A colostomy is a surgical procedure that creates a new opening, called a stoma, in the abdomen to divert the path of stool from the large intestine. This procedure is necessary when a portion of the colon or rectum needs to rest, heal, or be bypassed due to disease, injury, or blockage. The question of whether you can still have a bowel movement through the anus after this surgery does not have a simple yes or no answer. The outcome depends entirely on the specific surgical procedure performed and how much of the lower bowel remains connected.
Understanding the Colostomy Diversion
A colostomy reroutes the digestive stream by bringing a section of the colon through the abdominal wall, bypassing the remaining lower segment of the colon and the rectum. The location of the stoma determines which part of the colon is functional and, therefore, the consistency of the output collected in the external pouch.
For example, a sigmoid colostomy, placed in the final section of the colon, typically results in a more formed or solid stool because the majority of water absorption has already occurred. Conversely, an ascending or transverse colostomy, located higher up in the digestive tract, diverts output earlier, resulting in a more liquid or semi-formed output.
Colostomies can be temporary, allowing the distal bowel to heal before reversal surgery, or permanent if the lower bowel is removed or cannot be reconnected. Surgical techniques also vary, including an end colostomy and a loop colostomy. The remaining, disconnected section of the bowel is what leads to sensations or discharge from the anus.
The Phenomenon of Rectal Discharge
The feeling of needing to “poop” after a colostomy, even when all fecal matter is diverted, is a common experience known as passing rectal discharge. This discharge is not traditional stool; it is composed of mucus, old cells, and sometimes small amounts of dried matter shed from the lining of the disconnected bowel segment. The lining of the colon and rectum naturally produces mucus for lubrication and protection, and this tissue continues to function even without stool passing through it.
This ongoing mucus production accumulates in the remaining rectal stump, creating a sensation of fullness or the urgent need to have a bowel movement, often called “phantom stool.” The frequency of this discharge varies greatly among individuals, ranging from several times a day to just once every few weeks or months. For some, the sensation is strong enough to prompt a trip to the toilet, while others may experience passive leakage due to reduced sensation following surgery.
The discharge is typically clear, white, or putty-colored, often described as having the consistency of egg white or sticky glue. If the discharge contains bright red blood, pus, or is accompanied by severe pain, report it promptly to a healthcare provider. These symptoms could indicate inflammation, such as diversion colitis, in the unused segment of the bowel.
Managing the Remaining Output
Managing rectal discharge centers on proactive hygiene and evacuation techniques. Most people find relief by routinely sitting on the toilet when they feel the familiar urge, even if they know it is only mucus that needs to be passed. Gentle bearing down, similar to having a normal bowel movement but without straining, can help to expel the accumulated discharge and prevent it from drying into a hard ball.
If the mucus is difficult to pass or the sensation to evacuate is diminished, a physician may recommend the use of a mild laxative or a glycerin suppository. These suppositories are inserted into the anus, where they dissolve and help to thin the mucus, making it easier to pass. Developing a timed routine for sitting on the toilet can also help manage the output and reduce the chance of unexpected leakage.
For those who experience involuntary leakage, wearing a small, absorbent pad or liner can protect clothing and keep the area clean. The skin around the anus can become irritated by the discharge, so using a barrier cream or ointment can help protect the sensitive tissue. Strengthening the pelvic floor muscles through exercises may also improve control over the anal sphincter, helping a person hold the discharge until a convenient time to pass it.
Scenarios Where Nothing Passes
There are specific surgical scenarios where the answer to passing anything through the anus is a definitive “no.” This occurs when the entire rectum and anus are surgically removed, a procedure most commonly performed for low-lying rectal cancers or severe inflammatory bowel disease. This extensive operation is known as a proctectomy, and when combined with a colostomy, it often involves a procedure called an abdominoperineal resection (APR).
In an APR, the surgeon removes the rectum, the anal canal, and the sphincter muscles, and the anus is permanently stitched closed. Since the tissue that produces mucus is completely gone, there is no longer a source for any discharge or sensation of needing to pass anything. The colostomy, therefore, becomes the only way for waste to exit the body, permanently resolving the question of passing stool or discharge through the traditional route.
The recovery from a proctectomy includes a surgical wound where the anus once was, which can take time to heal and may cause temporary discomfort when sitting. While this procedure eliminates rectal discharge, it is reserved for cases where the entire lower segment of the bowel cannot be preserved.