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For those who don't know, a total colectomy is the removal of the colon (large intestine), usually with the attachment of the jejunum (second half of the small intestine, which receives digested food from the stomach) to the rectum. Sometimes the small intestine isn't attached to the rectum right away, and waste is removed through an ileostomy, a hole in the lower right side of the abdomen cut by the doctor to provide an opening for the small intestine, which empties fecal matter into a bag. An ileostomy may or may not be permanent, depending on whether a surgeon is able to reattach the small intestine to the rectum.

By the time you need a total colectomy, you've probably had years and years of painful digestive problems, a number of misdiagnoses, and several hospitalizations. Some people actually prefer an ileostomy to the complications of Crohn's disease, ulcerative colitis, or ischemic colitis that causes constipation, diarrhea, constipation alternating with diarrhea, flatulence, and episodes of intense abdominal pain. People literally get worn out by having to run to the bathroom. 

For others, total colectomy just brings a different set of problems. Doctors usually don't tell their patients that artificial sweeteners (especially Aspartame) can set off diarrhea. Some people simply can't tolerate any amount of fiber, not even a few spoons of applesauce or a half-cup of salad. (I know a total colectomy patient who nearly died after eating a large serving of kale.)

Because removing the large intestine interrupts the production of hunger hormones, some people have to force themselves to eat, having no appetite at all.

Sometimes people who have had colectomies are misdiagnosed as having eating disorders, such as anorexia. You can lose the sensation that tells you when you need to urinate or have a bowel movement. You may have to learn how to stimulate a bowel movement or urination by rubbing the appropriate abdominal muscles. You may have repeated problems with intestinal obstructions, which can be life-threatening if you don't get them treated by a doctor in time. You may have gotten misdiagnoses by doctors who dutifully ran tests for serological markers such as ANCA and ASCA, which fail to detect disease 50 percent of the time.

What can you do to minimize problems after a total colectomy,or a partial colectomy, subtotal colectomy, segmental coletomy, hemicolectomy, or prostocolectomy, for that matter? In addition to be careful with fiber and eliminating artificial sweeteners, it usually helps to:

  • Wear compression stockings when you sleep. This may sound like odd advice, but a frequent complication of this kind of surgery is the formation of blood clots. Compression stocking help prevent the formation of blood clots that can in turn cause deep vein thrombosis (DVT) or ischemic colitis. They can be a hassle to put on every night, but they can also save you some serious complications of surgery.
  • Always sit up in a chair when you eat. Your digestive tract needs all the help it can get (in this case, from gravity) to make sure food and later feces goes down, not up.
  • Pay attention to getting enough protein and enough iron when you start eating again. Not many people in North America and Europe suffer real protein deficiencies, but amino acid depletion is possible when you just don't feel like eating. Iron-deficiency anemia can become an issue, too. Even if you have hereditary hemochromatosis, removing your colon reduces your body's ability to absorb iron. Just have a blood test to confirm that iron deficiency is actually a problem before you take iron supplements.
  • Doctors often recommend walking off bloating or nausea. There's no real scientific evidence that this works, but it at least won't hurt you to try.
  • For those whose sex lives include anal activities, ask the doctor or a knowledgeable nurse practitioner before resuming them.

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