descending colon removal after colostomy?

[Not So New Ostomate]

I need your advice.

Eighteen months ago, due to rectal dysfunction and other issues, I had a loop colostomy at the upper end of the descending colon. It is functioning well with twice-a-day change of pouches for soft stool. I know that I will never want to reattach the colon.
But the remaining colon is long and produces a lot of mucus at the rectum. I wear a maximum Depend at night and a moderate Depend during the day.

Do I just accept living with the mucus? Or do I remove the colon?

I asked my gastroenterologist surgeon, and he said it is my choice. He said he would leave a stump, and I will still have some mucus, but much less.
I would really appreciate your opinions based on your experiences.

[sassie]

NSNO,I have 12 inches of my colon left as a stump, i do have mucus but not where its a problem ,if your sure you will never go back 100% sure, then there would seem to be no reason to put up with that mess....Seems your Dr. is willing to remove the extra, so it really would just be your choice, me i am intending to get reversed within the next month or so" hopefully sooner" and if that fails to work properly afterwards i will be going back to a colostomy...18 months ago i had this colostomy as well but where we differ is, mine will not have output not even once,unless i take milkof mag or irrigate and those are starting to fail me and i'm tired of waiting for that so called sweet spot the surgeon said it would find.. So i went to a diff. place and that Dr. said its time to go back and try normal, i was shocked but after thinking about it, i now can hardly wait.. I wish you the best in what you chose to do and pray daily for all on this forum...

sassie

[Not So New Ostomate]

sassie, thanks very much for your reply and your prayers. I am sorry to be so very slow to reply to you.

We do have a lot in common. Contipation was one of my problems before the colostomy. I now take Metamucil Wafer Thins, 1 package of 2 wafers when i get up and 1 package at bedtime. It keeps the stool soft and moving twice a day. Soft stool works with a colostomy pouch; Before i would have been incontinent. Hope you find what works for you.

I am still learning how the forum works. i think I need to ask my question to people who have rectum stumps. Are there any problems with having a rectum stump?

[sassie]

I do have a rectum stump, its 12 inches long, it has mucus but nothing that bothers overly much..

I also have a end of the descending but not a loop, it was cut 12 inches from rectum and 2 feet removed due to diverticulitis and brought up and its a stoma and the new surgeon thinks i will do best with a foot left of colon so it can be more pudding output and seems to think i can handle that , I sure hope that's enough , but its really lazy so maybe he is right on the mark...

[BillGK]

sassie, thanks very much for your reply and your prayers. I am sorry to be so very slow to reply to you.

We do have a lot in common. Contipation was one of my problems before the colostomy. I now take Metamucil Wafer Thins, 1 package of 2 wafers when i get up and 1 package at bedtime. It keeps the stool soft and moving twice a day. Soft stool works with a colostomy pouch; Before i would have been incontinent. Hope you find what works for you.

I am still learning how the forum works. i think I need to ask my question to people who have rectum stumps. Are there any problems with having a rectum stump?

There certainly can be problems. I have a colostomy and a rectal stump that I think is about 7" long. After I had it a couple of years I developed an ongoing condition, "diversion proctitis" - bloody mucus, inflammation, discomfort.

I prefer to leave it. My colostomy came about due to a perforated colon, a life threatening problem. Because my gut was hugely inflamed I am certain that there are adhesions and other complications. My concern is, if they go in and try to remove the stump, what other complications will arise? If things are stuck together I could well come out of surgery with no large bowel and a compromised small bowel.

I view surgery as an absolute last resort. I know that I would be trading my current set of problems for a new set of problems and I would prefer to deal with the devil I know rather than the one that I don't know. I have a good quality of life now, I can manage my conditions without undo effort, so I am leaving well-enough alone.

[steiconi]

I also had diversion proctitis, plus nasty recurring infections, so I had the anastemosis (sp?) surgery last year to remove the rectum, anus, and colon remaining below the colostomy. The proctitis can affect any of those areas if they are left in place.

The surgery was successful, but it took nearly 5 months to get rid of all the abscesses and drains afterward.

I would suggest that your problem should be pretty close to life threatening before you do more surgery.

Have you tried plain water enemas to clean out the mucus? That might reduce the output to an easier to manage level. There have been discussions here about dealing with mucous, a search should turn them up...

Yup, here's a link to the search. search.php?keywords=Mucous

[Not So New Ostomate]

Thanks so much for everyone's replies. Your experiences are very helpful to me.
I've decided not to have the surgery to remove the descending colon. I'll try not to let the mucus be a "problem", at least psychologically. The nurse did not recommend enamas and said that the mucus is good to keep the tissues healthy. I will keep reading, but will live with the mucus and keep in mind that it is better than the constipation and incontinence before the colostomy.

[Diane C]

I did have my rectum and anus removed in November. I'm now glad I did it. I never intended to but needed other surgery, too, so decided to go for it. Yes, a big decision. In January, I developed a wound at the rectal site. Wound care takes a LOT of patience. It took 5+ months for that wound to heal although it was not painful and I needed no drains but it required going to the wound care clinic, having a visiting nurse come 2x/wk to change the dressings as I could not reach it, and I couldn't exercise as I wanted. I believe it has now all healed although a couple of weeks ago I did get checked for another wound but the surgeon said it was a small sore that would heal with Desitin.

Many use a "lavage" system of washing out their rectums in the shower. Do a search for that as people have supplied detailed info. You may also hear about fecal transplantation and may want to Google it. There are short-chain fatty acids (SCFAs) in our stool that prevent diversion colitis which causes the inflammation and leakage. Re-populating your rectum may solve the problem. It didn't with me although I grew weary of these enemas of stool and water. I also tried other substances from a compounding pharmacy but nothing worked. At this point, I am so glad I don't have to deal with the leakage. I also got cramps before the leakage started due to the inflammation. That no longer occurs.

It's not an easy choice. I wish you luck in dealing with the issue and figuring it out. Do try some of the alternatives that many have posted by using the search feature up here.

Diane C