Dear Doctors: My husband is 78 years old. A second colectomy left him with one-fourth of his colon, and he suffers from chronic diarrhea. I've read that he should avoid sugar and alcohol, which he won’t give up. Should he see a GI doc, or perhaps a dietitian? I am the cook in our home. How can I help?
Dear Reader: A colectomy is a medical procedure in which a portion of the colon is surgically removed. The colon, along with the rectum and the anus, are all part of the large intestine. Colectomy is used in the treatment of a range of diseases. These can include cancers of the colon or the rectum; inflammatory bowel diseases such as ulcerative colitis or Crohn's disease; the presence of polyps that, due to their size, number or shape, cannot be successfully addressed during a colonoscopy; and in some cases of persistent intestinal bleeding. When it becomes necessary for the entire colon to be removed, this is known as a total colectomy.
Changes to bowel function are among the potential long-term side effects of this type of surgery. The persistent diarrhea that your husband is experiencing is common. Additional symptoms can include dehydration, the production of excess gas and constipation.
The colon absorbs water and nutrients from the digested food it receives and passes the resulting waste to the rectum. A colectomy alters the anatomy of the colon, sometimes significantly. This can lead to an imbalance in the gut microbiome, may adversely affect enzyme function, and can disrupt the complex mechanisms that control the passage of nutrients through the gastrointestinal tract.
You're correct that diet can help to manage the side effects of this type of surgery. Each person will have specific needs, but the basics remain the same. It is recommended that patients eat smaller, more frequent meals, which are easier for the remaining part of the colon to handle. Foods that are known to cause gas, such as beans, legumes and cruciferous vegetables, should be avoided. It's best to also steer clear of greasy, fried and high-fiber foods, which are a challenge to digestion. High-sugar foods can trigger diarrhea. They can also contribute to imbalances in the gut microbiome. Unfortunately for those who enjoy an adult beverage, alcohol acts as a stimulant on the intestines. Drinking can increase both the frequency and the urgency of bowel activity.
We think it would be wise to consult with a gastroenterologist. A specialist will evaluate your husband's medical history, as well as the origin and scope of the disease that led to a colectomy. They can then offer guidance about medications or treatments that may help manage the chronic diarrhea. And because this side effect can arise due to physiological changes to the colon, certain tests may be able to help narrow down a potential cause.
It's also a good idea for your husband to see a registered dietitian. Planning and managing a limited diet that is nutritional and enjoyable is a challenge. Some dietitians specialize in working with colectomy patients. Your medical care provider should be able to help you with referrals.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
