Abdominoperineal Resection of the Bowel (APR)
Cancer of the anus or lower rectum requires
one surgery in two parts. First, the surgeon
loosens the colon and rectum in the
abdomen. The colon is cut and the upper
part of the colon is pulled through an
opening on your lower belly. This opening
is a colostomy. Then, the lower end of the
colon, including the rectum, anus, and
lymph nodes are removed. The anus is
closed with stitches.
Getting Ready for Surgery
You will need to drink a bowel prep to clean
out your colon before surgery. You will
receive a handout about this and some
prescribed medicine. Be sure and read this
before your surgery. –.
You will have a colostomy. Part of the
colon connects to an opening in your
abdomen where stool drains out. Stool
collects in a pouch attached to the abdomen
which is changed when needed.
Your nurse will teach you how to care for
your colostomy. You will also have a home
health nurse visit you at home. It may seem
hard to do at first, but your skill at taking
care of your colostomy will improve over
time. Learning a new skill takes time,
practice, and patience.
Risks of Surgery
Your doctor will talk to you about these
Bleeding that requires a blood
Hernia at the wound site
Infections of the wounds (either
belly or anal wound)
o Men may have semen back up
into the bladder
o Men may have problems with
o Women may have pain with
Trouble passing urine
Wound healing that takes a long time
Plan to be in the hospital about 7days.
When you go home you will be slowly
adding foods to your diet as you can tolerate
them. You will have little pain. Stool will
pass through your colostomy. Walking
daily will help you to feel better and help
your body heal.
You will be able to shower in 2-3 days. You
can wash your wounds with mild soap and
water. You may not need to wear a bandage
on your wound. If you do, we will show
you how to change it. Do not use ointments,
powders, or lotions on your wounds unless
your doctor tells you to do so. Do not soak
in a hot tub, bathtub, or swim until your
doctor says it is okay.
The bowel that comes through your belly is
a stoma. A healthy stoma is pink and shiny,
like the inside of your mouth. It is important
to maintain the health of this skin and not
allow the stoma or the skin around it to get
sore and red. Your nurses will teach you
how to care for your stoma and pouch
Expect to have some pain after surgery.
You will have medicine to take for it. Work
with your nurse to get the most relief from
your pain. Remember, we want you to work
to keep your pain level mild. To do this,
you will need to take your medicine when
you first start to feel it.
Healing of the anal wound may take months.
There may be drainage from this wound.
You will need to wear a pad. Drains put in
during surgery will also help you heal. They
come out through your abdomen. They are
removed 3-5 days after surgery.
Stay off the incision as much as you can for
the first 2 weeks you are home. You want
as little pressure as possible put on the
incision. Sitting too long can decrease the
blood supply and delay healing. It also can
cause the incision to open up. It is best to be
standing or lying on your side. If you need
to sit, limit it to 5-10 minutes at a time.
Be careful when sitting in a recliner. You
tend to slide down in the seat and the anal
tissue might sheer and open up. Try to lie as
flat as you can when in a recliner.
A nasogastric (NG) tube is not routinely
used during this surgery, but it may be
needed in some cases. Once your bowel
action returns, you can drink clear liquids
and you can slowly advance to regular food.
As your bowel heals and you are able to eat
more fiber, the stool from your colostomy
will become more formed like a normal
bowel movement. At home, you will start
with the diet you had in the hospital and
then slowly add more foods to your diet.
Drink plenty of fluids (eight 8-ounce.
glasses a day) to help your body heal.
After surgery, stool collects in the pouching
system. The system is airtight; it does not
allow any air, fluid, or smells to leak to the
outside. The pouches need to be changed
regularly and the skin around the stoma
needs special care.
At home, expect to have at least one bowel
movement a day. Because your bowel
action is still sluggish when you go home, it
is possible for you to get constipated. There
are four factors to think about to prevent this
1. Water is essential for you. Drink 8-
10, eight-ounce. glasses of a non-
caffeine fluid each day.
2. . Fiber intake is limited the first 2
weeks after surgery. At your post op
visit we may have you advance your
diet to include some fiber foods. The
fiber foods will continue to be added
to your diet as your recovery
3. Exercise helps regulate bowel
4. Narcotic pain pills slow bowel
action. Remedy this side effect with
the above actions.
At home you will be taking stool softeners
(2 or more a day) to help prevent
constipation. If you do not have at least one
bowel movement a day, call us. We can
help you get more regular.
Most people are off work for 6-8
weeks for the rectal incision to
Rest as needed.
Walk 4 times per day. Start slowly,
once or twice per day. Progress to 4
times a day and walk longer amounts
of time as you become stronger and
tire less. Walking will help you feel
No lifting more than 10 pounds for
No intercourse until okayed by your
When to Call the Doctor
Shortness of breath or chest pain,
Pain, tenderness, swelling, or redness
in feet, legs, or arms
Pain in lower legs, calves, thighs, or
Trouble passing urine
Painful bloating or cramping
Bulge at wound site
Unable to pass gas or stool
Any ostomy concerns
Signs of a wound infection:
o Increasing redness or warmth at
o Temperature over 100.4 θ F. by
mouth, for two readings taken 4
o Bleeding or pus from wound
o Pain not controlled by pain pills
Digestive Health Center: (608) 890-5000.
After hours, weekends or holidays this number will be answered by the paging operator. Ask
for the doctor on call for Dr. ______________. Leave your name and phone number with area
code. The doctor will call you back.
If you live out of the area, call (855) 342-9900.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 4/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6148