Laparoscopic Total Colectomy and Ileoanal Pullthrough Program At Home Care

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Medications

If you took steroids before your surgery, you may be on what is called a "steroid taper" post-op. This is when the dose of the steroids is slowly decreased over the first few weeks post-op.

Review of Potential Complications

Before surgery, your doctor and nurses will have reviewed possible complications related to the surgery. Those complications include:

Pelvic Infections: Antibiotics and/or drainage may manage the infection. An ultrasound scan or computerized tomography (CT) scan may be done to diagnose and/or guide placement of drains to drain fluid collections that may be seen. Sometimes, surgery is required to achieve drainage of fluid collections.


Special Reminders

NEVER take a laxative. These are often given to clean out the large bowel which you no longer have. If you have concerns, contact your General Surgeon or GI doctor.

Be aware of different forms of medications you are prescribed. For example, time released or enteric-coated pills will not longer be effective. Consult your doctor or pharmacist before beginning a new medication.


Exercises

Pelvic exercises called Kegels may be started a few weeks before your last surgery for ileostomy closure. The purpose is to strengthen the tone of your anal sphincter muscle. These are the muscles that help you control your bowel function and keep the stool (poop) inside your body and prevent "accidents."

The Kegel Exercise

  • Tighten your anal muscle as if you are trying to stop a bowel movement. It should feel like the same sensation when you stop your urine stream when voiding ("peeing"). Do not squeeze the buttock ("bottom") muscles.

  • Hold to the count of ten while squeezing tightly then relax for a count of ten.

  • Repeat these exercises 10 times for one full set. Try to do 4-5 sets a day. You can do them anytime in any position. Most people remember to do them whenever they go to the bathroom or when watching TV.


Home Care Agencies

A nurse from a Visiting Nurse Agency (VNA) will be coming to your home to help review ostomy care instructions, and monitor your progress for any possible complications.
 

A Durable Medical Equipment (DME) company will deliver ostomy supplies to your home that have been ordered by the hospital. Your nurse will inform you of what the name and phone number of the company is.

Pelvic Infections: Antibiotics and/or drainage may manage the infection. An ultrasound scan or computerized tomography (CT) scan may be done to diagnose and/or guide placement of drains to drain fluid collections that may be seen. Sometimes, surgery is required to achieve drainage of fluid collections.

Pouch Irrigation

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These are started 4-6 weeks before your final surgery for ileostomy closure. The purpose is to slowly increase the volume of water that the "pouch" can hold. It helps strengthen the ability of the anal sphincter muscles to hold stool or gas and helps your pelvic muscles "learn" the sensation of fullness of the ileal pouch. Your surgeon and/or outpatient nurse practitioner will give you detailed instructions when to begin these fluid "challenges" and how much water to instill.


The Pouch Irrigation Procedure

  • A catheter is lubricated and placed into the anus.

  • Water is drawn up in a large syringe and instilled into the pouch -- usually beginning with 1 ounce of water one time per day. Remove the catheter. Try to hold the water in for as long as possible (15 minutes to 1 hour) then empty it out by sitting on the toilet.

Each week increase the amount by 1 ounce:

Week Ounces Time
Week 1 1 ounce total hold for 5-10 minutes
Week 2 2 ounces total hold for 10-15 minutes
Week 3 3 ounces total hold for 15-20 minutes
Week 4 4 ounces total hold for 20-25 minutes
Week 5 5 ounces total hold for 30-35 minutes
Week 6 6 ounces total hold for 35-40 minutes

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