rectal mucus

[Gooeyduk]

Thanks again Karen. This mucus topic brings up the issue of what happens following a colonoscopy. I should have one this year. Will I be wearing DEPENDS for six months after ?

[Jono]

It sounds, from your previous posts, like you have a diverting loop iliostomy.
That being said, you have a whole colon which will likely need to be prepped somehow prior to your colonoscopy.
If your mucous fistula (the downstream "barrel" of your iliostomy is accessable, and anterograde (downstream) prep with something like Golytely would likely be pretty easy and well tolerated. (Golytely is pretty isotonic, and it doesn't tend to have much of a lasting effect.) If the mucous fistula is not able to be accessed, a lot of times a gastrograffin enema is done in radiology a day or so beforehand. Gastrograffin is a water-soluble contrast (unlike barium) and it's hygroscopic, which means that it sucks water into the lumen of the bowel, increasing the amount of effective fluid present. Doing it under flouroscopy lets the radiologist determine that he's worked the contrast all the way to the end of the colon. With this, and no sphincter tone, you'd probably be messy for a while (but not 6 months)

The colonoscopy itself should be a piece of cake!

[sassie]

Thanks karen/button ..All is well and i did not use much water so i will do as you said "less is more" no drips today.. I sure do like that part clean and have used a old fashion water bottle but the fleet is so much easier and i will not make it a every time thing.
Again Karen Thanks for your input on all post ...

sassie

[Button]

Gooey duck:
A colonoscopy is usually well tolerated with an off-line large intestine. I would not be concerned.

Joni brings up some good points about a possible “prep” to clean the off-Line large intestine prior to the colonoscopy.

If you have a temporary loop ileostomy, you have two stomas:
1. A larger “working” stoma that is connected to your upstream and active digestive tract and from which fecal matter exits into your ostomy pouch.
2. A smaller “mucus” stoma that is connected to your downstream and resting/inactive large intestine.

The mucus stoma can be irrigated with a colon-prep solution prior to your colonoscopy to effectively clean-out the downstream intestine that will be scoped via colonoscopy procedure. Your surgeon or GI physician will discuss this you prior to the procedure and you can come back here and we can talk you through the process. No worries.

And, no, you will not be wearing a depends for 6 months. The colon-prep solution through the mucus stoma would clean your resting intestine and exit via your anus while you sit on a toilet. You would want to wear a depends or wear a urinary incontinence pad in a pair of men’s briefs (not boxer shorts) for a day or two to catch any latent/residual discharge.

A top-down clean-out has the benefit of fully clearing accumulated mucus/cellular debris. It is quite effective in “nipping in the butt” what you are experiencing now in terms of intermittent foul discharge from your anus. So there is a plus or benefit in undergoing the colonoscopy procedure.

You will make it through. And we will help you along the way. Keep faith.
Karen

[Button]

Sassie:
I am glad to hear that you are finding a rhythm and a ways and means to flush your rectal stump that works for you.

It really does take some trial and error. A bit of this and a bit of that. Each person is unique and will each have a unique approach.

You can add a drop or two of aloe Vera to the irrigating water. Aloe Vera provides a soothing anti-inflammatory healing effect. Aloe Vera is available at any Whole Foods or similar holistic grocery store or pharmacy as well as Amazon.

Rectal stump care and maintenance is, in many ways, more challenging than is care of a stoma and pouching.

I can guarantee you that your advice and comments to others on rectal stump care will be valuable and appreciated. Physicians and surgeons provide zero/zilch patient education on rectal stumps. This forum truly provides a form of public service announcement.
Karen

[Gooeyduk]

Thanks again Karen for all of your carefully written advice. Also thanks to Jono. I initially had a loop ileostomy but the inactive mucus stoma prolapsed until it looked like six inch long elephant’s trunk waving around. I then had revision surgery that appaerently just tucked the trunk inside my belly. Now there’s only the active stoma. I assume then that any colonoscopy prep would be a fluid irrigation from the bottom up as suggested by Jono, and a DEPENDS following the irrigation should be no problem.

[Button]

Gooey:
Your MD may recommend no pre-colonoscopy attention to your remainder large intestine given that you have only a “back-end” exit and no mucus stoma to allow for a top-down pre-colonoscopy flush. Your MD will let you know how he handles scoping a distal off-line resting large intestine.

What is the long term plan? Is there any discussion of the long length of intestine that you have retained? It can remain, as is. The concern is that a lengthy off-line retained intestine can become inflamed due to the lack of normal passage of poop that nourishes the inner intestinal lining with short-chain fatty acids. Disuse colitis ensues, which can make for an unhappy retained and resting intestine.

If you have the option to reconnect your digestive tract that would be one option to discuss.

Some people elect to have the remaining/residual intestine removed, with an end ileostomy.

Some people, who are medically compromised and not a candidate for additional surgery, keep the retained intestine and deal with disuse colitis as it manifests. The treatment is usually antibiotics, flagly or cipro.

Your lengthy off-line retained large intestine would be worthy of discussion with your MD/surgeon at some point. This is not an urgent matter, but rather a housekeeping matter of discussion between you and your MD/surgeon. Why you had an ostomy placed will also weigh in on the course of action.
Karen

[Jono]

Anything proximal to a sigmoid colostomy without a mucous fistula is asking for trouble, due to microbial overgrowth and “Blind Loop syndrome”.
That being said, not having rectal sensation or control, and being in continuity dooms the patient to, often, hours daily on the toilet with a finger in his butt trying to stimulate a bowel movement, often with incontinance to follow.
An end-descending or end-sigmoid colostomy puts things in reach, and markedly improves quality of life over God’s initial plumbing for these folks. They, as a group, often seem to do better with irrigation, as they commonly can’t feel if they’re getting “full”. I’ve done literally hundreds of these procedures for people with spinal cord injuries, and I think I’ve only been asked for a reversal once.

Not so sure I’d be liking an ileostomy quite as much, though,(were I in your position) just because the volume and low viscosity of output requires a lot more active management.

I generally do loop ileostomies only as a temporary diversion to protect something I’ve sewn together downstream.

God (or Gaia or whomever) plumbed you a specific way based on your initial configuration.

(your warranty ran out when you were 25, but you, like the rest of us didn’t read the fine print...)

Fortunately, we can cumulatlely pick up the pieces.

Of course, your mileage may vary....

Hit up your local general surgeon for an evaluation...

[Gooeyduk]

Great advice Karen. Actually I have an appointment with my surgeon this coming Monday and I’ll ask him about the risk of disuse colitis. I would never go for reconnecting my colon owing to the challenges I had with a flacid rectal sphincter.

[Gooeyduk]

Thanks Jono. My original problem was extremely low motility puting me in a constant state of miserable constipation. I irrigated for three or four hours every third day which became less and less productive. The ileostomy really gave me my life back and I wished I had done it years earlier. All this was caused by a plane crash requiring a spinal fusion at L1/L2 leaving me with a neurogenic bowl and bladder. The bowl motility slowed each year until the 35th year drove me to the ileostomy.

[Jono]

Well, I’m glad it’s working for you. As I said earlier, we don’t generally leave more than 18” or so of defunctionalized colon in place without a proximal (upstream) stoma called a mucous fistula. (This isn’t the stoma that produces stool, this is the upstream end of the defunctionalized bowel being left open to help prevent problems with distention and bacterial overgrowth)

I would be surprised if someone internalized the downstream limb of your iliostomy for that reason. (Also, when one has a prolapse like you described, it’s usually the “upstream end” that comes out, because peristalsis pushes the bowel, which is already turned inside out for a short distance in order to “mature” the stoma, through itself, leading to the proximal limb sticking out further and further)

I suspect that there is still some access to your upstream colon, even if it’s really small. As Karen noted, if this can be conveniently accessed, you may be able to do anterograde flushes of your colon periodically to obviate your difficulties.
This is definitely something you should discuss with your surgeon.

So if you don’t mind me being nosey, what was up with the plane crash? (I’ve been a pilot since 1982)

[Gooeyduk]

I used to compete in aerobatics and was practicing for a contest one day and landed at Burlington Wisconsin to get fuel. I paid for 10 gallons which turned out to include 4 gallons of water. The engine laid an egg at 300 ft and a Pitts Special glides like a streamlined brick forcing me to land in ready to harvest corn. I’m now into building twin engine seaplanes which you can check out at Gweduck.com

[Jono]

Thanks for sharing.
That plane you’re building is awesome!
I’ve always wanted to get a MES rating, but never had the chance....

[sassie]

Sense reading all these post, i was thinking what if you put a little vinegar in the water ,would that help the bacteria if all the water took its time to exit or some stayed in ???

sassie

[Button]

Gooeyduk:
Wow! And double wow-za!

I am mightily impressed by your obvious talents in the construction and design of airplanes. We do not often share who we are as individuals and it is fascinating to get a peek into the many talents that people bring to this forum.

I second Jono. The plane you are building is awesome. Simply awesome.
Karen