Anal Discharge After Rectum Removal

I had a total proctocolectomy on 4/13. Due to my 30 years of ulcerative colitis I was not a good candidate for a J-pouch...so I went for the permanent ileostomy. Post surgical complications have been non-existent with the exception of the phantom rectum annoyance feeling which should subside with time. I chose to have my rectum removed to avoid the continuous mucous generation and discharge issue. Up until last night I was pretty pleased with everything and then I had some discharge out my backside. The volume wasn't that great, but boy was it foul in odor!!! I had more discharge before I went to bed and then again in the morning. I am wondering if anyone else has experienced this after having their rectum removed. I still have my anus and a very small section or rectal tissue...

If you still have your anus then you'll have some discharge. See UCwhat? post www.healingwell.com/community/default.aspx?f=33&m=3720052&g=3723110#m3723110

She has been dealing with this situation the last few years.

Your condition is almost exactly like mine, except for the fact I am a woman and the discharge is coming out my vagina due to a recto-vaginal fistula which no one seems to be able to locate. Personally, I think it is up under the rectal cuff, but, I sure don't want anymore surgeries. I am seeing a new colorectal surgeon because mine retired in 2013 and this problem didn't develop until a year later. My surgery was in 2010. Did you happen to ask WHY that little bit of anus was left? When I asked my operating surgeon that question, he answered that there seem to be more complications with removal of the anus at the time of the initial operation. Makes sense. It's a pretty big operation. They also ran across a problem during the operation. I believe I started bleeding, so he didn't want to waste any time.

I suffered with ulcerative proctitis for twelve years before my operation. The operation was a life saver indeed! If the disease didn't kill me, the meds were doing a good job of it. Good luck

Sick4Decades:
My situation seems similar to your own. I have a small remaining 1/2-1" rectal cuff and anus (my surgery was an emergency procedure owing to an extensive intestinal perforation, so complete removal of the rectum and anus with closure of the backside, aka Barbie Butt, was not an option).

I am 6 years post surgery and still have intermittent anal discharge. It is an annoying nuance. And I will admit that my patience with the messy discharge is waning.

Be watchful for symptoms of proctitis - low grade fever, chills, feeling of pressure in the lower pelvic, and anal discharge that is putrid and foul in presentation. Bacterial overgrowth can lead to proctitis similar to what individuals with a J-pouch experience. Antibiotics (Flagly or Cipro) can be warranted.

One product that I have found very helpful is called the "Butterfly Pad." It is a thin, cotton pad that has been specifically designed to capture anal discharge. The pad is shaped like a butterfly, thus the name "Butterfly Pad." The pad fit between the two cheeks of the buttocks with a mild adhesive strip that keeps it comfortably in place.
Butterfly Pads are a brilliant product for those of us with this specific need.

You can find Butterfly Pads on Amazon.com.

My surgeon continues to be surprised that I am dealing with anal discharge. He states that for most people the tissue of the remaining rectal cuff atrophies over time. As the remaining tissue atrophies, discharge lessens. I am in the small minority of individuals who remain pestered by anal discharge. Hopefully, your incidences of anal discharge will lessen over time and gradually disappear entirely.
- Karen -

Christine: The description of your vaginal discharge sounds suspicious for bacterial or yeast overgrowth. It is common for the vaginal tissues to become dry in post menopausal women. The dryness lends to the formation of small cracks and fissures in the surface tissues, making a ready home for bacteria and or yeast. Your foul vaginal discharge could easily have been a yeast or bacterial overgrowth.

Were you on corticosteroids in the weeks prior to your initial surgery? If yes, that also points to a likely yeast or bacterial sourcing of the vaginal discharge. The use of prednisone (and any of the glucocorticosteroids) acts to suppress the immune system. The end effect is a lowered resistance to infections and overgrowth of bacteria, yeast, and fungus.

The removal of my residual rectal cuff and anus is not being offered to me as an option. The surgery would be a Big Deal to my physical state of being and I suspect that your new surgeon is also eyeing the procedure as weighing in with more downside risk then upward gain.

Why is removal of the rectal cuff and anus a Big Deal?

The surgery requires two surgical teams, working simultaneously - one team working through an open incision into the pelvis and the second team working externally with an approach through the patient's legs up in stirrups.

The rectum is a dense, thick muscle. The tongue and the rectum are the thickest muscles in the body. The rectum does not separate away from the body easily. It is a pain stacking process to respect the rectum. The lengthy surgical time in the operating room for a proctocolextomy is reflected by the labor intensive time to respect the rectum and anus in full.

The wound bed of a respected rectum and anus is typically a slow to heal wound. The wound bed has to heal by the laying of granulation tissue from the outside of the wound toward the inside. The infiltration of granulation tissue is a slow and measured process. Delayed wound closure is not uncommon. It can take anywhere from 6 months to a year for the wound bed to finally close.

If you have a history of corticosteroid use for treating your UC, this can leave you at risk for slow to heal wounds. Corticosteroid use dampens the immune system, leaving you at heightened risk for infection. Corticosteroid use also hampers healing by lowering the presence of collagen and fibrin, both necessary to promote strong tissue integrity.

For me, the risk is real that I could be worse with surgery to remove my rectal cuff and anus than to keep the state quo and deal with annoying anal discharge. I think your surgeon likely has reservations on the value to be gained in reaecting your rectal cuff and anus. There are
risks with every surgery. My hunch is that your surgeon has your best interests in heart in not offering you a surgical resection. I applaud surgeons who truly place a patient's best interests first. Instead of being frustrated with your surgeon, be grateful that he is not promoting a surgery that he feels may be counterproductive to your well being.

The Butterfly Pass that I mentioned earlier are
fabulous. Their shape and design are unique. Managing my
messy rectal cuff discharge is a infinately easier with the Butterfly Pads. Look for the Butterfly Pads on Amazon.

I hope you can find a sense of peace within yourself, said tf

Seashell, you gave me a better explanation than all three of my colorectal surgeons put together on why the anus was left intact. My original surgeon retired in 2013. I had much respect for him, but, he explained as little as possible to me about what exactly was done to me surgically. As a matter of fact, he only answered my direct questions. I never questioned whether he was going to leave the anus. I just took it as a given that when they take out the rectum and colon, they also take the anus and you're sewn closed. When that event with the foul smelling gunk came out of me happened, he thought it came out the anus. That was when I found out he didn't sew me closed. I didn't know! I thought I was sewn up inside there. Well, whatever happened must have torn through to my vagina, therefore, everyone agrees I have a rectovaginal fistula.

I do like my present surgeon. I have the highest confidence in him. I'm not crazy over surgeons who are anxious to cut either. He did say that if the discomfort interferes with my quality of life, only then will we talk about surgery. Believe me, even though I have discomfort inside the anus.....and today seems to be a pretty bad day for some reason or other, my quality of life far surpasses the low quality I had prior to my surgery in 2010. To answer your question about steroids....OMG...I was dependent on prednisone for two years straight before my operation. I was also on and off that drug for ten years prior. I tried Remicade and Humira, both failed. My disease was only in the rectum. My colon only had minor diverticulosis! My surgeon said my rectum was a mess though. My paternal grandmother died from rectal cancer at age 65 and that is a concern of mine. I will be 71 in August.

I noticed you are dealing with quite a few health issues. I had a close girlfriend who suffered with Addison's Disease. She also suffered with Crohn's. Unfortunately, she passed in 2005 from sepsis. The week before she had a bad backache, unbeknownst to all, it was an infection in her kidneys. I miss her terribly. Please take care of yourself. Thank you for all your information!

Sick for decades....are you having the surgery just because of some leakage? Or, do you have other problems? I've been having mucus coming out my vagina for a few years now. That really doesn't bother me, I just wear a panty liner. There is no odor. What does bother me is the discomfort inside my anus. The one colorectal surgeon I saw before this guy, told me I was very "tight" inside the anus. Could this be referred to as anal stenosis? My present surgeon suggests I have biopsies every year, not every two years as what was recommended by the doctor who told me I had a "tight" anus..lol. The rectal med, proctofoam, burns when inserted, so I gave up on that several months ago. Did your surgeon explain that even if you do have the surgery to close the anus, you STILL may have problems? My surgeon said there may be problems post surgery to close the anus, it takes a long time to heal and I may still have discomfort. OY...decisions, decisions!