Bowel cancer and bowel function: Practical advice

A guide for people with bowel cancer

Understanding Cancer

Adapted in accordance with Section 69 of the Copyright Act 1994 by the Royal New Zealand Foundation of the Blind, for the sole use of persons who have a print disability.

Produced 2011 by Accessible Format Production, RNZFB, Auckland

This edition is a transcription of the following print edition:

Published by Cancer Society of New Zealand Inc.

PO Box 12700, Wellington

Copyright 2010 Cancer Society of New Zealand Inc.

First edition 2010

ISBN 0-908933-84-3

Publications Statement

The Cancer Society's aim is to provide easy-to-understand and accurate information on cancer and its treatments.

Our Understanding Cancer and Living with Cancer information booklets are reviewed every four years by cancer doctors, specialist nurses and other relevant health professionals to ensure the information is reliable, evidence-based and up-to-date. The booklets are also reviewed by consumers to ensure they meet the needs of people affected by cancer.

Other titles from the Cancer Society of New Zealand/Te Kahui Matepukupuku o Aotearoa

Booklets

Advanced Cancer/Matepukupuku Maukaha

Bowel Cancer/Matepukupuku Puku Hamuti

Breast Cancer/Te Matepukupuku o nga U

Breast Cancer in Men

Cancer Clinical Trials

Cancer in the Family: Talking to your children

Chemotherapy/Hahau

Complementary and Alternative Medicine

Emotions and Cancer

Lung Cancer/Mate Pukupuku Pukahukahu

Melanoma/Tonapuku

Prostate Cancer/Matepukupuku Repeure

Radiation Treatment/Haumanu Iraruke

Secondary Breast Cancer/Matepukupuku Tuarua a-U

Sexuality and Cancer/Hokakatanga me te Matepukupuku

Understanding Grief/Te Mate Pamamae

Brochures

Being Active When You Have Cancer

Being Breast Aware

Bowel Cancer Awareness

Gynaecological Cancers

Talking to a friend with cancer

Thermography

Questions You May Wish To Ask

Page 1

Bowel cancer and bowel function: Practical advice

This booklet provides information on how and why bowel function sometimes changes after treatment for bowel cancer. Each person will settle to their own unique pattern. There are no rules; this information will provide only guidelines and helpful hints.

The treatment of bowel cancer usually involves major abdominal surgery. It sometimes involves the use of chemotherapy or radiation treatment or both. The treatment of your bowel cancer may change the way in which your bowel functions.

Page 2

Contents

Surgery for bowel and rectal cancer - Page 3

Surgery for bowel and Normal bowel function - Page 10

Understanding the bowel - Page 12

The colon - Page 13

The rectum - Page 14

The anus – Page 16

Summary of problems following treatment for bowel cancer – Page 16

Ways to improve bowel function – Page 17

Diet – Page 18

Food Guide - Page 18

Diet Sheet – Page 19

Trouble Shooting Guide – Page 22

Bloating and wind (flatus) – Page 25

Food with fibre and fibre supplements – Page 26

Which fibre should I be eating? – Page 26

Medication – Page 27

Good toileting habits – Page 28

Pelvic floor exercises – Page 29

Physical activity – Page 29

Skin care – Page 30

Cleaning the skin – Page 30

Protecting the skin – Page 31

Treatment for raw, sore skin – Page 31

Applying creams and ointments – Page 31

Sex after surgery for bowel cancer – Page 32

When you need further advice – Page 33

Feedback – Page 39

Page 3

Surgery for bowel and rectal cancer

Some of the more common types of surgery for bowel cancer are described in the following diagrams.

Page 4

Surgery to remove part of the bowel is called a colectomy. If the left side of the bowel is removed, it is called a left hemicolectomy.

Diagram:

Title: Left hemicolectomy

Caption: Diagram showing the part of the bowel removed with a left hemicolectomy. Copyright CancerHelp UK

Transcriber's Note: The diagram shows two images of the bowel.

In the first image there are two reference points. The first shows the descending colon, and the second shows the tumour sitting within the descending colon. About a third of the colon, including almost all the descending colon, is shown as needing to be extracted to remove the tumour.

The second image is of the colon sewn back up, with a reference point where the colon is joined back together. This is labelled "bowel re-joined". The colon is now considerably smaller.

End of note.

End of diagram.

Page 5

If the middle part of the bowel is removed (the transverse colon) it is called a transverse colectomy.

Diagram:

Title: Transverse Colectomy

Caption: Diagram showing the part of the bowel removed with a transverse colectomy. Copyright CancerHelp UK.

Transcriber's Note: The diagram has two images of the bowel.

The first image has two reference points: one to the transverse colon, and the other to the tumour in the middle of the transverse colon. It shows that this middle section of colon needs to be cut away to remove the tumour.

The second image shows where the bowel is joined after the tumour is removed. There is a reference point at the section of the join, this is labeled "Bowel Re-joined". The bowel is shown to be a little smaller than before the removal on the transverse colon.

End of note.

End of Diagram.

Page 6

If the right side of the bowel is removed it is called a right hemicolectomy.

Diagram:

Title: Right hemicolectomy

Caption: Diagram showing the part of the bowel removed with a right hemicolectomy. Copyright CancerHelp UK.

Transcriber's Note:

The diagram has two images of the bowel.

The first image has two reference points: the first to the ascending colon and the second to the tumour within the ascending colon. The whole ascending colon is to be taken out to remove the tumour.

The second image shows where the large bowel is joined to the small bowel. There is a reference point to this join called "Large bowel joined up the small bowel."

End of note.

End of diagram.

Page 7

If the sigmoid colon is removed it is called a sigmoid colectomy.

Diagram:

Title: Sigmoid colectomy

Caption: Diagram showing the part of the bowel removed with a sigmoid colectomy. Copyright CancerHelp UK.

Transcriber's Note:

The diagram shows two images of the bowel.

The first has two reference points: one to the sigmoid colon close the end of the bowel and he second to the tumour within the sigmoid colon. The sigmoid colon is shown to be removed.

The second image shows the bowel joined back together with a reference point at the join called "Bowel joined together". End of note.

End of diagram.

For more information you might like to read the Cancer Society's booklet Bowel Cancer/Matepukupuku Puku Hamuti. You can view the booklet on the Cancer Society's website (www.cancernz.org.nz), by contacting your local Cancer Society for a copy or by ringing the Cancer Information Helpline 0800 CANCER (226 237).

Page 8

Surgery for rectal cancer

You may have radiation treatment or chemotherapy or both to shrink a tumour before surgery to make it easier to remove.

For cancers in the upper part of the rectum, your surgeon will remove the part of the rectum containing the tumour. This is called a low anterior resection.

Diagram:

Title: Low anterior resection

Transcriber's Note:

The diagram shows two images of the bowel.

In the first image there are 4 reference points shown at the bottom of the bowel. The first is to the tumour which is between the rectum and the sigmoid colon. The second reference point shown is the sigmoid colon, which is cut away from the descending colon. The third reference is the rectum which is shown to be cut away from the anus. The last reference is to the anus itself.

The second image shows the bowel after it is rejoined. There are 3 reference points. They are the Colon, which is attached to the rectum, which is attached to the anus.

End of note.

End of diagram

Page 9

If the cancer is in the lower part of your rectum, your surgeon will not be able to leave enough of the rectum behind for it to work properly, so they will remove your anus and rectum completely. This is called an abdominoperineal resection (AP resection). Then the surgeon will divert the remaining bowel to make an opening on your abdomen. This called a colostomy.

Diagram:

Title: Abdominoperineal resection

Caption: Diagram showing an abdominal resection of the bowel. Copyright CancerHelp UK.

Transcriber's Note:

The diagram shows to images of the bowel.

The first image has 2 reference points. The first is to the rectum. The second is to the tumour which is shown at the very bottom of the anus.

The second image shows that the anus and rectum have been completely removed. There is a reference point to where the colon now ends. This is called a "Stoma". End of note.

End of diagram

Page 10

Normal bowel function

How often is it normal to go to the toilet?

There is no right or wrong answer to this. There is a very wide range of 'normal' bowel function between different people. It is not essential to have one bowel action per day and it is probably only a few people who have one bowel action a day. Some people always go several times per day; others have several days between bowel actions.

Understanding of what is normal is based on personal experiences and growing up with other people. Most of us do not discuss bowel habit with our friends, or even our family. A few people become obsessed with the need for a daily bowel action and spend a lot of time in the toilet or take laxatives to achieve this. Often this is unnecessary.

Source: www.stmarkshospital.org.uk

Page 11

You should be able to expect to:

You should not have to:

Page 12

Understanding the bowel

Understanding your bowel will help you manage any changes that may occur.

Diagram:

Title: The digestive system

Transcriber's Note:

The diagram shows the outline of the human body with the 13 reference points throughout the throat, gut and bowel.

Starting from the top of the body and working down the reference points are:

Oesophagus (Gullet) pointing to the throat.

Stomach – pointing to the stomach which sits just above the bowel

Liver – this is shown just above the stomach

Gallbladder – this is shown behind the liver and next to the stomach

Small bowel – this is between the stomach and the large bowel. It is shown to be very squiggly and sits under the stomach.

Large Bowel (Colon) – this is shown beneath the stomach and adjoined to the small bowel. It winds its way is a square shape down to the anus.

Cecum – this is where the small bowel joins the large bowel.

Ascending colon – from the bottom left of the colon this is shown to rise up from the cecum to the top left side of the colon.

Transverse colon – this joins from the ascending colon and runs across the top of the small bowel. It is the top side of the large bowel.

Descending colon – this is where the transverse colon stops and the large bowel drops down the right hand side towards the sigmoid colon.

Sigmoid colon – Is the mid-section between the descending colon and the rectum. It is a very small section on bowel.

Rectum – is the very last part of the bowel before the anus. It is between the sigmoid and the anus.

Anus – this is shown between the legs. It is adjoined to the rectum.

End of note.

End of diagram

Page 13

The colon

The colon is also known as the large intestine, the large bowel or simply the bowel. The colon of the adult human measures approximately 1.2 to 1.5 metres in length. The colon has three main purposes:

A bowel motion involves moving waste products from the colon to the rectum. Using a wave-like action, the bowel pushes the bowel motion (faeces) towards the rectum. This usually happens once every 12 to 24 hours.

The colon absorbs salts and 1 to 2 litres of water each day. It plays an important role in changing bowel motions from liquid to a soft, formed motion.

Changes that can occur following treatment:

  • loose bowel motions – the bowel length may be shortened by surgery and scarred by radiation treatment, therefore, less fluid is absorbed from the bowel motion.

  • An urgent need to go to the toilet – the bowel motion is moving through the bowel more quickly as a result of surgery, chemotherapy or radiation treatment or a combination of these.

  • More frequent bowel movement.

Page 14

Other problems:

  • damage to nerve endings and circulation, which can cause bowel movement to slow down. This may cause constipation.

  • damaged nerves can cause pain or a tingling sensation

  • abdominal bloating and wind (flatus) can be a problem for some people.

The rectum

Diagram:

Title: The rectum and anus

Transcriber's Note:

The diagram shows a side view of the rectum and anus.

The rectum is shown at the top in the middle, and the anus is shown as the exit point at the bottom of the diagram. To the outsides of the rectum there are two grey areas indicated on either side. The first is a light grey area, closest to the rectum. This is labelled the Internal Sphincter. To the outside of this on both sides of the rectum is a dark grey area labelled the External Sphincter. End of note.

End of diagram

Page 15

Diagram:

Transcriber's Note:

The diagram shows the anus from a view below.

There are three reference points given in this diagram.
The first is the anus, which is shown in the middle of two outer rings.

The first outer ring (closest to the anus) is shown as the Internal Sphincter. The outer ring is shown as the External Sphincter. End of note.

End of diagram.

The rectum is a storage area for a bowel motion (faeces).

Normally, it is quite elastic and is able to fill up with bowel motion without creating a powerful urge to go to the toilet.

Changes that can occur following treatment

The rectum may not be able to hold as much bowel motion as before. This may be due to:

  • surgery – where part of the rectum is removed or replaced with another piece of the colon that is not as specialised as the rectum

  • scarring or thickening of the tissues from chemotherapy or radiation treatment or both.

The bowel motion arriving in the rectum may be very loose (not bound together) and difficult to get rid of. You may need several visits to the toilet 'to complete the job'.

Page 16

The anus

This is the opening of the bowel to the outside of the body. The sphincter muscles control its opening and closing.

Changes that can occur following treatment

The anal sphincter muscles may be weakened by childbirth, some types of anal operations, chronic straining, aging and radiation treatment. If the anal sphincter muscles are weak, you will be less able to 'hold on' when you get the urge to go to the toilet.

Having difficulty holding on to or controlling your bowel motion is called faecal incontinence. This can be embarrassing and interfere with your lifestyle. It can also lead to skin problems such as itching and soreness around the anus.

Summary of problems following treatment for bowel cancer

Page 17

Bowel problems may be more severe if you have a combination of treatment, such as surgery/radiation treatment and/or chemotherapy.

Box:

Advice for people following treatment for bowel cancer may be different to advice given to the general population.

End of box.

Bowel function after treatment for bowel cancer is often changed. However, it is nearly always possible to manage it with simple treatment.

Bowel function is often at its worst immediately after bowel surgery (or the closure of a temporary ileostomy/colostomy).

Bowel function is likely to improve over the first few months and can continue to do so for up to two years. It is important not to be disappointed if your bowel function is difficult at first. It is likely to keep improving and you will develop a 'new normal'.

Ways to improve bowel function

A combination of:

Page 18

Diet

There is no specific diet; the aim is to eat a healthy, balanced diet. Sometimes you'll need to make changes to the food you eat.

Try to identify foods that make the bowel motions too loose, move too quickly or produce too much wind and then restrict them, or remove them altogether and try them again later.

At first, after treatment or if problems occur:

Food Guide

This Diet Sheet is only intended as a guide. Try to include as many foods on the 'Take care' list as you can tolerate.

Foods that are underlined in the 'Take care' list may be troublesome so add these foods cautiously, one at a time.

Page 19-21

Table:

Title: Diet Sheet

Food

Start with these foods

Take care with these foods

Breads and Cereals (Starchy foods)

White/wholemeal bread/toast, crackers, pasta, cornflake, Creamoata, Weet-bix, rolled oats, white or wholemeal flour, white rice, plain biscuits and cakes

Wholegrain bread, brown rice, bran, crackers and cereals containing whole grains, nuts or dried fruit.

Fruit

Ripe, peeled, raw or cooked without hard skins, pips or stringy parts, eg. Apples, apricots, bananas, nectarines, peaches, pears

Fruit that is stringy or has pips, seeds or hard skins, eg. Grapes, rhubarb, plums, feijoas, gooseberries, grapefruit, oranges, kiwifruit, passion fruit, pineapple, berry fruit, tamarillos, dried fruit, or peel.

Vegetables

Tender and well cooked, vegetables, eg. Asparagus tips, beetroot, carrots, cauliflower and broccoli tips, kumara, marrow, potato, pumpkin, silver beet leaves, swedes, spinach, yams, zucchini and pureed vegetables.

Vegetables with tough skins, pips or coarse stalks, eg. Green beans, Brussels sprouts, capsicums, lettuce, parsnip, tomatoes, cabbage, celery, cucumber, leeks, onions, radishes, sweet corn, beans, peas, lentils.

Milk and Dairy Products

Milk puddings, cheese, plain cottage cheese, yoghurt (no pips), ice-cream, dairy food, plain ice-cream

Strongly flavoured cheese, grilled cheese, yoghurt with pips, flavoured cottage cheese

Fats

Butter, margarine, cooking oils, etc. in moderation

Fried foods

Meat, Fish and Eggs

Tender red meat, chicken, fish, eggs as desired

Fried eggs, canned corned beef, sausages, saveloys, fried meat, deep fried fish or timed smoked fish

Fluids

Water, tea, coffee, Bovril, Milo, Bournvita, Ovaltine, Complan, strained fruit juices (not puree juice), smooth and strained soups, flat fizzy drinks, sports drinks

Alcohol (consult your doctor), lemon juice, fizzy drinks, eg. Lemonade, Coca Cola

Miscellaneous

Salt, essences, honey, jam (no pips), jelly, Vegemite, Marmite, smooth peanut butter, jellies, sugar, plain boiled sweets

Chocolates, liquorice, toffees, coconut, fruit cake, nuts, (including crunchy peanut butter), pastry, fruit, steamed pudding, pepper, mustard, spices, herbs, curry powder, relishes, pickles, and chutneys

End of table.

Page 22-25

Table:

Title: Trouble Shooting Guide

Problem

Possible causes

Suggestions to correct the problem

Bloating/Gas/Wind

Foods: Cabbage, onions, peas, dried beans, baked beans, sprouts, broccoli, pickled foods, fizzy drinks, chewing gum

Other: Gulping fluids

Foods: Avoid offending foods. Flatten fizzy drink before drinking (add a pinch of salt to each glass).

Hint: Eat in a relaxed environment and chew food well. Avoid talking too much while eating.

Odour/Smell

Foods: Cabbage, onions, dried beans, radish, cucumber, asparagus, leeks, garlic, eggs, some spices or seasonings, fish, strong cheese, alcohol (especially beer)

Foods: Parsley, yoghurt (natural unsweetened).

Other: Deodorising drops (discuss with your stoma nurse)

Loose Motions

Foods: Sweet corn, too much raw fruit or vegetables, liquorice, highly flavoured spices or seasonings

Spicy foods such as rice gravies and sauces, and/or fatty foods such as pies, pastries and sausages

Caffeinated beverages, alcohol, fruit juice, prune juice and some herbal teas, e.g. green tea

Foods that contain sorbitol

Other: Nervous upsets, bacterial infections

Foods: White bread, dry biscuits, mashed potato, noodles, pasta, white rice, tapioca, marshmallows, mashed ripe banana, sieved stewed apple, smooth peanut butter, cheese

Drink plenty of fluids, ie. Water, diluted fruit juice, weak tea/coffee, sports drinks

Drink between meals

Avoiding very hot or very cold drinks may help.

Other: Treatment of any infections. Try psyllium (Metamucil).

Constipation

Foods: Not enough fluid

Mot enough fibre

Other: Not enough exercise

Food: Bran-based cereals with extra fluid, prunes juice, kiwifruit, Kiwi Crush.

Increase fibre with soft raw fruit and vegetables.

Increase fluids to 8-10 glasses per day.

You may need a fibre supplement.

Other: Increase exercise.

If you do not open your bowels for 3 days contact a health professional.

Food Intolerance

Some individuals have specific intolerance to food products such as lactose in dairy products or wheat protein, gluten, or fructose. These products can provoke abdominal pain, bloating, gas/wind and diarrhoea.

Consult with dietician or health professional

End of table.

Bloating and wind (flatus)

Most wind is due to the production of gas from the bacteria that live in the large bowel and break down undigested food. It is normal to produce some wind each day. The amount varies from person to person. It depends on the diet and the type of bacteria that live in the bowel. Wind can be a problem if you pass it more than the usual 7 to 12 times a day or you are unable to control it.

Page 26

Suggestions

Some foods and drinks tend to cause too much wind – check the Trouble Shooting Guide. If you suspect a food or drink, it's best to leave them out one at a time. Watch the effect of removing one item for a few days before testing another.

Food with fibre and fibre supplements

Fibre absorbs water and makes the bowel motion thicker. There are different types of fibre. Most fibre containing foods have a mixture of fibres, but some foods contain more of one type than another.

The two main types of fibre are:

Which fibre should I be eating?

It's generally best to eat a mixture of both soluble and insoluble fibre. More soluble fibre can help improve constipation and loose motions. You may be encouraged to increase the amount of soluble fibre in your diet.

Page 27

If what you're eating isn't working you may consider a fibre supplement. There are many fibre supplements. You may need to try a few to find the one that's right for you.

A health professional or dietician can suggest what may be best for you.

Medication

For some people having problems with their bowel motions after treatment for bowel cancer, dietary changes on their own may not be enough. For others, for example, people with diabetes and vegetarians, it can be difficult to make the necessary dietary changes. In this situation, it's useful to use anti-diarrhoea medication that slows the colon transit time and firms up the bowel motion.

Many patients who have had treatment for rectal cancer find that regular use of medication improves their bowel function and quality of life.

Box:

Excessive use of anti-diarrhoea medication can cause constipation. These medications can be bought at pharmacies and supermarkets but should always be used under the direction of a health professional at a low dosage and steadily increased until they're working well.

End of box.

There are many medications that can cause loose bowel motions or make it worse. If you are on medications and have loose bowel motions, talk about it with your doctor or your health professionals.

Page 28

Other ways to improve bowel function:

  • Good toileting habits

  • Pelvic floor exercises

  • Physical activity

Good toileting habits

Box:

Always hold on till the urge is strong.

End of box.

Having a good bowel motion depends on getting to the toilet when the urge to go is strong. This is even more important if your bowel motions have been firmer and slower.

If you find you're sitting on the toilet for a long time before anything happens, it's best to get up and leave. Return only when the urge to go is strong.

Good posture when sitting on the toilet is important. Lean forward slightly and rest your elbows on your knees. At the same time, lift your heels (as if your feet are on tip-toes), or place a foot rest under your feet, so that your knees are higher than your hips. Bulging your abdomen outwards may also help.

Don't assume straining will help prevent leakage from happening later. Straining like this is harmful because it may lead to weakening of the pelvic floor muscles. Straining can be frustrating and exhausting.

Page 29

Pelvic floor exercises

Pelvic floor exercises are important in maintaining anal sphincter control. This is one of the key factors in preventing leakage. These exercises should be done regularly by both women and men to prevent problems, as well as to help improve any existing problems. If you have had recent treatment it is advisable to consult with a health professional before starting.

Physical activity

Many people find that leakage is made worse by heavy lifting, squatting and other physical exertion. In the first few weeks after treatment, avoid these activities wherever possible, especially when the bowel motions are particularly loose or soft. However, being active is important. Try gentle exercise, such as walking at least three times a week to benefit your overall health.

If you are nervous about walking because of sudden, difficult to control bowel motions, you may want to join a gym, that way a toilet is always handy. Talk to your GP about a .Green Prescription' if cost is an issue.

Page 30

Summary

Ways to improve your bowel function are:

Skin care (practical advice for a raw, sore bottom)

When bowel motions are frequent and loose, the skin around the anus can become raw, sore, itchy and prone to bleeding.

Keeping your skin clean and protected will improve the situation.

Cleaning the skin

Use products that do not contain alcohol or soap. Non-alcohol baby wipes can be used to clean the anal area after a bowel motion. Using soap and water to clean the area around your anus can alter the pH of your skin and increase the risk of breaks in the skin.

Page 31

Clean the skin frequently and always after a bowel motion. Use warm water and a mild pH balanced cleansing product, such as baking soda in warm water. Ask your chemist for a suitable product. Unperfumed toilet paper is recommended.

Protecting the skin

The first step is to avoid or reduce contact with the bowel motion. Use a barrier cream to protect the skin. Apply a thick layer to get a good coverage of the area.

To absorb leakage, a range of pads and absorbent products are available. These contain super-absorbent (and odour-reducing) substances to protect the skin from damage. You can buy these products at the supermarket, pharmacy or you may get a discounted price from a supplier. It is best to avoid using women's sanitary products because these are not designed to absorb leakage from the bowel.

Treatment for raw, sore skin

Raw skin around the anus is prone to fungal infection. Your doctor may prescribe anti-fungal or cortisone-based cream to heal the skin. These creams tend to wipe off easily. To help them last longer, you can combine them with an equal amount of a protective barrier ointment/cream.

Applying creams and ointments

Always cleanse and dry the skin well before applying any creams or ointments.

Apply the cream according to the instructions, for example, some anti-fungal creams should be applied sparingly.

Page 32

Sex after surgery for bowel cancer

Normally, it is safe to have sexual intercourse 6 to 8 weeks after your colon surgery, providing there have been no complications. Women who have had surgery involving the rectum are advised to wait 10 to 12 weeks before having intercourse. Sometimes, it can be helpful to try different positions to ensure you are comfortable. The risk that colorectal surgery will damage a man's ability to have an erection depends on whether there is nerve damage. If you have any problems with sexual activity after your treatment you can discuss this with a health professional. For more information you may like to read Sexuality and Cancer Hokakatanga me te Mate Pukupuku, which is available at your local Cancer Society or the Society's website www.cancernz.org.nz.

Anal sex can resume or may start when it's comfortable for patients and partners.

There are, however, some issues that need to be taken into consideration depending on the anastomosis (bowel join).

For patients with right-sided resections (ie. right hemicolectomy) and those with the anastomosis above 30 cm, anal sex may start when the patient is comfortable.

For those with a low rectal anastomosis, care should be taken, even in patients with proximal stomas, as the join could be disrupted and the penetrating penis damaged. Anal sex should, therefore, be avoided for six weeks to allow complete healing of the anastomosis.

Page 33

In many patients, the low anastomosis are formed with staples. With these anastomoses there may be loose staples, sharp edges and the join maybe narrower than the normal bowel. Careful digital evaluation with a well-lubricated finger should be undertaken prior to commencement of anal sex to check for these issues.

If you are in doubt please discuss this with your surgeon.

When you need further advice

If things don't get better or you feel concerned and the strategies outlined in this booklet are not successful, you may need to discuss this with your health care team. Before an appointment to talk about your bowel function and management it can be helpful to keep a diary for one week. This should include details of your bowel motion, such as:

The Bristol Stool Form Scale (see next page) may help you describe your stools to your doctor or nurse at your appointment.

Page 34

The Bristol Stool Form Scale

Type 1 - Separate hard lumps, like nuts (hard to pass)

Type 2 - Sausage-shaped but bumpy

Type 3 - Like a sausage but with cracks on its surface

Type 4 - Like a sausage or snake but smooth and soft

Type 5 - Soft blobs with clear-cut edges (passed easily)

Type 6 - Fluffy pieces with ragged edges, a mushy stool

Type 7 - Watery, no solid pieces Entirely Liquid

Image above was reproduced by kind permission of Dr K W Heaton, Reader in Medicine at the University of Bristol. Copyright 2000 Norgine Pharmaceuticals Ltd.

Page 35 - 36

Notes

You may wish to use this space to write down any questions you want to ask your doctor, nurses or health providers at your next appointment.

Page 37

Cancer Society of New Zealand Inc. Te Kahui Matepukupuku o Aotearoa

Cancer Society of New Zealand Inc.

www.cancernz.org.nz

National Office

PO Box 12700, Wellington 6144

Telephone: (04) 494-7270

Auckland Division

PO Box 1724, Auckland 1140

Telephone: (09) 308-0160

Covering: Northland

Waikato/Bay of Plenty Division

PO Box 134, Hamilton 3240

Telephone: (07) 838-2027

Covering: Tauranga, Rotorua, Taupo, Thames and Waikato

Central Districts Division

PO Box 5096, Palmerston North 4441

Telephone: (06) 364-8989

Covering: Taranaki, Wanganui, Manawatu,

Hawke's Bay and Gisborne/East Coast

Page 38

Wellington Division

52-62 Riddiford Street, Wellington 6021

Telephone: (04) 389-8421

Covering: Marlborough, Nelson, Wairarapa and Wellington

Canterbury/West Coast Division

PO Box 13450, Christchurch 8141

Telephone: (03) 379-5835

Covering: South Canterbury, West Coast, Ashburton

Otago/Southland Division

PO Box 6258, Dunedin 9059

Telephone: (03) 477-7447

Page 39

Feedback

Bowel cancer and bowel function: Practical advice

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4. What did you like the most about the booklet?

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5. What did you like the least about the booklet?

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6. Any other comments?

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Personal information (optional)

Are you a person with cancer, or a friend/relative/whānau?

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Gender: Female (Checkbox)

Male (Checkbox)

Age:

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Thank you for helping us review this booklet.

The Editorial Team will record your feedback when it arrives, and consider it when this booklet is reviewed for its next edition.

Please return to: The Information Manager, Cancer Society of New Zealand, PO Box 12700, Wellington 6144.

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Information, support and research

The Cancer Society of New Zealand offers information and support to people with cancer and their families. Information resources are available on specific cancers and treatments.

The Cancer Society is a major funder of cancer research in New Zealand. The aim of research is to determine the causes, prevention and effective methods of treating various types of cancer.

We would appreciate your support

Many Cancer Society services would not be possible without the generous support of many New Zealanders. You can make a donation by phoning 0900 31 111, through our website at www.cancernz.org.nz or by contacting your local Cancer Society.

Acknowledgments

The Cancer Society would like to thank for their reviews, advice and contributions:

Maria Stapleton Clinical Nurse Specialist (Lead Colorectal Cancer Care and Stomal Therapy), MidCentral Health District Health Board

Felicity Spencer Professional Advisor Clinical Dietetics MidCentral Health

Helena Paolozzi Clinical Nurse Specialist Colorectal Cancer/General Surgery Hawke's Bay District Health Board

Judith Warren Clinical Nurse Specialist—Lead Colorectal Cancer Care & Stomal Therapy, Waikato District Health Board

Professor Frank A Frizelle Professor of Colorectal Surgery, Editor in Chief of the New Zealand Medical Journal, Head of the Department of Academic Surgery, University of Otago, Christchurch

Dr Mark Jeffery Medical Oncologist, Christchurch Hospital, Christchurch

Associate Professor Chris Atkinson Medical Director of the Cancer Society of New Zealand and Oncologist at St George's Cancer Care Centre

Consumer reviewers

The Cancer Society wishes to acknowledge the input and expertise of our consumer reviewers.

Meg Biggs, Julie Holt, Michelle Gundersen-Reid Cancer Society Information Nurses

Sarah Stacy-Baynes Information Manager

Improving Bowel Function After Bowel Surgery: Practical advice, Commonwealth of Australia, copyright Commonwealth of Australia reproduced by permission.

Photography

Cancer affects New Zealanders from all walks of life, and all regions of our beautiful country. This photo of high alpine buttercups (Ranunculus godleyanus) was taken in the West Coast Region of New Zealand by Rob Suisted.

Cancer Society of New Zealand Inc. (2010)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.

www.cancernz.org.nz

Any Cancer, Any Question

0800 CANCER (226 237)

Cancer Information Helpline

End of Bowel Cancer and Bowel Function.