After anal cancer surgery
What happens after your operation depends on the type of anal cancer surgery you had and your general health. But you normally have some drips and tubes in your body when you wake up. And you have one or more wounds.
When the operation is finished
Your anaesthetist takes you to the recovery area next to the operating theatres. Depending what type of anaesthetic you had, you might feel dizzy and sluggish to begin with.
Your recovery nurse checks you very regularly. This includes checking your blood pressure with a cuff on your arm. And checking your oxygen levels and pulse with a little clip on your finger. They also make sure:
- you have no bleeding
- any pain is controlled
- any drips or drains you have are working
Once you are well enough, your nurse takes you to the ward.
Back on the ward the nurses will continue to check you regularly. They check you less often as you recover.
After surgery to remove your anus, back passage (rectum) and part of your large bowel (colon)
This is a large operation called an abdominoperineal resection (APR). Doctors also call it an abdominoperineal excision of rectum (APER).
After a large operation, you might wake up in the 
(ICU) or (HDU). You normally go to the HDU if your doctor or anaesthetist wants you to have checks more often. Or the ICU if they want to keep you a sleep for a short while after the operation to help you recover.
These units are busy and often noisy places that some people find strange and disorientating. Once you are well enough, your nurse will take you to the ward. This may be a day or so after your operation.
Tubes and drains
You usually have some tubes in you after your operation. This can be frightening, so it helps to know what they're for.
At first, you have oxygen through a mask on your face. Or a thin tube with prongs that go slightly up into your nose.
You are likely to have a drip into a vein (intravenous infusion) to give you fluids until you are eating and drinking. Some people have other medicines including painkillers through the drip as well. Electronic pumps may control how fast the medicine goes into a vein.
After an abdominoperineal resection, you might also have:
- a tube into your bladder (catheter) to drain urine
- tubes near your wounds called drains – these remove any fluid that collects and help the wounds to heal
- a tube down your nose into your stomach (nasogastric tube) - drains fluid and stops you feeling sick
- a fine tube in your back to give you painkillers (epidural)
Your wound after a local excision
After a local excision you have a wound around your anus. Your surgeon normally puts the stitches inside the wound so you cannot see them. The stitches will dissolve on their own. They also put a dressing over the wound.
Before you go home, your nurse will tell you how to look after your dressing and wound.
Your wound after an abdominoperineal resection
If you have had an abdominoperineal resection, you have:
- one or more wounds on your tummy (abdomen) – the number and size depend on if you had open, 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 around 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 surgeon usually uses dissolvable stitches to close the wounds. Sometimes they 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 them 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 near the wounds on your 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 (catheter) that connects to a pump. This gives you a constant dose of painkillers.
The catheter might be:
- in your back – doctors call this an epidural
- near the nerves in your abdomen – this is called a rectus sheath infusion
If you had laparoscopic or robotic surgery, your surgeon may inject local anaesthetic around the small cuts at the end of the operation. This is instead of a rectus sheath infusion.
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 your bowel 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.
Your stoma
During an abdominoperineal resection, your surgeon opens the end of your large bowel (colon) onto the skin of your abdomen. This is a type of called an end colostomy. You wear a stoma bag over the colostomy. When your bowel is working properly you pass wind and poo into the bag.
Your stoma nurse sees you on the ward. They check the colostomy is ok and help you find the best stoma bag. They also talk with you about caring for and coping with a stoma.
Your stoma nurse will give you their phone number. Ring them if you feel worried or need advice once you are at home. They may also arrange to see you at home.
Getting up
Your nurses and physiotherapists help you to start moving around as soon as possible after your surgery. They help you sit out in the chair later the same day as your operation or the next day.
The day after, they’ll help you to start walking around the bed. Over the next couple of days you build up how far you walk. The aim is to be able to walk a short distance, such as the length of the ward, before you go home.
Your nurses and physiotherapists also check you’re doing your breathing and leg exercises. These help prevent blood clots and chest infections.
Making progress
During the first couple of days after your operation, you’ll start to feel better. The drips and tubes will come out. And you’ll normally be eating and drinking and can move about more.
You’ll begin to feel like you’re making progress.
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
Your sex life
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 are also your opportunity to raise any concerns you have about your progress.
Support when you go home
Your colorectal specialist nurse can help if you’re finding it difficult to cope or if you have any problems. They can get you the help you need. They can also give you information and signpost you to support in your local area.
Specialist nurses are usually your first point of call if you have any questions or concerns. Make sure you know who your specialist nurse is and have their phone number.
More information
We have more information about what happens after surgery for cancer including:
- how you feel after an anaesthetic
- going to the recovery area and ward
- different types of painkillers
- questions to ask before you go home
