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Dietary recommendation for patient who has undergone Total Colectomy

  My wife underwent a Total Colectomy with Ileorectal Anastomosis in November 1997 as a large number of polyps were detected in her colon and rectum. Since then she has had many bowel movements a day. This has come down from about 12-14 per day just after surgery to about 6-8 per day now (May 1998). Are there any dietary reccommendations for this condition? Could I have any references? Are the questions on dumping syndrome relevant here?
  regards
  Sunny
  

Dear Sunny,
Surgical procedures that disturb the continuity of the intestine can lead to poor absorption of water and nutrients post-operatively. One of the important functions of the colon is to absorb water and electrolytes and give more form to the stool. Without the colon, water and other substances are dumped from the ileum to the rectum causing diarrhea. This is not dumping syndrome in the classical sense. Dumping syndrome generally occurs after resection of the stomach and refers to changes in glucose (sugar) and insulin levels when large amounts of food is dumped into the small intestine. Many patients prefer colectomy with ileorectal anastomosis because it restores intestinal continuity by using the normal route of defecation, eliminates the need for expensive stoma appliances and avoids the psychosocial concerns of having a colostomy.
Most patients will have less bowel movements with time after such an operation. Nevertheless, most patients will have more frequent and looser stools than the general population. A variety of foods have been associated with increased stool frequency. These include: apple juice, raw fruits, raw vegetables, popcorn, seeds, nuts, beans, corn, beer, caffeine, chocolate, milk & milk products and spicy foods. If weight loss is a problem, it is recommended to try oral nutritional supplements and to take in enough fluids to prevent dehydration. It is also important to review the medications that your wife is taking. Many medications can exacerbate diarrhea. A number of medications to slow intestinal transit can be helpful as well. Included in this list are: loperamide (Immodium), diphenoxylate (Lomotil), codeine, paregoric or tincture of opium. Other medications that are sometimes helpful are bulking agents such as psyllium (Metamucil) and bile acid binders such as cholestyramine (Questran). Topical agents for perianal irritation may also be needed especially if incontinence is a problem. It is also important to exclude a superimposed intestinal infection.
A fairly recent study published in the Journal of the American Dietetic Association (volume 92:pages 861-863) looked at diet tolerance and stool frequency in patients with a similar type of the surgery to the one your wife had. They concluded that patients concerned about bowel output should: A) consume no more than three meals per day B) eat their last meal at least 2 hours before bedtime C) evaluate their bowel patterns to determine how long after a meal they can leave home. They also cite a previous study which concluded that soft, formed stools and a daily average of 4-6 bowel movements per day occurred in individuals who consumed a high fiber diet, limited concentrated sweets, separated fluids from meals and avoided caffeine.
Finally, if life is too uncomfortable, another option to consider is the formation of an ileostomy (pouch or stoma on the outside of the abdomen; stool is collected in a bag attached to the stoma). It is important to discuss your problems with your colorectal surgeon prior to considering another operation. Your wife also needs to be aware that polyps or cancer can develop in the rectal area and that she requires surveillance of the area with sigmoidoscopy.
Good luck to you. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution, please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Eggenberger, one of our expert Colorectal surgeons.
HFHSM.D.-ym
*Keywords: colectomy with ileorectal anastomosis, post-operative diarrhea, dietary changes
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