Have you been sewn closed? Questions about that.

Hi,

So, you are all likely tired of my questions and no, I haven't even seen the surgeon or know what exactly they will do in surgery. I do have a question though....I have read that some people get their butt sewn shut when they have surgery. I understand that sometimes people have issues with discharge or mucous or whatever even after surgery (if not sewn shut). So, can anyone tell me about this? What are the reasons people do or do not have that done? Who decides (the doc, the patient)? Pros and cons of doing it vs not doing it?

I know I ask a lot of questions and stuff, but it sort of eases my mind to get more information about what I have to look forward to and get some idea of what to expect.

Just a couple more weeks until Mayo. Then I should know what's happening and exactly what they will do in surgery. Just looking forward to that week being over with. I'm ready to do this and move on. I HAVE to call Mayo today to get more details on stuff like what meds to take when and what I'm allowed to eat on what days, etc.

Thanks always for your support and for sharing your stories and thoughts with me.

It depends on several things: first what disease or reason you have for surgery. Then on what your surgeon wants and finally on what you want, though typically they don’t seem to ask and you have to assert what you want and see if it is feasible. If you are having a proctocolectomy with a permanent ileostomy most of the time they sew you up, but I am not sewn up because I requested I not be. If one has Crohns they probably and rightfully will remove anus and give Barbie Butt with UC it is more optional. The leaving of the anal canal and associated tissues hasn’t caused me any problems. Very minor mucus. Leaving a rectum or rectal stump is a whole different manner and often causes diversion colitis and this can be very hard to control.

Katie, the rectum and anus can be left indefinitely as long as they aren't causing problems for you. Probiotic still has his and as far as I know doesn't have plans to remove them. You *need* to have sigmoidoscopes for surveillance if you choose to keep your rectum because you are still at an increased risk of developing rectal cancer, but otherwise as you long as you feel fine it's fine.

I felt great immediately after my colectomy but my remaining rectum started flaring about six weeks after surgery, when I finished tapering off of prednisone. It was nowhere near as bad as a UC flare, but I did have to evacuate blood and mucus several times a day, and it was sometimes urgent, and I had low grade fevers until my rectum was removed. So I guess that's sort of an example story for why some people DO go on to have the rectum removed, but Probiotic is a good example of someone who hasn't felt the need to move forward.

@Eva Lou...I'm happy to hear it finally healed! So now that it is, do you have any lingering pain? I think that's been the worst part for me, the pain and the itching that goes with the healing. My stitches are dissolvable but I still feel some there. I go to my surgeon on Wed. so I'll find out more.
I'm just hoping to hear from you that once you're healed, no more discomfort.

I'm only 4 weeks out so maybe I shouldn't be expecting so much but I can't help it. Ugh

rdm said...
I think it important to get the terminology correct. The rectum is the located at the bottom of the colon and is actually part of the colon. The rectum is connected to the anus/anal canal, there is something called the anal verge where this connection occurs. The outside/end of the anal canal, the anal opening/butt hole is what you see from the outside. People with UC it is rare (but not unheard of) to leave any substantial amount of the colon and that includes the rectum. The UC can recur anywhere in the colon so typically all is removed. How much rectum is left after the first step of a 3 step J pouch surgery I don’t know but it would seem that they would just leave the few centimeters (called the rectal cuff) above the anal verge to make the connection. UC can recur in this (usually doesn’t) and it is called cuffitis. In the old days they would strip this area of its outer layer to avoid this. Today that is not usually done as it allows more of a chance for incontinence to occur when the J pouch is completed. However UC does not occur in the anus nor are fistulas very common with UC therefore it can be viable option to leave the anus and not sew oneself up. Periodic scoping of the few inch remaining is recommended. Other than IBD there are other reasons people have an ileostomy and colostomy, some are sewn and some are not. Don’t know the % but the majority seem to get Barbie Butt.

While we're clarifying all the details, the entire rectum and often a decent amount of the sigmoid are left after step 1 of a three stage j-pouch procedure. The integrity of the rectal cuff can't be maintained if it's the only part of the rectum left and it isn't attached to anything, and the rectum and some of the sigmoid are located in the pelvis and harder to access during the first step. Normally whatever is accessible in the abdomen is removed, then the remaining rectum and sigmoid are tacked to the front of the abdominal cavity and the incision is closed. In step 2 surgeons access the pelvis to create the j-pouch and remove everything except the rectal cuff.

Caren- I do still get itching... not as bad as when it was full-on healing, but it still itches if
I poke around, or sit a certain way, etc. It's easily relived by shifting position. I can't say I have any discomfort or pain, just a sensation like I know it's different than before. I guess more of an awareness of that particular body part! I just checked after  a shower, stuck the mirror down there & poked around- right now it's about 2 mm's long by 1-2 mm's deep. So it's definitely healed up, even in the 2 weeks since my wound center appt. I swear that alginate dressing is magic! Ask your surgeon for some, if you think of it. A fairly large amount of my anus was removed too, not all of it, but enough! The fistula was very low, hence so much anal tissue removed.

My surgeon told me that she usually does remove everything and sew up the backside. But in my case, she felt that I was too sick for my body to properly handle healing that wound along with everything else I was and would be going through. Instead, she removed my large intestine, rectum and most of my anus, leaving only a small anal stump. She told me I could later go back in and have the stump removed and get sewn closed. She made it sound optional, while my GI seemed to think I would need to have it done for sure at some point in the future. I do not need to have what is left back there checked or scoped or anything like that.

It has been about 16 months since my surgery and I have done very well. As far as issues from not being sewn shut....I do have quite a bit of muscus discharge back there on a daily basis. It happens every time I sit down to use the bathroom, and also leaks out at random times throughout the day and a lot while I am sleeping. I can't always control it, sometimes it feels like urgency or pressure and can be uncomfortable. Once in a blue moon there will be a little blood in it. I've asked my GI about it a couple times via email, and he seems to think it is normal, though at times it does feel a bit excessive to me. I'm hesitant to get the rest of the surgery done though. I don't like the idea of getting more surgery in general and being laid up again. And honestly, every time I see someone talking about the butt wound healing, it seems beyond awful. So, I guess for now I stick it out and just get used to having a soggy bottom!

Ulcerative for many years. I have a permanent ileo. Surgery November 2007. Nothing was discussed about rectum/anus removal. I was very sick. I said I just want the colon out. Did no research about options. He mentioned j-pouch. NO. I just wanted to be done. I have my anus and rectum. Never had a problem. Mucus and seepage stopped long ago. Have never gone for any scopes or exams. Don't plan to. If it ain't broke don't fix it.

Happy with what I have
Dan