How to Fix Your Plumbing

I have to admit — until recently, I didn’t totally understand the mechanics of the surgery I’m having on Monday. (In case you’re wondering, the technical name: “low anterior resection, colorectal/anal anastomosis, loop ileostomy.” I just copied that off a sheet I got today.) Now that it’s been explained to me in more detail, I think I mostly do. The plumbing analogy might seem rough, but it’s helpful, so I’ll try to share it in a way that’s as close as possible to medically and anatomically accurate based on my limited understanding. I’m sure doctors and people who’ve actually had this surgery will cringe a bit at my attempt, but here goes.

The rectum is the last 6-8 inches of the colon (large intestine). Like much of the rest of the digestive tract, it approximates a pipe. In my case, part of that pipe has a tumor in it — so that part needs to be removed. Once it’s removed, there will be a gap in the pipe, so the two ends remaining on either side of that gap will need to be soldered together.

When you solder two ends of pipe together, however, you can’t immediately send high-pressure water rushing through the pipe; the new connection needs time to set. (This might be where the analogy, or at least my version of it, breaks down. Consult a plumber or surgeon, or better yet, both.) In the case of the human rectum, that healing usually takes 2-3 months.

So how do you give the newly reconnected rectum a few months to rest? (In other words, how does one not poop for a few months?) You have to divert stool somewhere else. That’s where the bag comes in. I’m actually going to have an ileostomy bag, not a colostomy bag as I incorrectly thought when I wrote my last post. “Ileostomy” means they’re pulling the ileum, which is part of the small intestine, through the abdomen so that stool can exit the body (and enter the bag) there. Since the colon comes after the small intestine in the digestive tract, that means the stool will skip the colon altogether. Because one of the colon’s jobs is to absorb liquid from the stool, the waste that collects in an ileostomy bag is more liquid in consistency than that of a colostomy bag. That last part might have been info that some of you could have done without, I suppose. 

Anyway, in a few months, once my rectum has healed, the small intestine will get pulled back inside my body; everything will get reconnected into one continuous, complete digestive tract; and I will once again have end-to-end plumbing. Because the rectum’s primary job is to hold stool until it’s time to use the bathroom, having less of a rectum might mean I have to go more frequently or urgently, or have trouble holding it in. It sounds like the degree to which patients regain “normal” bowel function varies, but most everyone does experience at least some changes in that department post-reconnection. Which makes sense, since these aren’t minor procedures. (I mentioned infertility risk in my last post as well — we went ahead and banked some sperm just to be safe. Ah, the many surprising places I never thought this adventure would lead us.)

My main question is, though, who first thought of trying this? I’m really glad they did.

We got up to Cleveland last night, and today I had a bunch of prep appointments (including getting the stoma placement drawn on my stomach in sharpie — Addie thinks it’s a cool tattoo). My arrival time on Monday is 5:45 a.m., and then I have 5-7 days in the hospital after surgery. The long-retired athlete in me has been trying to get jacked up as though Monday is a big championship game, but a wise friend shared what I now think is a much better perspective: “The scary parts are over; now all you have to do is show up and take a nap.”