Eighteen months ago (Feb 2018) I had my large intestine removed. Since then I've been asked many times 'What's it like having no large intestine?' Read on to find out!
DISCLAIMER: For people who are very 'British' (i.e. my friends and family), this post has a lot to do with bowel movements, so you may wish to stop reading now! Please understand that when I faced the daunting prospect of having my large intestine removed I couldn't find much information about what to expect. I found that most people didn't/don't like to talk about this subject, but I really wanted to know. So, if you've stumbled across this page and you're facing the total colectomy, or you are supporting someone who is, this is written with you in mind. I hope it helps.
In my experience, there are two major differences between having and not having a large intestine:
- You need to go for a 'number two' more frequently.
- The consistency is a bit looser.
Want to know more?! Well, I'm past the point of embarrassment and I finally have a good reason to talk cr@p! So, here we go....
How much more frequently do I need to 'go'?
During the first couple of weeks after my surgery I was needing to go between eight and 13 times per day. Needless to say, things got quite sore. TOP TIP: Sudocrem is a great and essential companion in the first few weeks! However, as my body began to recover and I worked out what foods I could and couldn't tolerate the frequency reduced.
After a few months I was going about four times a day and I remain at that level today. It usually works out like this: once first thing in the morning, once around lunchtime, once around dinner time and once around bed time. Sometimes once during the night too. It took about a year to stop waking at night to go to the toilet and I feel very fortunate that now I can go through the night more often than not, but TOP TIP: don't eat too late at night. I try not to eat an evening meal much after 7pm, which seems to allow enough time for things to pass through before bed time. In case you're wondering, my 'personal best' between toilet trips currently stands at nine hours. I'm pretty happy with that and I'm optimistic that my body might continue to adapt - the human body really is amazing!
What foods can/can't I tolerate?
Before answering this I should point out that my pre-operation and post-operation diets are entirely different, so my toilet frequency before and after can't really be compared. Before I was diagnosed with bowel cancer I had a low fibre diet and I ate a lot of meat and processed foods. Today, I eat a high fibre diet with very little meat and I try to eat foods that are organic and free from artificial additives and preservatives. I'm part of a generation that has been raised on a lot of processed, refined, artificial and chemically-affected foods. But, lots of credible research about bowel cancer has opened my eyes to recognise that this is not a good thing, hence the reason for trying to adopt a 'cleaner' and more traditionally healthy diet.
Things I can't tolerate: anything too chewy (i.e. things that can't be broken down well in the mouth cause problems further down the digestive system) - this includes red meats and the tough skins of some fruits and vegetables.
Things I have found particularly good: vegetable soups and broths that are not completely liquidised (like borscht, brocolli and cheese, chicken, fish, and butternut squash), sweet potatoes, hummus, avocados (including guacamole), dark chocolate, organic fresh bread, nuts (must be chewed well!) and most fruits and veg (but I have to be careful about the amount of vitamin C that I consume, because too much can cause diarrhoea).
TOP TIP: I find that chewing food well limits the strain on my digestive system further down the line (apparently it also releases more nutrients, which is good).
I guess that if I chose to eat a low fibre diet then I would need to go to the loo less. It's a toss up between eating healthily and going frequently or eating unhealthily and going less frequently. For me, although it took my body and my palate a few months to adjust to a new diet, I've felt so much better eating healthily and I've hardly been ill since recovering from surgery. So, going to the toilet frequently seems like a small price to pay for good health.
How much looser is the consistency?
My young son described it beautifully when he told someone "daddy does cowpats". I can't beat that brutal description! Apparently the main role of the large intestine is to 'firm everything up' before it passes out, which involves removing liquid. Obviously, that part of the process no longer exists for someone without a large intestine. However, my rectum does surprise me from time to time and occasionally I do produce something quite 'normal'. Usually, the longer I am able to wait before going, the firmer it is.
Do I take any medication?
No. However, following my operation I was given Laperamide/Imodium in both pill and liquid form. The purpose of this drug is to slow down gut movements and it is often used to combat diarrhoea.
On this note, diarrhoea can be a problem and I was warned by my consultant about The 'Diarrhoea Loop'. This occurs when you get diarrhoea and you need to drink water to stay hydrated, but the water causes further diarrhoea. But, for me, medicine doesn't seem to make that much of a difference - I've experimented with taking it and not taking it and and I've found that waiting it out has been the best approach and diarrhoea has never lasted more than 12 hours. On average I get this problem roughly once every three months and it's never a major issue... so long as I'm near a toilet! I'm yet to discover what causes it and the saving grace is that, when it happens, I am given a warning as I can both feel and hear it starting inside. TOP TIP: Having a Radar Key can offer great peace of mind when you're out and about.
Over the past 18 months I've concluded that there are three things that affect how often I need to go to the loo. In priority order, these are:
- What I eat and drink
- Where I am (Professor Clarke from St Mark's Hospital in Harrow once said to me "your rectum has a social function". I found that funny, but it's surprisingly true. If I'm in a meeting, for example, then I'm distracted from going to the loo and I find I can hold it much longer than when I'm relaxed and at home).
- Stress and anxiety. I'm a firm believer that mental and physical health and wellbeing are linked. When I'm stressed or anxious, I'm more prone to digestive issues.
In closing I must say that there are some positives to having no large intestine! Here they are:
- Those close to you really benefit because... you don't pass wind very much and, when you do, it doesn't really smell (I'm pretty sure I could get away with it in a public space, but I haven't tried... yet!!).
- Likewise, poos don't have a very potent smell either. We have a new saying in our house: "that was definitely someone with an intestine...!"
- Constipation seems to be rare - I've not experienced this since my operation
- You get to spend more time on the toilet and I've learned to enjoy having more private 'time out' in today's busy busy world.
So, there it is - the answer you've all been waiting for! If you have any questions or care to start a discussion, feel free to drop me a line or write a comment below.