After anal cancer surgery
Your recovery depends on the type of surgery you have. And your general health.
It takes a few weeks for you to recover after your operation. You will need to spend a few days in the hospital and then give yourself time to recover once you are home.
When you wake up from the operation
After a local excision
You wake up in the recovery area next to the operating theatres.
At first, you’ll be wearing a mask or having small tubes (a nasal cannulae) put into your nose to give you oxygen. You might feel dizzy and sluggish to begin with.
You have a blood pressure cuff on your arm and a little clip on your finger to measure your pulse and oxygen level.
Once you are more awake, your nurse will take you back to the ward. They will measure your blood pressure and check your dressings regularly.
After an abdominal-perineal resection (APR)
After a big operation, you might wake up in the 
(ICU) or (HDU). You usually move back to the ward in a day or so.
In ICU you have one to one nursing care. And in the high dependency unit you have very close nursing care. Your surgeon and anaesthetist also keep an eye on your progress.
These units are busy and often noisy places that some people find strange and disorientating. You might feel drowsy because of the anaesthetic and painkillers.
Tubes and drains
When you wake up, you'll have several tubes in you. This can be frightening, so it helps to know what they're for.
You are likely to have a drip into your arm (intravenous infusion) to give you fluids until you are eating and drinking again. You might also have:
- a tube into your bladder (catheter) to drain urine
- a fine tube (called a wound drain) near the wound to drain away any fluid that collects and help it to heal
- a tube down your nose into your stomach (nasogastric tube) for 24 hours, to drain fluids and stop you feeling sick
You may also have an oxygen mask on.
Electronic pumps may control any medicines you have through your drip.
Your wound after an abdominoperineal resection
If you have had an abdominoperineal resection, you will have:
- one or more wounds on your tummy (abdomen) – the number and size of the wounds depend on if you had an open operation, keyhole (laparoscopic) or robotic surgery
- a wound in the area of your anus
Open surgery to your abdomen
If you have an open operation, you have a long wound down the middle of your abdomen. This normally goes from just above your belly button (navel) to just above your pubic hair.
Laparoscopic or robotic surgery
Your surgeon normally makes 3 or 4 small cuts in your abdomen if you are having laparoscopic surgery. Or 5 if you are having robotic surgery.
Anal wound
The wound where your surgeon removes your anus may need to be covered with skin and muscle from elsewhere in your body. This is called a flap. A specialist called a plastic surgeon, cuts some skin and muscle from your abdomen or buttock. But they leave a small part still connected to a to help the wound heal. They then place the flap over the wound and stitch it in place.
If you have a flap, you will not be able to sit or lie on your bottom until the wound has healed. This may be 2 to 3 weeks after your operation.
Wound closure
Your surgeons usually uses dissolvable stitches to close the wounds. Sometimes they may use surgical clips or stitches that need to removed. These stay in place for at least 10 days. Your nurse takes them out before you go home.
If you go home before they are removed, your nurse tells you where and when to get them taken out. You may need to make an appointment for the practice nurse at your GP’s surgery to do it. Or you may have to go back to the hospital.
Dressings
If you have stitches or clips, your wounds will be covered with a dressing. Your nurse takes the dressings off a couple of days after your operation. They will only put another dressing on if needed.
Sometimes your surgeon may put a dressing on the wound on your bottom with a small pump included. This is called a VAC dressing.
If your surgeon uses surgical glue on laparoscopic or robotic surgery wounds, you don’t need to have a dressing over them.
Wound drains
The wound drains stay in until they stop draining fluid. This is about 3 to 7 days after your operation. You may have drains in both your abdomen and your bottom.
Painkillers
It’s normal to have pain for the first week or so. You have painkillers to help.
Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.
Immediately after surgery you might have painkillers through a drip into the bloodstream that you control. This is called patient controlled analgesia (PCA). Analgesia is another word for painkillers.
Or you might have painkillers through a small thin tube that is put into your back. This tube connects to a pump that gives you a constant dose of painkillers. This is called an epidural.
You get painkillers to take home. Your nurse will talk to you about:
- how often to take them
- when to take them
- what side effects you may get
Contact your doctor if you still have pain or if it gets worse.
Eating and drinking
Your doctor or nurse will tell you when you can start eating and drinking after your operation. This is normally soon after you wake up. You start having sips of water in the recovery area and then small amounts of food.
Sometimes after surgery on your abdomen, your bowel can become very slow and sluggish. And you have to stop eating and drinking until it starts working properly again. This may take 4 or 5 days.
Your doctor listens to your abdomen with a stethoscope to check for sounds that it has started working properly again. When it has, you slowly build up the amount you drink daily until you can start eating a light diet.
You should be able to eat normally before you go home. But you may find that you are not able to eat all of the foods you could before your operation.
Getting up
Your nurses and physiotherapists help you to move around as soon as possible. They check you’re doing your breathing and leg exercises. This helps you recover.
You might be sitting in a chair within 12 hours of your operation. The day after, you’ll be walking around your bed. And within a few days you’ll be able to walk along the hospital corridor.
Making progress
During the first 24 hours after your operation, you’ll start to feel better. The drips will come out, you’ll start eating and can move about better.
You’ll begin to feel like you’re making progress.
Before you go home the nurse gives you information about how to care for your wound. If you have a colostomy the nurse will show you how to care for your stoma.
Your colorectal nurse
Apart from a specialist stoma nurse, you might also see a colorectal nurse specialist. The nurse will:
- give you advice and support
- make arrangements for you to go home
- book your follow up appointments before you go
The specialist nurse will give you their phone number. Ring them if you feel worried or need advice once you are at home. Some specialist colorectal nurses may visit you at home.
Going home
You will probably be able to go home about a week to 10 days after an abdominoperineal resection.
If you live alone or think you'll struggle to manage at home, tell the nurses at your pre-operative assessment or when you first go into hospital. This way they can start planning any help you’ll need as soon as possible.
Before you leave the hospital your nurse explains:
- how to look after your wounds
- if you have any stitches or clips that need taking out and where to get them removed
- any medicines you need to take at home
- who to contact if you have any problems
- when to expect your outpatient follow up appointment - this is so your surgeon can check how well you are recovering
Driving
After surgery on your abdomen, you can’t normally drive until you can safely do an emergency stop. This may be 6 weeks or more after your operation. Ask your surgeon or specialist nurse about when you can start driving again. You should also speak to your insurance company about when you can restart.
Even as a passenger, you may find it uncomfortable to sit for long periods after surgery to your anus. And you may need to plan frequent stops on longer journeys.
Speak to your stoma nurse for advice if you find that seat belts irritate your colostomy.
Working
When you can go back to work depends on what you do. For example, if heavy lifting is part of your job you may need to be off for longer. Or you may need to speak to your employer about lighter duties for a period of time.
Talk to your doctor or specialist nurse about when you can go back to work and what you can do when there.
Caring for others and looking after your home
You should avoid lifting anything heavy for up to 6 weeks after surgery on your abdomen. So you may need help if you care for others including young children.
You may also need help with jobs about the house such as:
- clothes washing
- lifting heavy pots and pans
- hoovering
Sex
Your surgeon and specialist nurse will talk to you about this before and after your operation. For some people surgery for anal cancer can have a big impact on their sex life. But this depends on what your sex life was like before.
Follow up after surgery
You’ll have follow up appointments to check your recovery and sort out any problems. They‘re also your opportunity to raise any concerns you have about your progress.
