A proctectomy is surgery to remove all or part of the rectum, the last six inches of the large intestine located just above the anus. It is most commonly performed to treat rectal cancer, but it can also be necessary for severe inflammatory bowel disease or certain genetic conditions that cause precancerous growths. The specific type of proctectomy you have determines whether your digestive system can be reconnected or whether you’ll need an external bag to collect waste.
Why a Proctectomy Is Performed
Rectal cancer is by far the most common reason for this surgery. When a tumor develops in the rectum, removing the affected tissue is often the most effective way to eliminate the cancer and prevent it from spreading. In a study of 324 patients who had minimally invasive proctectomy for rectal cancer, five-year survival rates ranged from 96% for very early-stage disease down to 77% for stage III cancer.
Beyond cancer, a proctectomy may be recommended for ulcerative colitis or Crohn’s disease when medications and other treatments have failed to control symptoms. These inflammatory bowel diseases can cause deep ulcers, chronic bleeding, and serious damage to the rectal lining. A third, less common reason is familial adenomatous polyposis (FAP), a genetic condition that causes hundreds of polyps to form in the colon and rectum, dramatically raising cancer risk.
Types of Proctectomy
The type of surgery depends largely on where a tumor sits or how much tissue is diseased. The two main approaches differ in one critical way: whether the surgeon can reconnect your bowel or not.
Low Anterior Resection (LAR)
In a low anterior resection, the surgeon removes part or all of the rectum and then reconnects the remaining bowel to the colon using staples or sutures. This reconnection point is called an anastomosis. Because the anus stays intact, you can eventually have bowel movements the usual way. Many patients receive a temporary stoma (an opening in the abdomen that diverts waste into an external bag) for several weeks while the internal connection heals, but this is later reversed.
Abdominoperineal Resection (APR)
When a tumor sits very low in the rectum, close to the anus, preserving the anus isn’t possible. An abdominoperineal resection removes the sigmoid colon, rectum, anus, and surrounding lymph nodes. Because these organs share blood vessels, they come out together. The surgeon then closes the skin below where the rectum was and creates a permanent colostomy, an opening in the abdomen where waste exits into a bag worn on the outside of the body.
J-Pouch Surgery
For people having their entire colon and rectum removed, often due to ulcerative colitis or FAP, surgeons can construct an internal reservoir called a J-pouch. The surgeon shapes the end of the small intestine into a pouch resembling the letter J and connects it to the anus. This is typically done in two stages: the pouch is created during the first operation, and a temporary stoma handles waste for two to three months while everything heals. A second, smaller surgery then closes the stoma so you can pass stool normally again. About 90% of people who have J-pouch surgery report satisfaction with the results.
Open, Laparoscopic, and Robotic Approaches
Any type of proctectomy can be performed through a traditional large abdominal incision (open surgery) or through several small incisions using a camera and specialized instruments (laparoscopic surgery). Robotic-assisted surgery uses the same small incisions but gives the surgeon enhanced precision and a three-dimensional view, which can be especially helpful when operating in the narrow, bony confines of the pelvis. Research published in JAMA suggests that robotic-assisted surgery may lead to earlier recovery of bladder and sexual function compared to conventional laparoscopic surgery, though both approaches produce similar cancer outcomes. About 14% of minimally invasive procedures end up converting to open surgery when the situation requires it.
What Recovery Looks Like
Hospital stays after a proctectomy vary depending on the surgical approach and complexity but generally range from several days to about a week. In the early days after surgery, the medical team monitors your bowel function, manages pain, and watches for signs of complications. You’ll start with liquids and gradually return to solid food as your digestive system wakes up.
Most people need several weeks at home before returning to regular activities. During this time, heavy lifting is off limits. If you received a stoma, you’ll learn how to care for it before leaving the hospital, including how to change and empty the external bag. For those with a temporary stoma, the reversal surgery typically happens two to three months later once the internal connections have fully healed.
If you had a low anterior resection, expect your bowel habits to be different for a while. Many people experience more frequent bowel movements, urgency, or difficulty fully emptying, a cluster of symptoms sometimes called low anterior resection syndrome. These issues often improve over the first year or two but may not fully resolve.
Risks and Complications
As with any major abdominal surgery, proctectomy carries risks of bleeding, blood clots, infection, and reactions to anesthesia. Infections can develop at the surgical site, in the urinary tract, or in the lungs. Scar tissue (adhesions) can form inside the abdomen and occasionally cause bowel blockages weeks or months later. If the bowel was reconnected internally, there is a risk of anastomotic leak, where the connection doesn’t seal properly and intestinal contents spill into the abdomen. This is a serious complication that may require additional surgery.
One of the more significant concerns is nerve damage. The nerves that control bladder and sexual function run through the pelvis very close to the rectum. Even with careful surgical technique, these nerves can be stretched or injured during the operation.
Long-Term Effects on Bladder and Sexual Function
Urinary and sexual problems after proctectomy are more common than many patients expect. In a prospective study of over 900 rectal cancer patients, 20% experienced urinary incontinence at least once a week at the one-year mark, with women affected more often than men (29% vs. 14%). Nearly half of all patients reported difficulty fully emptying their bladder, and 58% experienced urinary urgency.
The type of surgery matters. Patients who had an abdominoperineal resection (the more extensive procedure) had higher rates of urinary incontinence (27% vs. 17%), urgency (12% vs. 5%), and emptying problems (14% vs. 9%) compared to those who had an anterior resection. Sexual dysfunction, including erectile difficulties in men and pain or reduced sensation in women, is also common after pelvic surgery, though recovery rates vary widely and tend to improve gradually over the first one to two years.
Living With a Stoma
If your surgery results in a permanent colostomy, your day-to-day life will include managing a stoma. The stoma itself is a small, round piece of intestine visible on your abdomen. It has no nerve endings, so it doesn’t hurt. You wear a pouching system over it that collects waste, and most people empty or change the pouch a few times a day. Modern pouching systems are flat, discreet under clothing, and odor-controlled.
People with permanent stomas travel, exercise, swim, and work without major restrictions. The adjustment period is real, both physically and emotionally, but most people develop a comfortable routine within the first few months. Stoma nurses (specialized nurses who focus on ostomy care) are a key resource during this transition and are typically available both in the hospital and for follow-up visits.