About Your Low Anterior Resection Surgery

About Your Surgery

This guide will help you prepare for your low anterior resection (LAR) surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery. Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

Your Digestive System

Understanding how your digestive system works can be helpful as you prepare for and recover from your surgery. Your digestive system is made up of organs that break down food, absorb nutrients, and remove waste from your body. They include your mouth, esophagus (food pipe), stomach, small intestine, colon (large intestine), rectum, and anus (see Figure 1).

Figure 1. The digestive system

Figure 1. The digestive system

After your food has been chewed and swallowed, it moves into your esophagus. This is a long, muscular tube that serves as a passageway for food as it travels from your mouth into your stomach. Once the food enters your stomach, it mixes with stomach acids. These acids begin to digest (break down) the food.

When the food leaves your stomach, it moves into your small intestine. There, it continues to be digested, and many nutrients are absorbed. Anything that is not absorbed is called waste.

The waste then moves to your colon, where some water is reabsorbed (taken back) into your body. The remaining waste enters the last portion of the colon, known as the rectum. Your rectum serves as a holding area for these waste products until they are eliminated through your anus.

Low Anterior Resection (LAR)

LAR is a surgery that is done to treat cancer of the rectum. The part of your rectum containing the cancer is removed. The remaining part of your rectum is reconnected to your colon so that you will be able to move your bowels in the usual way.

LAR surgery can be done using different techniques. Your surgeon will talk with you about which options are right for you. Depending on what type of surgery you have, your surgeon will make one or more incisions (surgical cuts) on your belly.

  • When one long incision is made on the belly, this is called open surgery. The part of the rectum containing the cancer is removed thorough the incision.
  • When several small incisions are made on the belly, this is called minimally invasive surgery. Small surgical instruments and a video camera are inserted into the incisions to remove the part of the rectum containing the cancer. Some surgeons use a robotic device to assist with the surgery.

Once the part of your rectum containing the cancer is removed, the remaining part of your rectum is reconnected to your colon with tiny metal staples or sutures (stitches). The place where the 2 ends are reconnected is called an anastomosis.

LAR surgery usually takes about 4 hours.


Some people will need to have an ileostomy for a short time after LAR surgery. An ileostomy is a small opening in the abdomen where stool can leave the body. It keeps solid waste from passing through the colon and rectum, which allows the anastomosis to heal. During surgery, a part of the small intestine is brought out through the opening in the abdomen. This is called a stoma. It is pink or red, and looks shiny and moist. Stool and gas leave the body through the stoma and go into a plastic pouch that covers the stoma.

In most cases, your surgeon will know before your surgery if you will need a temporary ileostomy. However, the final decision will be made at the time of your surgery. If you will have a temporary ileostomy, a wound, ostomy, continence (WOC) nurse will help teach you how to care for it before and after your surgery.

If you have a temporary ileostomy, it will be closed a few months after your surgery. A permanent ileostomy is rarely needed.

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Before Your Surgery

The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

Preparing for Your Surgery

You and your healthcare team will work together to prepare for your surgery.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with us about your alcohol intake so that we can plan your care.

  • Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medications to help prevent them.
  • If you drink alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do to prevent problems before your surgery:

  • Be honest with your healthcare provider about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you cannot stop drinking.
  • Ask us any questions you have about drinking and surgery. As always, all of your medical information will be kept confidential.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox ®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
  • I take prescription medications, including patches and creams.
  • I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I have had a problem with anesthesia in the past.
  • I am allergic to certain medication(s) or materials, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.

About Smoking

People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods of time while sleeping. The most common type is called obstructive sleep apnea (OSA). With OSA, the airway becomes completely blocked during sleep. It can cause serious problems during and after surgery.

Tell us if you have sleep apnea or if you think you may have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.

Within 30 Days of Your Surgery

Presurgical Testing

Before your surgery, you will have presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office. You can eat and take your usual medications the day of your PST appointment.

During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). Your nurse practitioner will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.

Your nurse practitioner will discuss which medications you should take the morning of your surgery.

Bring the following things with you to your PST appointment:

  • A list of all medications you are taking, including patches and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.
  • The name(s) and telephone number(s) of your doctor(s).

Meet With a Wound, Ostomy, Continence (WOC) Nurse

If you will have a temporary ileostomy, you will meet with a WOC nurse during your PST appointment. A WOC nurse is a registered nurse who specializes in wound and ostomy care. They will teach you and your family how to care for your ileostomy and help you become more independent. Your WOC nurse will also show you the pouch that will cover your stoma so that you can become familiar with it.

Be sure to ask your WOC nurse any questions you or your family have about your ileostomy.

Complete a Health Care Proxy Form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent.

If you are interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advance directive, bring it with you to your next appointment.

Breathing and Coughing Exercises

Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.


Try to do aerobic exercise every day, such as walking at least 1 mile, swimming, or biking. If it is cold outside, use stairs in your home or go to a mall or shopping market. Walking will help your body get into its best condition for your surgery and make your recovery faster and easier.

Eat a Healthy Diet

Eat a well-balanced, healthy diet before your surgery. If you need help with your diet, talk to your doctor or nurse about meeting with a dietitian.

10 Days Before Your Surgery

Stop Taking Vitamin E

If you take vitamin E, stop taking it 10 days before your surgery, because it can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Purchase Supplies

You will need to purchase the following supplies for your bowel preparation at your local pharmacy. You do not need a prescription from your doctor.

  • 1 (238-gram) bottle of polyethylene glycol (MiraLAX®)
  • 1 (64-ounce) bottle of a clear liquid (see the clear liquid diet menu in the “Start Bowel Preparation” section of this guide)

This is also a good time to stock up on clear liquids to drink the day before your surgery. For a list of clear liquids that you can drink, see the table in the “Start Bowel Preparation” section of this guide.

7 Days Before Your Surgery

Stop Taking Certain Medications

If you take aspirin, ask your surgeon if you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Stop Taking Herbal Remedies and Supplements

Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about whether you should continue.For more information, read Herbal Remedies and Cancer Treatment.

Watch a Virtual Tour

This video will give you an idea of what to expect when you come to Memorial Sloan Kettering ’s main hospital on the day of your surgery.


2 Days Before Your Surgery

Stop Taking Certain Medications

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

To reduce your risk of infection, please avoid shaving or waxing your abdominal area.

1 Day Before Your Surgery

Start Bowel Preparation

You will need to start your bowel preparation 1 day before your surgery. You will also need to follow a clear liquid diet the day before your surgery. Examples of clear liquids are listed in the table below.

During your bowel preparation:

  • Do not eat any solid foods.
  • Make sure to drink plenty of liquids other than water, black coffee, and tea. Try to drink at least 1 (8-ounce) glass every hour while you’re awake.



Do Not Drink


  • Clear broth, bouillon
  • Clear consommé
  • Packaged vegetable, chicken, or beef broth mixes

Any products with any particles of dried food or seasoning

Sweets and


  • Gelatin, such as Jell- O®
  • Flavored ices
  • Hard candies such as Lifesavers®

All others


  • Clear fruit juices, such as white cranberry, white grape, apple
  • Soda, such as 7-Up®, Sprite®, ginger ale, seltzer
  • Gatorade®
  • Black coffee
  • Tea
  • Water
  • Juices with pulp
  • Nectars
  • Milk or cream
  • Alcoholic beverages

On the morning before your surgery, mix all 238 grams of MiraLAX with the 64 ounces of clear liquid until the MiraLAX powder dissolves. Once the MiraLAX is dissolved, you can put the mixture in the refrigerator, if you prefer.

The MiraLAX bowel preparation will cause frequent bowel movements, so be sure to be near a bathroom the evening before your surgery.

At 5:00 pm on the day before your surgery, start drinking the MiraLAX bowel preparation. Drink 1 (8-ounce) glass of the mixture every 15 minutes until the container is empty. When you’re finished drinking the MiraLAX, drink 4 to 6 glasses of clear liquids. You can continue to drink clear liquids until midnight the night before your surgery, but it is not required.

Apply zinc oxide ointment or Desitin® to the skin around your anus after every bowel movement. This helps prevent irritation.

At 7:00 pm on the day before your surgery, take your antibiotics as instructed.

At 10:00 pm on the day before your surgery, take your antibiotics as instructed.

Note the Time of Your Surgery

A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. The clerk will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm the evening before your surgery, call 212-639-5014.

On the day of your surgery, go to the main hospital at 1275 York Avenue between East 67th and East 68th Streets. Take the B elevator to the 6th Floor to the Presurgical Center (PSC).

Shower With Hibiclens®

Your nurse will give you a bottle of Hibiclens skin cleanser before your surgery. Hibiclens is a skin cleanser that kills germs and will reduce your risk of infection. The night before your surgery, shower using Hibiclens.

To use Hibiclens, open the bottle and pour some solution into your hand or a washcloth. Move away from the shower stream to avoid rinsing off the Hibiclens too soon. Rub it gently over your body from your neck to your waist and rinse.

Don’t let the solution get into your eyes, ears, mouth, or genital area. Don’t use any other soap. Dry yourself off with a clean towel after your shower.


Go to bed early and get a full night’s sleep.

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Do not eat or drink after midnight.

The Morning of Your Surgery

Shower With Hibiclens

Shower using Hibiclens just before you leave for the hospital. Use the Hibiclens the same way you did the night before. Do not use any other soap. Do not put on any lotion, cream, powder, deodorant, makeup, or perfume after your shower.

Take Your Medications as Instructed

If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.

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Two hours before your scheduled arrival time, drink the Clearfast® carbohydrate drink your doctor or nurse gave you. After you finish the Clearfast, do not eat or drink anything else. This includes water, hard candy, and gum.

Things to Remember

  • Don’t put on any lotion, cream, deodorant, makeup, powder, or perfume.
  • Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
  • Leave valuables, such as credit cards, jewelry, or your checkbook, at home.
  • Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
  • If you wear contact lenses, wear your glasses instead.

What to Bring

  • A pair of loose-fitting pants (sweat pants are a good choice).
  • Brief-style underwear that is 1 to 2 sizes larger than you normally wear.
  • Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can accommodate this swelling.
  • Only the money you may need for a newspaper, bus, taxi, or parking.
  • Your portable music player, if you choose. However, someone will need to hold this item for you when you go into surgery.
  • Your breathing machine for sleep apnea (such as your CPAP), if you have one.
  • Your incentive spirometer, if you have one.
  • If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.
  • Your Health Care Proxy form, if you have completed one.
  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.

Parking When You Arrive

Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital. If you have questions about prices, call 212- 639-2338.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Once You’re in the Hospital

You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having surgery on the same day.

Get Dressed for Surgery

When it is time to change for surgery, you will get a hospital gown, robe, and nonskid socks to wear.

Meet With Your Nurse

You will meet with your nurse before surgery. Tell your nurse the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Meet With Your Anesthesiologist

Your anesthesiologist will:

  • Review your medical history with you.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia (medication to make you sleep) you will receive.
  • Answer any questions you may have about your anesthesia.

Prepare for Surgery

Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it is time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery.

You will either walk into the operating room or you can be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs.

Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia during your surgery.

Your anesthesiologist may also put an epidural catheter (thin, flexible tube) in your spine (back). This will be used to give you pain medication. The medication is delivered into your epidural space, which is the area just outside your spinal cord. It will give you pain relief with fewer side effects, such as nausea, vomiting, and sleepiness. This is similar to what is given to women when they have babies.

Once you are fully asleep, a breathing tube will be placed through your mouth into your windpipe to help you breathe. You will also have a urinary catheter placed to drain urine from your bladder.

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After Your Surgery

    The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

    What to Expect

    When you wake up after your surgery, you will be in the Post Anesthesia Care Unit (PACU). You will stay there until you are awake and your pain is under control. Most people return to their room after a few hours in the PACU, but some will need to stay there overnight for observation.

    You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.

    You will have a Foley® catheter in your bladder to monitor the amount of urine you are making. You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk. You will also have 1 or 2 drains in your lower abdomen to drain extra fluid from the area. Most of the time, the drains are removed after a few days. If you will go home with a drain, your nurse will show you how to care for it.

    You will be given medications to control your pain and keep you comfortable. There are different ways that these medications can be given.

    • Epidural catheter: Some people may get pain medication through an epidural catheter in their spine.
    • Nerve block: Some people may get a nerve block before or during surgery. In a nerve block, your doctor injects medication into some of your nerves to reduce pain after surgery.
    • Intravenous (IV) medications: Some people may get pain medication straight into a vein through their IV line.
    • Oral medications: Some people may get oral pain medications (medication that’s swallowed, such as pills).

    You may have one or more of these after your surgery. They’re all effective methods to control your pain, and your doctor will talk with you before choosing the best one(s) for you.

    Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them. After your stay in the PACU, you will be taken to your hospital room in the inpatient unit. There, your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.

    • It is important to walk around after surgery. Your nurse will help you get out of bed the day after your surgery. Your activity will be increased until you can walk the halls in the hospital without help. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs and reduce your risk of pneumonia.
    • Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, read How to Use Your Incentive Spirometer.

    Commonly Asked Questions

    Will I have pain after my surgery?

    You will have some pain from your incision(s) after your surgery. Your doctor and nurse will ask you about your pain often. You will be given medication to manage your pain as needed. If your pain is not relieved, tell your doctor or nurse. It is important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and get out of bed and walk.

    Once you can swallow liquids, you will get your pain medication by mouth. You will be given a prescription for pain medication before you leave the hospital.

    Will I need to change my diet after my surgery?

    For the first few days after your surgery, you will be given clear liquids. Then, your diet will progress to solid food.

    Your doctor will give you dietary guidelines to follow after your surgery. Your dietitian will go over these guidelines with you before you leave the hospital.

    How long will I be in the hospital?

    Most people are in the hospital for 4 to 6 days after having a low anterior resection surgery, but this will depend on the exact surgery that is done.

    Can I shower?

    You will be able to shower in the hospital and after you go home. Do not take tub baths or go swimming until your doctor says it is okay.

    How do I care for my incision(s)?

    The location and size of your incision(s) will depend on the type of surgery you had. It is normal to have numbness of the skin below the incision(s) because some of the nerves were cut, even if you had a nerve-sparing procedure. This sensation will lessen over time.

    Your incision(s) will be closed with sutures, staples, or surgical glue. By the time you are ready to leave the hospital, your surgical incision will have begun to heal. You and your caregiver should look at your incision with your nurse before you leave the hospital so you know what it looks like. If you have sutures or staples, they are usually removed the morning you leave the hospital. This is done in your hospital bed and is not painful. If you go home with your staples or sutures in place, you will need to come back to the clinic to have them removed.

    Tape strips called Steri-StripsTM will be placed across your incision(s) to make sure it stays closed. After about 14 days, these will loosen and you can remove them. Your incision(s) will stay closed.

    Change your bandages at least once a day and more often if they become wet with drainage. If any liquid is draining from your incision, you should write down the amount and color. Call your doctor’s office and speak with the nurse about any drainage from your incision. When there is no longer any drainage coming from your incision(s), they can be left uncovered.

    You should check your incision(s) every day for any signs of infection until your doctor tells you it has healed. Call your doctor if you develop any of the following signs of a wound infection:

    • Redness
    • Swelling
    • Increased pain
    • Warmth at the incision site
    • Foul-smelling or pus-like drainage from your incision
    • A temperature of 101° F (38.3° C) or higher

    To prevent infection, do not let anyone touch your incision(s). Clean your hands with soap and water or an alcohol-based hand sanitizer before you touch your incision(s).

    When you take a shower, gently wash your incision(s) with a fragrance-free, liquid soap. If you have Steri-Strips or surgical glue on your incision(s), do not scrub it or use a washcloth on it. This could irritate your incision(s) and prevent it from healing. While it is safe to take a shower, do not let your incision(s) be wet for too long. When you are finished with your shower, gently pat your incision(s) with a clean towel. Allow it to air dry completely before getting dressed.

    Will I have pain when I am home?

    The length of time each person has pain or discomfort varies. Some people may have soreness or tightness at their incision, or muscle aches for up to 6 months or longer. This does not mean that something is wrong. Follow the guidelines below to manage your pain.

    • Take your medications as directed and as needed.
    • Call your doctor if the medication prescribed for you doesn’t relieve your pain.
    • Don’t drive or drink alcohol while you are taking prescription pain medication.
    • Pain medication should help you as you resume your normal activities. Take enough medication to make sure you can gradually increase your activities. Pain medication is most effective 30 to 45 minutes after taking it.
    • Keep track of when you take your pain medication. It will not be as effective if you allow your pain to increase. Taking it when your pain first begins is more effective than waiting for the pain to get worse.

    As your incision(s) heals, you will have less pain and need less pain medication. A mild pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil) will relieve aches and discomfort. However, large quantities of acetaminophen may be harmful to your liver. Do not take more acetaminophen than the amount directed on the bottle or as instructed by your doctor or nurse.

    If I have a temporary ileostomy, how do I care for it?

    If you have a temporary ileostomy, your WOC nurse will teach you how to care for it after your surgery. For more information, read A Guide for Patients With an Ileostomy or Colostomy.

    What should I expect if I have a temporary ileostomy?

    It is very important that you stay well hydrated while you have a temporary ileostomy. You can become dehydrated if the amount of stool you are making is more than what you eat or drink. Drink 8 to 10, (8-ounce) glasses of liquids a day. Call your doctor if you have any of the following signs or symptoms of dehydration:

    • Excessive thirst
    • Dry mouth
    • Dry skin
    • Fatigue
    • Loss of appetite
    • Feeling dizzy when you stand
    • Headache
    • Leg cramps

    While you have a temporary ileostomy, you are at risk for having a bowel obstruction. A bowel obstruction happens when the intestine is partly or completely blocked. The blockage prevents food, liquids, and gas from moving through the intestines in the normal way. The blockage can be caused by food, scar tissue, or a twist in the intestine. Call your doctor if you have any of the following signs or symptoms of a bowel obstruction:

    • Tender and bloated stomach
    • Abdominal cramping
    • Nausea or vomiting
    • Inability to pass gas or stool
    • Decreased or no output from your ileostomy

    What exercises do I need to do if I have a temporary ileostomy?

    If you have a temporary ileostomy, you will need to strengthen your anal sphincter muscles by doing Kegel exercises. These muscles help you hold back stool until you get to a toilet. Strengthening these muscles will help prevent incontinence, the inability to control your bladder or bowels, after your ileostomy is closed.

    Start doing Kegel exercises right after your surgery. Continue to do them after your ileostomy is closed to keep your anal sphincter muscles strong.

    You can do Kegel exercises while you are sitting, standing, and walking. To do Kegel exercises:

    1. Tighten your buttock muscles like you are trying to hold back a bowel movement. Hold this position for 5 to 10 seconds.
    2. Release and rest. Repeat 10 times.
    3. Do this exercise 4 times a day.

    How will my bowel function change after surgery?

    Your body will still be able to turn food into solid waste after your surgery. However, most people have changes in their normal bowel function after this surgery. You may have more bowel movements than usual, or feel an urgent need to have a bowel movement. This is because the holding area for your waste is now smaller. You may have “cluster” bowel movements, which occur several times an hour, several times a week.

    You may be instructed to take a fiber supplement such as Metamucil® starting 4 weeks after your surgery. This is gentle fiber that adds bulk to solid waste, which stretches the rectum. This stretching takes place over many months, but eventually, your bowel movements should become less frequent and less urgent. Your surgeon may also prescribe medications to help regulate your bowel movements.

    If you have soreness around your anus from frequent bowel movements:

    • Soak in warm water 2 to 3 times a day.
    • Apply zinc oxide ointment or Desitin to the skin around your anus.
    • Do not use harsh toilet paper. Use a nonalcohol wipe instead, such as a baby wipe.
    • Take medication, if your doctor prescribes it.

    For more information, read Managing Bowel Function After Your Low Anterior Resection.

    What other changes should I expect from my surgery?

    The nerves that control sexual function lie within the pelvis. You may worry that they will be damaged. Surgeons at MSK have special training to reduce this risk. Only a small number of people experience changes in sexual function as a result of this surgery. If you have any concerns about sexual function, talk with your surgeon.

    The nerves that control urination also lie within the pelvis. There is a small chance that you may have changes in urinary function. Your surgeon will make every effort to protect these nerves. However, a small number of people lose urinary control for a short period of time after surgery. If this happens to you, you may need to use a catheter for a longer amount of time after your surgery. Permanent loss of urinary control is uncommon. Your surgeon will discuss this risk with you.

    When can I resume my normal activities?

    Doing your normal activities is an important part of regaining your strength. However, follow the guidelines below:

    • Do not lift anything heavier than 10 pounds (4.5 kilograms), strain, or do strenuous exercise for at least 6 weeks after your surgery.
    • Walking is a good way to increase your endurance. You can climb stairs but try to limit how often you do this for the first week you are home. Do not go out by yourself until you are sure of what you can do.
    • Rest as needed, but if you cannot sleep at night, it may be a sign that you are resting too much during the day.

    When can I resume sexual activity?

    Your surgeon will tell you when you can resume sexual activity.

    When is it safe for me to drive?

    Do not drive until your surgeon tells you it is okay. This will be some time after your first follow-up appointment after your surgery. If you are still taking your prescribed pain medication, your surgeon may want you to wait longer before driving. The pain medication can slow your reflexes and responses, making it unsafe to drive. Also, braking requires use of the abdominal muscles, so driving may increase your discomfort.

    When will I get my test results?

    After your surgery, the tumor and the tissue around it will be sent to a pathologist. Your test results will be ready about 5 business days after your surgery. Your surgeon will discuss the results of the tests with you and recommend whether you need any additional treatments.

    What type of follow-up care will I receive after I leave the hospital?

    Your surgeon will want to see you 1 to 3 weeks after you leave the hospital. If you do not have an appointment before you leave the hospital, call your surgeon’s office to schedule it.

    At this visit, your surgeon will check your incision(s) and overall condition. At other follow-up visits, you may have blood tests, x-rays, or colonoscopies.

    It is important that you go to all of your follow-up visits after your surgery. You can call your doctor or nurse if you have any questions in between these visits.

    If you need more treatment, it can be done at MSK or at a facility near your home. Your surgeon will plan your care with the doctors in charge of these treatments.

    How can I cope with my feelings?

    After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt sad, worried, nervous, irritable, or angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support.

    The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It is always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to you. Whether you are in the hospital or at home, your nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.

    What if I have other questions?

    If you have any questions or concerns, talk with your surgeon or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm at the numbers below.

    After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the doctor on call for your doctor.

    Call Your Doctor or Nurse if You Have:
    • A temperature of 101° F (38.3° C) or higher
    • Abdominal pain, nausea, and/or vomiting
    • Any of the following signs of infection in your incision:
      • Redness
      • Swelling
      • Increased pain
      • Warmth at the incision site
      • Foul-smelling or pus-like drainage
    • Difficulty urinating
    • Pain at your incision that is not relieved by pain medication
    • Bleeding from your rectum
    • No output for 2 hours (if you have an ileostomy)
    • Any of the following signs and symptoms of dehydration:
      • Excessive thirst
      • Dry mouth or skin
      • Fatigue
      • Loss of appetite
      • Feeling dizzy when you stand
      • Headache
      • Leg cramps
    • Any questions or concerns
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    MSK Resources

    This section contains a list of MSK support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.

    Call to discuss private room or luxury suite options. If you want to change your room choice after your presurgical testing visit, call 212-639-7873 or 212-639-7874.

    Call with questions about anesthesia.

    Blood Donor Room
    Call for more information if you are interested in donating blood or platelets.

    Bobst International Center
    MSK welcomes patients from around the world. If you are an international patient, call for help.

    Chaplaincy Service
    At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, call the hospital operator and ask for the chaplain on call.

    Counseling Center
    Many people find counseling helpful. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.

    Integrative Medicine Service
    Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

    Look Good Feel Better Program
    Learn techniques to help you feel better about your appearance by taking a workshop or visiting the program online at www.lookgoodfeelbetter.org.

    Patient-to-Patient Support Program
    You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.

    Patient Billing
    Call Patient Billing with any questions about preauthorization from your insurance company. This is also called preapproval.

    Patient Representative Office
    Call if you have any questions about the Health Care Proxy form or if you have any concerns about your care.

    Perioperative Clinical Nurse Specialist
    Call if you have any questions about MSK releasing any information while you are having surgery.

    Private Nursing Options
    Patients may request private nurses or companions. Call for more information.

    Resources for Life After Cancer (RLAC) Program
    At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

    Social Work
    Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also refer you to community agencies and programs, as well as financial resources if you’re eligible.

    Tobacco Treatment Program
    If you want to quit smoking MSK has specialists who can help. Call for more information.

    For additional online information, visit LIBGUIDES on MSK’s library website at http://library. mskcc.org. You can also contact the library reference staff at 212-639-7439 for help.

    External Resources

    In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who are unable to take the public bus or subway.

    Air Charity Network
    Provides travel to treatment centers.

    American Cancer Society (ACS)
    Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

    Cancer and Careers
    A comprehensive resource for education, tools, and events for employees with cancer.

    275 Seventh Avenue (between West 25th & West 26th Streets) New York, NY 10001
    Provides counseling, support groups, educational workshops, publications, and financial assistance.

    Cancer Support Community
    Provides support and education to people affected by cancer.

    Caregiver Action Network
    Provides education and support for those who care for loved ones with a chronic illness or disability.

    Corporate Angel Network
    Free travel to treatment across the country using empty seats on corporate jets.

    Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

    Gilda’s Club
    A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

    Good Days
    Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that is part of the Good Days formulary.

    Healthwell Foundation
    Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

    Joe’s House
    Provides a list of places to stay near treatment centers for people with cancer and their families.

    LGBT Cancer Project
    Provides support and advocacy for the LGBT community, including a online support groups and a database of LGBT friendly clinical trials.

    National Cancer Institute

    National Cancer Legal Services Network
    Free cancer legal advocacy program.

    National LGBT Cancer Network
    Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

    Needy Meds
    Lists Patient Assistance Programs for brand and generic name medications.

    Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

    Partnership for Prescription Assistance
    Helps qualifying patients without prescription drug coverage get free or low-cost medications.

    Patient Access Network Foundation
    Provides assistance with copayments for patients with insurance.

    Patient Advocate Foundation
    Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

    Provides assistance to help people obtain medications that they have trouble affording.

    The Ostomy Association

    Wound Ostomy Continence Organization
    Go to this website to find a WOC nurse in your area. The website also has information on resources, suppliers of ostomy products, and support groups.

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    Additional Resources

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