UOAA Discussion Board

I've had a colostomy for nine years now but have never read anything about mucus discharge from the rectum. My own discharge began appearing about five years ago and has taken various forms as time rolled on. In a nutshell, the discharge first showed itself as solid ovals (about the size of deer scat) over which I had no more control containing than I did poop before my colostomy, and these were annoying because they were unpredictable in emergence, smelly like rotten fish, and very sticky/messy. After a time the "solidity" of these mucus balls disappeared, evolving into just a mucus flow -- still unpredictable, still smelly, and so thick and sticky the discharge would sit on the surface of a liner pad in my underwear and not be absorbed by the pad at all ... so I would always feel like I had wet myself until I could get to a bathroom and clean myself up. Most recently the mucus changed to a flow which which is no longer smelly, clear in color, and just annoying due to the quantity of its flow; liner pads now are effective but still a bother.

I spoke with my colostomy surgeon to ask about solutions to this condition. I was advised that removal of the rectum and accompanying stub of my sigmoid colon was the only sure solution ... so I signed up. I really wanted to be done with having to always be looking for a bathroom; I certainly had thought those days were over once I got the colostomy. Last week I came down with severe bronchitis which has pretty much zapped me of all my energy; I've had to cancel the surgery and forfeit the price paid for two non-refundable roundtrip airfares to Seattle because it's unlikely I can get rid of the bronchitis before the surgery date.

Interestingly, the flow of mucus I'd been dealing with has diminished since the onset of the muck in my head and lungs ... so now I'm wondering if the mucus flow has once again gone through yet another metamorphosis ... and perhaps will continue to do so(?) and dare I hope that this evolvement might continue in my favor?

Has anyone else who still has his/her rectum had experience with this? What advice and/or tales might you have to share? Has your output lessened or increased over the years?

~Zenobia

Zenobia:
It’s good to see you again, although I am sorry that annoying rectal stump discharge has been increasingly problematic and lending you to consider complete resection of your rectum and anus.

Now that surgery has been postponed due to an upper respiratory infection, spend a few moments and browse through recent threads/posts by Bill and Diane on fecal transfer to ease rectal irritation and bacterial overgrowth. The thread(s) are active and on this page of the forum.

Production of mucus from a diverted rectal stump is normal and expected. Your rectum has no idea that it is no longer connected to your functioning digestive tract. The soft tissue of the rectum continues to produce long-chain fatty acids and mucus, which normally serve to nourish the rectal tissues and provide lubricant to ease the passage of formed stool as it passes through the length of the digestive tract and out of the body.

The rectal mucus, serious fluids, sloughed cellular debris, and short-chain fatty acids continue to be produced by a diverted rectum. This material continues to need to exit the body via the anus. For individuals with a long rectal stump (ex. 4-5 inch remaining rectal stump), a common problem becomes contained mucus and cellular by products that build up over time. Because there is no formal passage of fecal matter, residual material accumulates and is retained. This is what you are encountering when you finally pass “mucus poops” that are foul in smell and appearance. The retained cellular by products are fermenting with added bacterial overgrowth, causing mucus poops that are off-smelling and putrid.

I have a tiny 1/2 - 1 inch residual rectal cuff. I used to be bothered by foul mucus discharge of about a tablespoon, randomly once or twice a week. Wearing a menstral pant liner was not ideal, as the pant liner did not coincide with the anal discharge. It was discouraging and annoying.

Then I read a few posts by our forum member Sandy with her stoma “The Dude.” Sandy had her entire rectum retained with a sigmoid level diversion. Messy mucus poops were affecting her quality of life. Then Sandy took the initiative and began irritating her rectal stump with warm/soapy water, using a baby eye dropper to infuse 5-10 ml of warm/soapy water into the recital stump while standing in the shower showering - effectively irrigating the reveal stump and flushing out retained mucus and cellular debris. Viaola! Success! With regular irrigation of her retained rectal stump, the incidence of foul mucus discharge ceased.

I took Sandy’s story and applied it to my own situation. I use a baby eye dropper and flush my remaining rectal stump with warm/soapy water when I am showering. It has been a very positive experience for me. I no longer have errant mucus discharge and I feel better systemically as the bacterial overgrowth was reined in. I feel like myself again. And I thank Sandy for sharing her story and her experience.

There are pads specifically designed to contain mucus discharge. They are called “Butterfly Pads” for anal discharge. “Butterfly Pads” are available on Amazon, about $12 for 30 pads.

I highly recommend “Butterfly Pads.” The pads look like a butterfly with two sets of wings. You fold the pad and place it between the cheeks of the buttocks, covering the anus. The pads have a light adhesive similar to that on the back of a Post-It note that keep the pad secure and in place. Once in place, you do not feel its presence. I remove the pad when I urinate (to keep the pad from becoming soiled by the flow of urine) and then simply replace. Butterfly Pads are a god-send.
Karen

Wow, Karen! The solution you write about sounds far preferable to the requisite 2-team, 4-5 hour surgery I was looking at. Ha, I am so delighted the bronchitis forced me to cancel! My surgeon had earlier suggested I try solving the problem with periodic store-bought enema solutions, but that proved ineffective, excruciatingly uncomfortable, and not something I could continue to engage in because of my knee replacement. He never mentioned using a baby eyedropper to infuse a tiny bit of warm soapy liquid while showering. Now to go buy myself one of those!

Please confirm that I'll want to get an eye-dropper and not one of those wee basters for cleaning out a baby's snotty nose; is this correct? Then off to the market I'll go. Many thanks.

Zenobia

I use a fleet enema bottle filled with plain water, and infuse it in the shower. Same idea, larger quantity of water--but you don't have to fill the bottle all the way.

My knees would complain, too!

Zenobia:
Actually, it is a baby snotty nose baster that I use, not an eye dropper. I did not know how to describe the slightly larger baby nose baster . . . Your terminology is accurate for what I use.

I have a small plastic cup that I take with me into the shower, it is about 6 oz. I make a warm water + liquid baby soap solution (no chemical additives, no parabens). Irrigate the rectal cuff/stump with 2-3 fillings of the soapy water filled baby snotty nose blaster. The water irrigation exits while standing in the shower. Often it clears accumulated mucus.

I have also used a mixture of water + aloe vera juice (available at any organic/Holostic grocery store or pharmacy) when my rectal cuff has been particularly irritated. Aloe Vera is innately soothing and healing.

My primary care physician and surgeon were both clueless about anything that I could do to ease the mucus and cellular debris associated with my rectal cuff. I was prescribed Flagyl (antibiotic) several times. The surgeon only offered surgical resection of the rectal cuff, which owing to my fragile health is not an option nor an option that I was willing to entertain.

Leave it to this forum to provide me with a simple and creative solution. Thank You and Merci’ to Sandy.

Steniconi is also resourceful and correct in suggesting a Fleet’s enema bottle as an option. I have a 1/2 - 1 inch cuff, so a wee baby’s snotty nose irrigator is well sized for my needs. If you have a longer rectal stump (3 to 5 inches of retained rectum) a Flelet’s enema bottle may best serve your needs. Again, do NOT use the Fleet’s solution (as you experienced, the Fleet’s solution is irritating and harsh to the internal tissues). Empty and clean the Fleet’s bottle and replace with warm/soapy water for irrigating while showering.

Use a gentle, non-irritating liquid soap. I use an organic liquid Bay soap that has no chemical additives, no parabens.

Give irrigation of your rectal stump a try. It may take a f ew irrigation sessions to loosen accumulated buildup on the walls of the rectal stump.

I have been irrigating my rectal cuff for several months now. I am a happy camper. No more smelly, foul discharge. No more soiling of underware. I feel better systemically. The mucus discharge was my nemesis.

Fingers and toes crossed that rectal stump irrigation brings you relief.
Karen

Hi Zenobia , you are describing a big problem for me currently .In my case I do have the rectal stump and the mucus fistula which had mucus coming out both ends .It's the rear end that is a huge problem .My surgeon, whilst assessing whether my anus had stenosed put his finger in to test .He said it wasn't as closed up as my records had indicated - and said there was not a chance he would consider major surgery to get rid of the stump .The mucus had become annoying - exactly as Button described so I had consulted him with a view to getting rid of it . He was very forthright and said he saw no reason whatsoever to risk major surgery to get rid of this "small " problem .So shortly after this ,my mucous became even more annoying .It had changed from little clear pellets to like a sludgey mess .Once again I would go dashing to the toilet or risk as Button said , a mess on a pad kind of thing.This makes me feel depressed and unclean .I am just getting over a very bad chest infection and when I coughed, the worst would happen .I am starting to feel a little better now and am once again concerned about this gross condition .I don't know if it was the widening of the passage by the doc or what , but I shall definitely try the fleet bottle when I find out what they are and where I can get on in the UK .
thanks
L.x

Lola:
It feels like home-coming week. I have not been on the board for several months and decided to check-in . . . I forgot my password and reregistered as ButtonButton.

I gather you have a loop ileostomy or loop colostomy, with two closely approximated stomas. A working stoma, the active aroma from which fecal output from the upstream intestine exits. And a non-working stoma, the mucus stoma that communicates with the resected and resting remainder of lower intestine.

So you are asking if it is A-OK and safe to “flush” the resting and remainder lower intestine from the top down? That is, infusing warm water/gentle soap/aloe Vera through the mucus stoma (which you call a mucus fistula), infusing water from the top down, flushing the lower resting digestive tract.

The answer: Yes, you can.

You would likely use the same or similar baby snotty nose droplet or nose baster that is mentioned in the posts above.

Children with chronic constipation due to Hirshburger’s syndrome have a surgically fashioned stoma made at the umbilicus. Parents use a top-down flushing once a day to effectively flush the lower colon of retained fecal material. It is called a Meitroff (? spelling) stoma. It is similar to a hanging bag enema, a soft silicon cone/tip inserted into the umbilical aroma, the clamp of the enema bag gradually opened, water allowed to flow through the lower digestive tract, with waste material then exiting through the anus as the child sits on a toilet.

You could do something similar to flush your lower respected digestive tract of retained mucus and fatty-chain acids and built-up cellular debris that is likely accumulating over time and “clogging” your lower unused digestive tract. The water flush would exit through your still opened but narrowed anus (I imagine you would sit on a toilet as the water infusion would infused through and down your lower intestine).

We have a member, Diane C., who is an adult with a Meitroff stoma. She would be able to explain how she flushes her lower intestine. Diane C. has been actively posting the past several weeks.

You could also talk with an Ostomy nurse to figure out exactly what hanging enema-type system would work for your mucus stoma.

In the meantime, you could try the eye dropper or baby’s stuffy nose baster technique as a bottom-up approach to flush the last several inches of your remaining rectal stump - as discussed in my earlier posts to Zoebia.

I hear you and empathize with you regarding the distress and anguish that persistent rectal stump mucus causes. I have but a small rectal cuff but the mucus flow was often significant and consistently foul in order and thick and messy. Mucus discharge became my biggest nemesis. I adapted easily to the ileostomy. The mucus discharge, however, gave me significant distress. It was an unwanted guest.

Look into the ButterFly Pads for anal discharge on Amazon. These pads are specifically designed to contain anal discharge. They are a god-send. Shaped like a butterfly, you fold the pad and place it between the cheeks of the buttocks, covering the anus. A light adhesive (similar to the adhesive on the back of a post-it note) holds the pad in place. I highly recommend the Butterfly Pad.

Rectal stumps and rectal cuffs can be a source of distressing mucus. I disagree with your surgeon. Rectal mucus is not a small problem. It is a source of significant physical and emotional distress.

I hope this discussion is helpful.
Karen

Hi Karen , thank you for the speedy reply ! I have figured out from looking on amazon.co.uk that a fleet enema looks like a small pear shaped bag with a tube coming out of it- ( we're not very big on douches in the UK ! ) and have ordered a small one .I think this is going to be trial and error on my part as stoma nurses have only ever tried to thread a very long thin tube through the fistula which then appears at the rectum,and then a skinny amount of water goes through ,resulting in - nothing ! The last nurse just left the irrigation bag and long tube and said- have a go yourself,I'm squeemeish Luckily my long suffering husband will help me if I try to insert it at rear end ,as I'm not sure how I could actually do the deed !


The surgeon was adamant and dismissive of this kind of problem .I suppose if you yourself haven't got a stoma and are dealing with a colostomy, then mucous might seem like a small deal to you .To me though , it has become debilitating and I have started to dread being around people .My next stop will be the butterfly pads - thank God I've just signed up to prime on amazon !
So glad you visit pages these Karen ,I already feel a little bit less stressed

Steiconi, like you, I still have my entire rectum; I also have some sigmoid colon still attached to it. (I have a transverse colostomy.) My surgeon did not make light of my mucus problem nor does he have a colostomy himself; after reading Lolapergola's input, I appreciate even more now that my surgeon was very sympathetic to my condition while also stressing that this IS a major surgery (4-5 hours) requiring 2 teams of surgeons working simultaneously from front and rear, and he wanted me to try all other possible solutions before scheduling me for the surgery.

I had bought an over-the-counter enema package complete with solution and followed the instructions on the package. The hardest part was kneeling while bending forward and reaching behind me to insert the fluid -- way too painful for my knee replacement AND, the third time I did this, I managed to give myself hemorrhoids which stung like crazy for three whole weeks! Ha, I was not trying enemas anymore!

But I like the idea of simply squirting the warm-water-filled bottle while standing up in the shower; I think I can manage that one. I will also now go buy myself a baby's snotty nose baster and start with that, but my guess is I'll need the larger water container since I'm dealing with the linings of a full rectum and a partial colon. Maybe I'll pick up some of Dr. Bonner's Peppermint Soap (liquid) -- I remember that product from my hippie days. Thank you so much for these suggestions. Yes, indeed, Karen, when it comes down to the nitty-gritty details of "how to," we learn far more from our fellow ostomates right here. This site is a godsend!

~Zeno

NOOOO! don't use the Dr. Bonners! IT BURNS! just speaking from personal experience.

use a non-scented soap, if any. I make my own liquid soap from the glycerin soap I use for everything--just put a chunk of soap and a little water in a large bowl, microwave it for about 15-30 seconds, stir and let cool.

Ha, there's a real learning curve in using this baby's stuffy-nose baster, squirting warm soapy water* into my rectum while showering ... but, by gosh, it seems to be working! And sure beats the surgery option - egads! Thank you again, Karen, for your post; and thank you, also, Lee, for the "save" from a Dr. Bonner burn.

xoxxo Zeno and her bum

Hi Folks,

I'm sorry for my absence. Seems that a number of us caught bronchitis or chest colds. Whew, mine has been horrendous. I don't often travel but in early December, I went to New Orleans on a short tour which was fun and informative (though I didn't love the spicy food!). Unfortunately, someone on the tour had bronchitis. By the end of the trip, I had a cold and it developed into full-fledged bronchitis about 2 wks ago. Headache, coughing, wheezing, the works. I recently went back to the doctor who'd given me inhalers, etc.(Several years ago, I was diagnosed with moderate exercise-induced asthma which never bothered me and never used inhalers) and although bronchitis is caused by a virus, he gave me antibiotics (which often upset our guts) and other meds as bacteria can be involved. I FINALLY feel I'm emerging from this and hope no one else catches it. I'm on a soapbox. If you are sick, have the flu, or bronchitis, PLS stay home and don't spread it -- and keep washing your hands.

I'm primarily addressing the rectal mucous issue here. Yes, I have a Malone Appendiceal (or Antegrade) Colon Enema (MACE) procedure but that's irrelevant to this subject. It's a surgical procedure that some babies with spina bifida or other paralyzing conditions or children with other conditions that cause constipation obtain so that parents can irrigate their colons and prevent constipation and a build-up of gas. In my case, because my anorectal sphincter muscles were dysfunctional (like my dad's) from birth and did not relax in synchronicity (also called pelvic floor dysfunction) resulting in severe constipation or incomplete evacuation, and I had tried everything from botox to biofeedback to galvanic stimulation to yoga and meditation to numerous diets and didn't especially want a colostomy (especially after breast cancer -- diagnosed early, thank goodness), a surgeon in Chicago (now retired) performed this procedure in 2000 to eradicate -- we hoped -- the constipation. The water that was to flush out my system which flows with gravity downward from my navel to the caecum did not have the force to open my sphincters -- even with biofeedback -- so in 2002, I opted for a colostomy. I now irrigate -- which colostomates only can do -- using this MACE procedure in the morning so I don't have much output and gas during the day. (Below is a forum about irrigation for colostomates.) This form of irrigation works well for me and probably is unique. One does not acquire a MACE procedure for irrigation. It's a procedure to avoid constipation. There are irrigation supplies that colostomates use to irrigate and they perform this procedure differently than I but the ultimate result is the same.

A wonderful guy on the board, Bill, had addressed the issue of diversion colitis which causes the mucous and sometimes (often with me) bloody discharge from the anorectal canal. Button/Karen has done a great job explaining the cause of the mucous. To repeat, since our anorectal canals no longer receive stool that's now eliminated through our stomas and because stool contains beneficial short chain fatty acids (SCFAs), our anorectal canals can become inflamed. It seems this doesn't happen right after we have our ostomy surgeries. It takes a few years for the body to recognize the absence of the helpful SCFAs. Once the anorectal canal recognizes the absence of these, we may start to expel mucous (often tan or brown and foul-smelling) and even some blood which signifies inflammation similar to colitis -- so the condition is called diversion (an ostomy diverts our stool from the rectum) colitis.

Apparently Button and others are having success with soapy water enemas. Some of us have tried oily enemas called Rowasa or Canasa suppositories that subdue the inflammation somewhat. And more and more of us, it appears, are turning to fecal microbial transplantation or FMT -- which is very different from the procedure that the FDA has approved for a condition called C. Difficile -- for NON-ostomates. I'm referring to fecal transplantation which means taking a small amount of our stool -- perhaps 4-6 ounces -- and re-inserting it in our anorectal canals to repopulate the area with healthy short chain fatty acids which may heal he inflammation and leakage of bloody mucous.

Bill suggested a tool that I purchased at Amazon. It's actually an applicator that provides vaginal or anal lubrication and it works wonderfully. See https://www.amazon.com/Launcher-Persona ... on+syringe Using this applicator, you collect some stool, add distilled water, make a soupy concoction and insert the stool -- with those healthy short chain fatty acids -- back into the anorectal canal. I had tried other means to do this with far less success. It's recommended that you try to hold a small amount of the substance for about 15 minutes and roll around so that it coats the anorectal canal's entire wall.

I've tried this 3 times and unfortunately, it did not help me yet. Sigh. Remember, my anorectal muscles are dysfunctional and while they usually are tight, when I insert this concoction, it's hard for me to hold the material inside. Someone suggested I do this on puppy pads due to the messy leakage but now, I just do it in the tub. While I've had bronchitis, I didn't have the energy to do this procedure but soon will try again -- and pray that it works for me eventually. I still am leaking much mucous -- and some blood -- and wear sanitary pads daily. I use a rectal tube several times a day to extract the mucous.

More recently, I've experienced pain in my sigmoid and had surgery to correct an abscess there in 2015. In February, I went to the Cleveland Clinic in Weston, FL and was diagnosed with colitis near my stoma. So, my GI doctor here where I live in N. Virginia has suggested I insert those Rowasa enemas and Canasa suppositories into my stoma to reduce the inflammation there. I've only been doing this about a week and haven't noticed improvement but my gut is also dealing with antibiotics and mucous from the bronchitis.

I am weary of the diversion colitis and leakage so asked my surgeon about removing my rectal stump. Since I did not have cancer, it remained when I had my colostomy. However, I've now had three abdominal surgeries. This surgeon is outstanding and the rectal stump is generally removed via laparoscopy from the FRONT -- not from the rectum. My surgeon felt that I'd have much scar tissue and adhesions after the surgery -- and also have the MACE tube made from my appendix in my abdomen -- and would not guarantee success or subsequent pain. One can have the rectal stump removed from the rear if it is small -- but mine is too long. So, I must try the fecal transplantation on a much more regular basis. Bill had much success with it as did someone locally. Maybe I need a more healthy substance? My almost 101-year old mother is actually healthier than I gut-wise and I'm debating using some of hers.

Question (probably should be a separate thread and I may create that): has anyone been developing painful sores in the mouth and on the tongue that last about 1-2 weeks? My immunity isn't booming and I saw about 5 doctors over several years. Believe it or not, a very curious podiatrist diagnosed these sores as alpheous abscesses. One doctor did say they are part of an auto-immune condition and there's no cure. You can rinse your mouth with mouthwash that does not contain alcohol. In time, they subside and heal -- but in my case, they recur. The mouth, after all, is part of our digestive system and mine is dealing with much inflammation.

I'm aiming to solve some of this and have a healthier 2018. I'll admit my get up and go has largely gone and I'm asking it to return. I won 7 gym training sessions in a theater raffle. I'm hoping that after I work with a trainer (once the bronchitis is gone), I'll be energized to work out again. If nothing else, it gets those endorphins moving, helps memory and bone density, and improves mood. And, having been cooped up, I can't wait to swing dance again! And lose some weight!

Wishing you all a happy holiday season and all of us good or better health in the new year.

Diane C

1976 -- partial lateral sphincterotomy due to chronic, severe constipation caused by non-relaxing puberactalis colorectal muscles (pelvic floor disorder)
2000 -- Malone Appendiceal Colon Enema Procedure (MACE) to irrigate the colon and treat constipation
2002 -- Colostomy (rectum retained)
2015 -- Removal of abscess in sigmoid area due to ongoing constipation despite irrigation and correction of twisted intestine below stoma with insertion of mesh -- "peristomal hernia"

A quite from Eric Polsinelli (VeganOtomy) which I read a while ago on a forum 'Assholes are overrated'.

Depending on your situation or if you will be having surgery removal of the cuff is not as bad as often found online. It's uncomfortable but at least for me was a really good QOL improvement. Surgeon's prefer to leave a cuff rather than remove it because of the healing issues that can arise when you have just undergone major surgery.

It really depends on what's been left, if you have more than just a cuff it would be a much more difficult recovery and therefore a much more difficult decision.

Anadevi,

At this point, my very experienced surgeon here in N. Virginia has told me he will guarantee nothing if he removes my rectal stump. After 3 abdominal surgeries, I have scar tissue and probably adhesions which make this a challenge. Among the surgeries was the creation of a MACE tube from my former appendix which extends from my caecum to my navel and through which I am lucky enough to be able to irrigate (this was done to avoid an ostomy but didn't do the trick in eliminating constipation due to my pelvic floor myscles). So, it's complicated.

I plan to write a book about my gut journey and I will include that surgeons and doctors should give patients full info before surgery. Why was I not told that I MIGHT have mucous and blood leaking from my rectum in the years to come? For some, this can also be frightening. But more, it's literally a pain in the butt, causes cramping, and IF the fecal transplantation does work, it can be messy and time-consuming. I take Vitron-C daily for iron -- partially due to this blood loss. Why wasn't I given the option to have my rectum removed in 2002? This is what gets to me and I hope all patients are better informed but doubt it. I'd gladly live without it. Yes, healing time would have been longer and more complex but I'd be in far better shape now. I can't have the rectal stump removed via the "back door" as it's too long. (Has anyone done this without laparoscopy?) I stayed up one night last week into the wee hours and found that doctors were aware of diversion colitis -- certainly in 1980 and maybe before. Patients need and deserve full information. A cooperative and good relationship with a doctor requires this.

Thank goodness for this discussion forum that helps us all. I just contributed -- late -- but today. And go to my local ostomy support group. I hope all find the help they need. This issue will be continuing in 2018 and beyond.

Diane C

2000 MACE for chronic constipation/pelvic floor syndrome
2002 Colostomy
2015 Removal of sigmoid abscess due to continued constipation and repair of peristomal hernia

Diane C wrote:Anadevi,
At this point, my very experienced surgeon here in N. Virginia has told me he will guarantee nothing if he removes my rectal stump. After 3 abdominal surgeries, I have scar tissue and probably adhesions which make this a challenge.

I do feel that we should be given the choice and informed of the pros/cons having the stump removed when a permanent ostomy is formed. For me I struggled to deal with it.

If it's really causing a QOL problem for you, at least get a second opinion. It can be removed though the rectum in some cases without reopening the incision site. But it really depends on just what was left.