Severe nutrition issues after LAR surgery and stoma reversal surgery

Sorry you’re having so many issues - makes a hard situation just harder. When I had my resection and temp ileostomy, my surgeon prescribed a prenatal vitamin since I had lost so much weight. Maybe that would help with your nutrition needs. I hope things get more pleasurable for you soon!😘

Hi @apuakumamma, in addition to the helpful reply you got from @cjay, I'm tagging @lou3 @happygrandpa @pjebp @verol65, who may have experiences to share with you regarding nutrition and low anterior resection and ostomy reversal.

You might also be interested in these related discussions:

- Appetite Satiety: Normal to feel full after a small amount of food?
https://connect.mayoclinic.org/discussion/appetite-satiety/
- Dealing with LARS (low anterior resection syndrome)
https://connect.mayoclinic.org/discussion/dealing-with-lars/
@apuakumamma, have you consulted with an oncology dietitian?

Hi there, a dietitian may help you with these issues. I take Ensure drink(20 g of protein) it has lots of other nutrients as well. It was recommended by a dietitian. Also, how about sour dough bread with grape jelly(it doesn’t contain seeds)? I had an ileostomy bowel blockage after LAR not fun at all but they determined it was from inflammation so I was in hospital for 3 days and slowly started eating again. Reach out if you have any questions and I hope I was able to shed light on a few things.Lou

@apuakumamma, I'm sorry to hear you are doing so poorly nutritionally. I apologize for taking so long to answer; I was on a vacation.

I too am a 59-year old woman. I had my LAR on Jan 26 as a Turnbull-Cutait pullthrough, so no ostomy, and my coloanal anastomosis on Feb. 2. I lost almost 9% of my weight due to the LAR. In the period between both surgeries, my intestine got paralyzed (I think from the gas the apple juice and the Ensure were provoking) and I was on parentaral nutrition for 4 days. After the second surgery, I was one day still on parenteral nutrition, then 1 day on a liquid diet, then allowed low-residue foods limited to chicken breast, white fish filet, eggs, peeled potatoes, white rice, white bread in small quantity, corn tortilla (I live in Mexico), peeled and cooked carrots, and peeled and cooked apples and pears. Just water to drink. I stuck to eat for a week or ten days, then a clinical nutritionist I consulted told me to add the following foods one at a time over a full week: turkey, cooked asparragus, peeled and cooked chayote (mirliton), peeled, seeded and cooked zucchini, peeled green grapes, peeled and cooked peaches, peeled and cooked nectarines, bananas, Ritz crackers, olive oil, avocado, and creamy peanut butter (no salt, no sugar added). The last three are healthy fat that can help with recovering weight and are nutritious. I monitor my meals, meds, snacks, drinks and BMs with an app called My Symptoms; this is how I know that green beans slow me down, for example.

With LAR, you should avoid whole grains, red meats, pork (due to the fat content both these proteins), beans (all legumes) and dairy products. Most people with LAR can no longer eat onion, broccoli, coliflower, or salads (lettuce). They will make you very gassy and/or provoke diarrhea. Some people take protein shakes, but with caution since some of us with LAR cannot tolerate many of the sweeteners in those powders. Some find that psyllium helps them with diarrhea (when taken with little water and taking little liquids during the day) or with constipation (when taken as indicated on the box).

I've been adding more foods, respecting the one per week rule. I now eat my grapes and zucchini without peeling them. I tried lamb (red meat) and cheese rather high in fat during my vacation at my brother's (because he insisted so much), and as expected, I had a lot of bowel movements after that. But now I eat hummus (gives me a little bit of gas, but really not significant) and add garlic to my dishes for flavor.

With LARS (Low Anterior Resection Syndrome), it's really unpredictable how you will react to a specific food, and it's different from one person to the next, this is why dietitians/nutritionist can't really help us. They can only help us identify soluble fiber foods and insoluble fiber foods. We must find the balance between the two that works for us.

There are some medications that can help. Ask your doctor what's best for you. Coming out of the hospital, I was taking simeticone with trimebutine and omeprazol. After ten days, the surgeon changed me to macrogol and ondansetron, a balance between a stool softener and a med that constipates to slow down the peristalsis and reduce the severe clustering. I was able to reduce both over a month, when the surgeon said I could switch to taking 1/2 loperamide (Imodium) 30 minutes before each of my three main meals, but that was too much for me. For a few days, I took it only before breakfast and dinner, then I stopped. Now I only take 1/2 loperamide when I anticipate that some meal might affect me (like when I go to a restaurant where I won't be able to control all the ingredients), or before an important event I must attend.

Three more things that make a difference: 1) 3 small meals and 2 snacks in-between; 2) stick to a schedule as much as possible for the meals; 3) do not drink anything starting 30 minutes before eating and don't drink anything until an hour has passed after you finished eating. All this helps with the clustering.

Finally, there are FB group for people with colorectal cancer, with LAR, and with LARS, if you're interested. Just let me know and I can share the links with you.

Thank you much for the detailed reply . It would have taken from your own time for sure 🙏
I am going through your suggestions and advice carefully . Meanwhile I am trying the low FODMAP diet from Monash University , with a modicum of improvement in my diet status .
Yet not all food allowed by this diet agrees with me .
For eg , Sweet potato , lotus seeds, coconut , ivy gourd , egg , almond milk , tofu , soya milk etc are all allowed by FODMAP diet , but are a complete no-no for me .
I am normally an eggetarian and yet so far what agrees with me is

Carrots
Spinach
French beans
Cucumber
2 slices normal tomato
30 gms red cooked pumpkin
Raw banana
Small amount of potato
Ripe banana
Dragonfruit
Blueberries
Tahini sauce 2-3 tsp
Peanut butter 2 tsp
Sesame oil unrestricted
Sesame seeds 2 tsp
Rice

That is it so far .
I must say that I tried two pieces of chicken , though culturally is an enormous challenge for me , and found it seemed to agree with me .

Do not know if I can accept eating chicken though …… have to work that through in my head first . …..
Will keep posting here as I progress .
Thank you to all the kind members , who posted here for me . Your concern and inputs are very valuable to me .
PS - I am a researcher in public health and quickly realized that most dietitians will give only general advice and not pointed to my unique problem ….. it is only information locations like this group that will hopefully help me to climb out of this place .
Regards
Apuakumamma

PS - please also do share the links with me .

I can tolerate a small amount of kefir in a smoothie with fruit, amaranth and hemp, which is a way to take in protein. During my stay at my brother's, I also ate a dish of lentils and rice and did tolerate it, so I'm thinking of adding lentils to my diet.

Really, it's mainly a matter of trial and error to find out what suits us personally. From the groups I'm in, it also seems that what works one day can suddenly stop working and one has to start over finding out what one can tolerate.

This is the first group I joined after the forums here on Mayo Clinic Connect:
Living with Low Anterior Resection Syndrome: https://www.facebook.com/groups/lwlars/about
More recently I heard about and joined: COLONTOWN®
"a unique, online community of more than 120 “secret” neighborhoods [on Facebook], dedicated to the exclusive use of colorectal cancer patients, survivors, and caregivers. There are neighborhoods focused on patients with different stages of disease, the differing types of treatment, and special interests – such as CRC clinical trials, young-onset CRC patients, and local support groups. Each single group is led and cared for by a “Neighborhood Admin,” themselves living the experience that is the topic headlined and under discussion in the group that they lead. Check out our list of neighborhoods at the link below; to join a group, simply send a friend request to the admin listed, and then send them a message requesting to be added. https://docs.google.com/spreadsheets/d/1zTi75-cNR1K2-ACmulA3TTnjfOtxwkpe87m7n0oQSgc/edit?usp=sharing".
To be able to join, you need to follow a process which you can find here: https://colontown.org/colontown-on-facebook/.

You might like listening to this podcast: https://my.clevelandclinic.org/podcasts/butts-and-guts/low-anterior-resection-syndrome
You might want to read various pages of this site: https://fightcolorectalcancer.org/blog/low-anterior-resection-syndrome/