rectal mucus

[Diane C]

Thanks very much, Anadevi. The surgeon didn't refuse -- he just said he'd guarantee nothing and it's a last resort. So, since Bill gave such fabulous advice and suggested an implement that I bought to make fecal transplantation easier, I'm trying that route first. Maybe that will be my one and only 2018 resolution! I did also see my surgeon at the Cleveland Clinic in Weston, FL in February and had some tests done. He confirmed I now have "regular" colitis near my stoma and my GI doc advised using Rowasa enemas or Canasa suppositories right into the stoma. ALSO, I seemed to have developed some kind of reflux issue and thought this occurred if I didn't irrigate but it's not so. Ah, aging. Anyway, the surgeon in FL who also is excellent (but never told me about diversion colitis in 2002) did say he'd be wiling to remove the rectal stump but also said it takes a real whack out of the body. I heard from a gal I trust in my local support group that someone is taking morphine now quite often due to pain after surgery due to adhesions and I don't want the situation to get worse. So first things first.

I appreciate your comments and hope you have a good new year. Thank you!

Diane C.

[Diane C]

Yikes, sorry I just saw your comment, Anadevi. A new and very qualified surgeon moved to my area several months ago and I went to see him. I'm having various challenges and one is the diversion colitis or rectal mucous. Much of this has been posted on the thread with a title about a question for Button. Anyway, I'll see him in 3 weeks. He gave me a prescription for sodium butyrate enemas daily from the Alexandria (VA) Compounding Pharmacy in VA -- they do ship the bottle of sodium butyrate to other locations, keeping it chilled. My insurance paid for some of it. After I try these enemas, I'll return to discuss several matters. My surgeons have all indicated that my rectal stump is too large to be removed from the "back door." However, this new surgeon said he may be able to remove it using robotic surgery. We have several things to discuss so I'll let you all know after 3 weeks.

Diane C.

[Sandywr]

I haven't been on the board for a while. I use a few drops of pure castille soap mixed with water. I use a baby aspirator every morning. Squirt it in ..release it..do it again..third time I squirt in three times holding all three.. wash my hair and release it. Then about 10 minutes after shower I sit on toilet and get rid of rest of mucus. No problems rest of day.

[Diane C]

Gosh, this is a late reply! Apologies! I'm now seeing a new surgeon who moved to VA from NJ and he's fabulous. I'm taking some tests to determine the best kind of surgery to have. I have pelvic floor disorder which causes chronic, severe constipation and got a colostomy in 2002. (Also a MACE -- but that's a different subject -- but I can irrigate through it.) I have been VERY distended for 6 months and while I thought the colostomy was the answer, I may need an ileostomy due to slow transit time. (I irrigate daily.) And over the years, I've developed both colitis and diversion colitis -- the latter causing the rectal discharge. This surgeon gave me a prescription for sodium butyrate enemas but the jury is still out on whether that helps with the mucous. It's a short chain fatty acid -- similar to what's found in the stool. In any case, this surgeon thinks he can help with laparoscopy and robotic surgery. I may have my rectum removed. We'll decide soon. Surgery would be after July 20. Btw,, I was able to fill the sodium butyrate prescription and get coverage through my insurance at Alexandria Compounding Pharmacy in Alexandria, VA. Good luck to all and I'll try to be more responsive -- you were right!

Diane C.
2000 -- MACE procedure for pelvic floor syndrome and chronic constipation
2002 - sigmoid colostomy
2015 - peristomal hernia repair and excision of sigmoid abscess

[Pam1955]

In my case, my two surgeries were emergency. The first was on 12 July 2017 after eating supper. My colon died in less than 24 hours and I was rushed into emergency surgery and came out of ICU 3 days later with an Ileostomy. At that time, the doctor told me he had left about 6 to 8 inches of my rectum and I could be rehooked up later on. My whole colon was dead however, and gone. The next 7 months, I suffered in severe pain, not able to hardly eat or sleep. I went to the emergency room many times asking for help and finally, after 7 months and two cat scans, an anomaly was seen and I was rushed back into surgery where my stoma was rebuilt. It had strictured shortly after the first surgery and my intestines were swollen and ready to burst. The doctor rebuilt my stoma and cut off numerous adhesions. I still had the part of the rectum the first doctor left. The second surgery was on 18 February 2018. I never had any mucus until 2 days ago when I started to feel like I had to have a bowel movement. When I was in the bathroom, the mucus showed up as a pinkish, putty type substance with a very bad smell. I tried to push out as much as I could and wash well but I still felt like smelled and that upsets me greatly. It has been almost a year and I never had this issue. So why now, and what can be done for this? You see, I didn't have a choice in my surgeries. I had to have them or I would have died both times. I called my Osteo nurse and he stated that it was normal that I just needed to try to push it out when I felt the need to go. But how can I get rid of the odor?? I feel very self conscious about it and I don't want to be around anyone which is a problem as I drive patients to appointments and take them on outings so this causes me great distress. Any help would be greatly appreciated.

[Button]

Pam:
You are not alone in experiencing a discharge of foul and odiferous mucus/mucus plug many months after the original diversion surgery and remained rectal stump.

Your rectum, although disconnected from any upstream intestine, has no idea that it has been disconnected and is off-Line. Your rectum is a dense, thick muscle with an epithelial lining that continues to secrete serious fluids, mucus, fatty-acids, as well as sloughed off cells/cellular debris.

For some people, this material is thick and sludge like, a slurry, that only becomes noticeable as its build-up becomes more pronounced and triggers the rectum to respond as if there were an actual bowel movement. This is likely your situation. The buildup of mucus and secretions within your reveal stump became sufficient/sizable enough that your rectum “notified” you in feeling as though you needed to pass a bowel movement.

Mucus poops can be thick and pasty and foul smelling. The odor is due to normal bacteria and decayed body secretions that have been retained in the rectal stump.

The order of business, moving forward, is to flush the rectal stump on a regular basis to clear it of normally secreted mucus and celluar byproducts. If you read this thread from the beginning, you will read discussion as to how to flush your rectal stump. It’s an easy process. Use a baby nose aspiration or small bulb irrigator, full with warm water and/or a few drops of glycerin soap, and infuse into the rectal stump while standing in the shower. The infused water will flush out retained material in the reveal stump and pass out via your anus while standing in the shower. You may need to repeat the flush 2-3 times while showering.

When you feel an urge to have a bowel movement, quietly sit on the toilet. Sitting on the toilet often helps to pass a mucus poop/mucus plug. Do not forecefully strain so to prevent hemorrhoids. Sitting on the toilet engages the mind-body connection that you are doing what you need to do to ease communication from your rectum that it is full, and will ease rectal muscle spasms and contractions.

You may want to wear a disposable pad in your underware until your rectal stump has been cleared of retained mucus/cellular debris.

It is a sad truism that surgeons fail to inform people with a rectal stump about mucus poops and that need for regular care and maintence of a rectal stump. Almost everyone comes to awareness much as you did . . . Through an unexpected, baffling, and distressing passage of an odiferous mucus poop. Know that you are not alone in this experience.

Read this thread from its beginning to better understand flushing of the rectal stump. You can also type in “mucus poops” or “rectal stump management” into the search bar of this forum. There are lots and lots of prior threads on the subject.

Managing your rectal stump will get easier from here on forward.
Karen

[Gooeyduk]

What wonderful contributions on this nasty subject. Two years post ileostomy I have the same mucus problem described by everyone else on this page. But I think my situation is unusual in that I have a completely flacid rectal sphincter (you could drive a car up my butt) resulting from a spinal cord injury in a plane crash. Consequenty I think I would need a larger flow volume of water than would be provided by the nose blasting tube or ennema squirter thing suggested here. I’m thinking about an old fashion douche bag and nozzle (if they still make them). Any thoughts ?

[Nomadic]

Thanks All!
Once again, I have found creative options for my condition. I've had the mucous flow from the beginning and was warned that to expect it. I thought I'd just need to consider it the cost of solving my greater problem.

[Button]

Gooeyduk:
Do you know, off hand, if you have a remaining rectal stump? Or do you have also a segment of large intestine and rectal stump remaining?

That is, what describes the large intestine that was disconnected and remains off-line? Rectal stump only? Or rectum and additional portion large intestine (sigmoid, descending colon, or even transverse colon)?

The length of remaining/off-line intestine you are wanting to irrigate to flush accumulated mucus and cellular debris can be longer or shorter from person to person.

That you do not have a sphincter reflex will not have too much bearing on the actual process of flushing a rectal stump.

A word to the wise: You do not want to flush a remaking rectal stump where there is additional remaining large intestine (ex. rectal stump with continuation of sigmoid colon and descending colon) with a copious water of enema bag volume (4 cups). The infusion of a large volume of water into a lengthy remaining/off-line segment of water can lead to too much moisture being retained that does not flow out. The highly moist environment can then cause unwanted bacterial or fungal overgrowth that would exacerbate the existing mucus/cellular debris problem. That is, you will have more foul discharge, not less.

You want to use the lowest volume of water that brings effect to flush the rectal stump. Introducing water via a typical enema bag where there is a longer residual intestinal segment can be counterproductive - that is, water will be retained in the more distal intestate segment and that moisture will contribute to more bacterial overgrowth and more foul discharge (as there is no top down stream of fecal matter that keeps moisture in check).

I would not advise using a large infusion of water with a typical enema bag.

Use of a Fleet’s enema size bottle is OK (active Fleet’s ingredients discarded the the bottle used for a warm water or warm water + few drops of glycerin soap flush).

A baby’s nose baster or small volume syringe (without hypodermic needle) is usually sufficient for a 4-5 inch remaining rectal stump. Infusing about 1/2 cup of water or less for a 4-5 inch rectal stump.

The important point: You do not want to create an environment where there is excessive moisture remaining in the rectal stump or, more importantly, in a longer residual intestine. Excessive moisture will encourage bacteria and fungus to thrive.

The goal: To flush the rectal stump and have the infusion of water exit freely and completely. This is where using a baby nose blaster is advantageous. You can use the baster (dry, empty) to then suction water from the rectal stump after irrigating the stump. You expelled the air from the bulb of the baby nose blaster, hold bulb closed, insert tip into rectal stump, and release the bulb. The negative pressure will draw from the rectal stump remaining fluid/water and reduce retained moisture.

Good question, on your part. This aspect of rectal stump maintenance has never been fully discussed.
Karen

[sassie]

Thanks to all for such great ideas to get rid of that nasty mucus, I also coughed at work and felt a gob come out but what was worse was the smell...I love the idea of the fleet bottle in shower to be sure in a few mins. i will do this, as i have a unused fleet in the closet, i'll dump the contents out and use plain water and just make that part of shower time, I have 12" hanging inside and i sure wish it wasn't there but no way will i consider getting it removed I have had enough surgery, but i am wondering why they left so much being mine is permanent.

EEK, i just reread and see to get the water out, i did not use much and it felt like it push out as if that part still worked, I sure hope so as i am fighting a fungal infection at this time and a baby nose thing would be to small for 12" remaining.

sassie

[Gooeyduk]

Thanks Button for you quick response. I’m afraid I’m not familiar with the proper medial terminology. When I had my ileostomy all other components of my digestive system were left in tact. My rectum is totally flacid and the sphincter that admits stool to the (stump ?) is very tightly closed. It seems that if I flush water in, the sphincter is tight enough to prevent very much water getting in the descending colon. It’s that a reasonable expectation ?

[Button]

Sassie and Gooeyduk:
Most individuals with rectal stumps do have active sphincter muscle tone.

Keep the process of flushing the rectal stump simple.

You do NOT need to flush the entire length of any remaining and off-line intestine. In both of your cases, you have remaining off-line intestine that is longer than a 4-5 inch rectal stump.

Flushing the rectal stump will suffice.

You need NOT flush the entire length of retained intestine. Mucus that is secreted from intestinal tissue higher up will migrate down to where it can be successfully flushed. You do NOT want to irrigate water too far upwardly and create a moisture rich environment like a terrarium

Use a baby nose baster with bulb or a fleet’s enema bottle (with original enema fluid discarded prior to use). Use warm water or warm water with a few drops of a liquid glycerin soap or gentle gentle soap free of additives. Flushing the rectal stump while in taking a warm shower is an ideal setting as the warmth of the shower will relax lower pelvic and sphincter muscles.

You do want to have the infused water freely exit the rectal stump. Excessive retained moisture in the rectal stump can lead to bacteria and fungus multiplying and causing more foul discharge.

To help siphon and remove water after flushing, leverage the use of negative pressure. To wit: Expell air from the fleets bottle or baby nasal baster (press on the plastic fleets bottle or bulb of the baby’s nasal baster), and use the resultant negative pressure to essentially “suck out” any retained water. You will most likely NOT get a significant return volume of retained water. It will be a minuscule amount. The vast majority of the water flushed will exit naturally with gravity while standing and showering.

As you are up and about and moving around following the rectal stump flush, you may find that the stump expels additional water/mucus. A pad in the underwater can containing this discharge. You may also expel water later in the day when sitting on the toilet. Gravity itself will help mobilize retain water.

The caveat and take-away learning: You need only irrigate the rectal stump. Do not overlay analyze the process and get too caught up in feeling the need to do an exacting flush with a large volume of water. Repeated practice will tell you what works and doesn’t work for you and your anatomy. Try to avoid excessive retained moisture in the remaining strump and any off-line intestine, as moisture can cause bacterial and fungal overgrowth and subsequently more foul discharge, not less.
Karen

[Diane C]

Since I recently finally had my rectal stump with anus removed, I do want to emphasize a couple of points. I'd not have done so if the output was only mucous. It had become mixed with what seemed quite a bit of blood over the years. I was using a lot of sanitary pads despite flushing the area out with various medications and other substances.. This was worrisome to me. I had done quite a bit of research to see if diversion colitis could lead to cancer. I did not find evidence of this -- but also didn't find evidence that it does not. That's still under study but if you're only leaking mucous, I'd not worry about it. If you are bleeding, do see the doctor -- although (s)he may still be unsure what course to follow.

Also, I had quite a bit of severe cramping right before I had the mucous and bloody discharge. I'm not sure why this occurred but it certainly was unpleasant. If you don't have these symptoms and the condition is not severe, I hope that you'll do well with the "soap flush."

An ostomy nurse advised me to use Dove or Ivory soap. Dove has quite a bit of chemicals in it although commercials state it's "pure and gentle" and you've probably seen animals, especially ducks, who were caught in oil spills washed with it. Years ago, I used Ivory with success though dislike the scent. Here are its ingredients: sodium tallowate, sodium cocoate or sodium palm kernelate, water, sodium chloride, sodium silicate, magnesium sulfate, and fragrance. Maybe better than many other soaps. The point back then was not to use a soap with moisturizers which could make the skin slippery and prevent ostomy appliances from adhering. Frankly, I didn't find that any soap was a culprit that affected how well my face plate stuck to my skin but we're all different. I recently went to the baby aisle and found soap that's sensitive for infants -- but yes it has chemicals as does glycerin soap from my health food store -- but these are probably lacking the chemicals in many other soaps. I'm using thee baby soap to wash the area near my rectum surgery wound site. It's really tough to find chemical-free soap -- so buy a soap that has less chemicals than most. Thanks, Karen/Button for your recommendations and I agree that aloe vera can be soothing.

Diane C.

[Gooeyduk]

Thanks Karen, I’ll use a small volume flush and avoid any water going above the stump into the inactice (off line) colon.
Ben

[Button]

Gooey:
The adage “less is more” rings true with flushing of a rectal stump.

A large volume of water infused into the rectal stump where there is also a lengthy segment of the large intestine/colon remaining can be counterproductive. Infusing a large volume of water (say, a typical suspended enema bag set-up that holds several cups of water) would create retained water and a moist environment like a plant terrarium. Bacteria and fungus would bloom and cause more discharge.

Keep it simple. A low volume of warm water. Enough to flush a typical rectal stump of 4-6 inches. Use the negative pressure of the nasal baster bulb compressed or plastic bottle of a fleet’s enema compressed and then allowed to relax, open, and fill with air to draw up any gross volume of water that may remain.

Practice will make you more comfortable with the process. It can be awkward at first to get the hang of a technique that works best, as we are each unique people.

Come back and share your successes . . . as well as any struggles. We all learn through each other.

Rectal stump discharge is a common theme on this forum of expressed dismay, angst, and “yuck.” Few surgeons or ancillary clinicians (home health nurses, ostomy nurses) give any pre-emptive teaching or advice on living with a rectal stump. It is fairly common for a person to have an episode of smelly discharge from the anus weeks or months after ostomy surgery, with utter bewilderment and confusion mixed with fear and concern.

You and Sassie are not alone in what you are experiencing.

Let us know how you are doing.
Karen