Physical effects and sexuality
It takes time to come to terms with being diagnosed with bowel cancer and having treatment. It can also be difficult to cope with the physical effects of bowel cancer treatment. If you have had a colostomy or ileostomy operation as part of your treatment, the end of the bowel is brought out into an opening on the abdomen.
What is a colostomy?
A colostomy is a surgical operation in which the colon (main part of the large intestine) is shortened to remove a damaged part and the cut end diverted to an opening in the abdominal wall.
What is an ileostomy?
An ileostomy is a surgical operation in which a damaged part is removed from the ileum (part of the small intestine) and the cut end diverted to an artificial opening in the abdominal wall.
What is a stoma?
In both a colostomy and an ileostomy, the opening is called a stoma.
Some people have a temporary colostomy made during their treatment for bowel cancer. The colostomy is closed a few months later when the bowel has fully healed. But some people have a permanent colostomy or ileostomy.
It can take a while to get used to dealing with a stoma. You will have help both practically and emotionally. Your stoma nurse can give a lot of advice and support.
Altered body image after bowel cancer treatment
It is normal to feel worried about how you will look. You may also worry about how other people react. While you are in hospital the stoma nurse will teach you how to manage the stoma. It might be helpful for a close family member to be there too. Then you can both get used to your colostomy or ileostomy and can ask the nurse questions.
Once you get home, help is still available if you need it. You might have problems or questions about looking after and dealing with your stoma. Or you may feel low or depressed. Do talk to your GP or stoma nurse. They will either be able to help you, or put you in touch with someone who can.
Coping with your stoma
As you learn to look after your stoma, it should affect your daily life less and less. With time, things like going to work, going out socially and taking part in sports and hobbies will feel easier.
Your relationships and sex life after bowel cancer treatment
You may worry about how the stoma will affect your relationships with a partner or with friends. You may have practical worries about the stoma bag being noticeable, leaking or smelling. Or you may have emotional worries about your friends or partner rejecting you.
Stoma bags are very well designed. They can’t be seen through your clothes and should not smell or leak.
Many people find that if they talk openly to close family and friends their fears of rejection disappear. Most people want to understand what is happening so they can help you. It may help to read our section about sex, sexuality and cancer.
If the stoma bag smells
If the stoma bag smells it could be due to the bag not fitting properly or it could be due to diet. There are anti odour products that can help.
Types of colostomy bag
Stomas are different shapes and sizes. If the bag doesn’t fit properly you are likely to have problems with smell and possibly leakage. You could get in touch with a stoma nurse at your hospital. They can get different types of bags for you to try. If you don’t have a stoma nurse, ask your GP or surgeon to refer you. You might have to try a few before you find the one that suits you best.
Some bags have charcoal filters built into them. Charcoal is good for absorbing smells and the filter lets gas escape from the bag so that it doesn’t get too full and uncomfortable. If the bag fits properly you should only be aware of the smell when you are changing or emptying the bag.
Some products can help to mask the smell from a colostomy. They are often liquids, and you use a few drops each time you change your bag. These are a last resort, because you shouldn’t have this problem if at all possible. But some people have difficulty finding the perfect fit for their colostomy bag and these products can then help.
After having a stoma, some people may have discharge from the back passage. The discharge is mucus from the lining of the bowel. The mucus may leak out of the anus, or you may feel the urge to go to the toilet. The mucus is normally clear or white, and looks a bit like egg white or glue. Sometimes the mucus dries up into a ball inside the rectum and can cause pain.
Depending on the type of stoma you have, a small amount of faeces may pass into the bottom part of the bowel, resulting in a brown discharge.
How often and how much rectal discharge there is varies in different people. It may be once every few weeks or months, or a couple of times a day. If the mucus looks green, smells or has blood in it, you should let your stoma nurse or doctor know as you may have an infection.
Sitting on the toilet every day and gently bearing down (without straining) may help you to pass the mucus out of your rectum naturally. Some people may need a suppository to help loosen the mucus. If you are worried about leaking discharge unexpectedly, you may want to wear a small absorbent pad to protect your clothes.
If mucus does leak out, it can make your skin sore. So you may want to use a barrier cream to help protect your skin. If you are having radiotherapy, you should check with the team looking after you before using any creams. After a shower, remember to pat your skin dry with a towel rather than rub it.
Although having rectal discharge may feel embarrassing, the team looking after you will be very used to supporting people with this. Your stoma nurse can give you advice on what to expect and how to deal with any discharge.
Coping with diarrhoea
When going back to your normal diet, it’s a good idea to introduce one food a day at first. You can keep a food diary and make a note if a particular food causes cramps or diarrhoea. If so, you can try it again in a few weeks to see if it has the same effect. The small bowel is narrower than the large bowel, and so some foods such as celery, tough fruit skins, nuts and mushrooms, may cause a blockage. This is usually only temporary but can cause pain and cramps. When you start to eat these types of foods again, try eating them in small portions and chew them really well. It is important to drink plenty.
Side effects of radiotherapy
Radiotherapy destroys cancer cells in the area of the body it is aimed at. The treatment also affects some of the normal cells nearby. Radiotherapy affects people in different ways, so it’s difficult to predict exactly how you will react. Some people have only mild side effects but for others the side effects are more severe.
Before you start your treatment, talk about any likely side effects with the staff in your radiotherapy team. Knowing about the side effects may help you to prepare and to manage any problems.
Side effects during treatment
The main side effects of radiotherapy treatment include:
- Tiredness and weakness;
- Sore skin; and
- Loss of hair in the treatment area.
Most people feel tired while they are having radiotherapy, particularly if they are having treatment over several weeks. This is because the body is repairing the damage to healthy cells, or tiredness can be due to low levels of red blood cells (anaemia).
Some people get sore skin in the area being treated. The skin may look reddened or darker than usual. It may also get dry and itchy. The skin may break or small blisters can start to form in the area. The staff in the radiotherapy department can advise you on the best way of coping with this.
Radiotherapy makes the hair fall out in the treatment area. Hair in other parts of the body is not affected. The hair should begin to grow back again a few weeks after the treatment ends.
Long-term side effects of radiotherapy
It is important to ask your doctor, specialist nurse or radiotherapist about the possibility of long-term side effects. Depending on the position of the cancer the possible long-term effects may include:
- A change in skin colour in the treatment area;
- Loss of ability to become pregnant or father a child (infertility);
- Low sex drive;
- Erection problems (impotence);
- Long term soreness and pain;
- Bowel changes; and
- Bladder inflammation.
If you are undergoing treatment for bowel cancer, this website has information on topics such as:
- Coping with feelings and emotions after a cancer diagnosis
- Coping with fatigue from cancer
- Advice on diet and nutrition during and after bowel cancer treatment
You can also download a copy of the free booklet, ‘Bowel Cancer: From diagnosis to recovery‘ here.