about hi jackin Buck.....just started rambling.....couldn't stop
Hugs To Buck and Buzz...from Me. Now I have water in my eyes.0 -
Surgery
My tumor was very low and my first surgeon said I'd probably have a permanent ostomy but got a second opinion and said if you can spare me permanent without putting me in jeopardy please see what you can do. Just told him that I'd have an ostomy if him trying to save me from it would cause me to not get all the cancer. His answer, "you have a good chance of having a temporary and I'd never compromise your health." Made me feel like this was the surgeon for me.
Make sure you have them mark you, but can't understand one above the waist line. You might want to get a second opinion on that. My friend is heavy and her's is below the belt. You might be restricted if it is placed above the waist line.
Hoping and praying that your surgery goes well. Make sure you walk, walk, walk as others have said. It hurt for me to walk so bad, but if you do, you will feel so much better. And don't only do it when you are in the hospital, do it when you get home and that means for weeks. Walking helps you heal. Let us know how you are doing.
Kim0 -
expect the unexpectedAnnabelle41415 said:Surgery
My tumor was very low and my first surgeon said I'd probably have a permanent ostomy but got a second opinion and said if you can spare me permanent without putting me in jeopardy please see what you can do. Just told him that I'd have an ostomy if him trying to save me from it would cause me to not get all the cancer. His answer, "you have a good chance of having a temporary and I'd never compromise your health." Made me feel like this was the surgeon for me.
Make sure you have them mark you, but can't understand one above the waist line. You might want to get a second opinion on that. My friend is heavy and her's is below the belt. You might be restricted if it is placed above the waist line.
Hoping and praying that your surgery goes well. Make sure you walk, walk, walk as others have said. It hurt for me to walk so bad, but if you do, you will feel so much better. And don't only do it when you are in the hospital, do it when you get home and that means for weeks. Walking helps you heal. Let us know how you are doing.
Kim
I hope your surgery goes well.
From what I have learned from meeting heaps of other bowel cancer patients and this great forum is everyones surgery will be different.
I really liked Buzz comments about love and life and smiling. No matter how ****
and rough our journeys are we all sound remarkable. I have liked reading of everyones surgeries and I get the impression even if in pain we can smile, somehow!!
I thought I had an ultra low APR but I kept my bottom which I am grateful for. The surgeon said it may go but he would try to keep my BUT and the potential of fathering a few more kids. I actually paid for a second colorectal surgeon to assist as my surgeon said he wanted a second pair of expert eyes. sounded good to me.
I mentioned the horendous NG tube before and suggest taking a notepad or mobile phone. When i could not talk for a few days I would communicate with me phone by writing text messages to the nurses. I look back at these unsent draft sms messages on my phone.
Some just said " can I please have an ice cube.
goodluck Pete0 -
Electronicspete43lost_at_sea said:expect the unexpected
I hope your surgery goes well.
From what I have learned from meeting heaps of other bowel cancer patients and this great forum is everyones surgery will be different.
I really liked Buzz comments about love and life and smiling. No matter how ****
and rough our journeys are we all sound remarkable. I have liked reading of everyones surgeries and I get the impression even if in pain we can smile, somehow!!
I thought I had an ultra low APR but I kept my bottom which I am grateful for. The surgeon said it may go but he would try to keep my BUT and the potential of fathering a few more kids. I actually paid for a second colorectal surgeon to assist as my surgeon said he wanted a second pair of expert eyes. sounded good to me.
I mentioned the horendous NG tube before and suggest taking a notepad or mobile phone. When i could not talk for a few days I would communicate with me phone by writing text messages to the nurses. I look back at these unsent draft sms messages on my phone.
Some just said " can I please have an ice cube.
goodluck Pete
I will have a Droid, an iPad and a laptop, so no lack of technology at my bedside!
Th pain is getting worse, my wife wants me to go back into the ER and get readmitted, maybe to speed things up...0 -
F-thisBuckwirth said:Electronics
I will have a Droid, an iPad and a laptop, so no lack of technology at my bedside!
Th pain is getting worse, my wife wants me to go back into the ER and get readmitted, maybe to speed things up...
The pain is too much. On my way to the ER to see if we can speed things up!0 -
Praying for relief for youBuckwirth said:F-this
The pain is too much. On my way to the ER to see if we can speed things up!
Hope that the ER can help you get control of the pain.
If doing the surgery now is an option, praying that all goes well and you have a speedy recovery.
Hugs,
Marie who loves kitties0 -
Hope you have a pleasant trip on the morphine if you get itLovekitties said:Praying for relief for you
Hope that the ER can help you get control of the pain.
If doing the surgery now is an option, praying that all goes well and you have a speedy recovery.
Hugs,
Marie who loves kitties
You probaly will get some morphine, I had the most wild and vivid dreams of my life and I could not tell if i was awake or asleep. it was not to bad until they got a little scary, the dreams that is, eventually they turned into nightmare I guess and I knew it was time to stop pressing the magic button.
goodluck in ER.
My prayers are with you for pain relief and the op.
Pete0
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