A colostomy is a surgical procedure that redirects the large intestine to an opening on the abdominal wall called a stoma. This diversion allows stool to exit the body into an external pouch, bypassing the lower segment of the bowel. While care often focuses on the stoma, the rectum and anus remain in place and undergo distinct changes. Understanding the status and care of this distal segment is important for managing post-operative life and addressing common symptoms.
Anatomical Status After Surgery
The anus and rectum are typically not removed during a standard colostomy, unless the condition requires it, such as in an abdominoperineal resection for low rectal cancer. The remaining section of the bowel, often called the rectal stump, is disconnected from the flow of digestive waste. This segment retains its original blood supply and nerve connections, meaning it is still a living, functional part of the body.
Since the anus is no longer the route for stool, its primary function is bypassed, which can lead to minor changes. The anal muscles, or sphincters, usually remain intact, which is important if a colostomy reversal is considered in the future. Without the constant passage of stool, some patients may notice a decrease in the sensitivity and tone of the anal canal. The physical structure remains, but its role in waste elimination is suspended.
The Role of Mucus Discharge
One of the most common changes after a colostomy is the production of mucus discharge from the anus. The lining of the colon and rectum naturally produces mucus to lubricate the passage of stool. Even without stool passing through, the cells lining the bypassed segment continue this physiological process. This discharge is the body’s way of expelling accumulated lubricant and shed cells from the inactive section of the bowel.
The mucus is typically clear, white, or yellowish, and may have a sticky, glue-like consistency. The frequency of discharge varies widely, ranging from several times a day to only once every few weeks or months. When mucus builds up in the rectum, some people feel a sensation similar to needing to pass a bowel movement. Sitting on the toilet and gently bearing down, as if having a normal bowel movement, can help pass the accumulated mucus and relieve the sensation.
If the mucus is not expelled, it can dry into a firm ball inside the rectum, causing discomfort or pain. While clear or pale discharge is normal, any change to green, foul-smelling, or bloody discharge should prompt a conversation with a healthcare provider. This change may indicate underlying inflammation or infection in the rectal segment.
Potential Long-Term Issues and Symptoms
The unused distal segment can be susceptible to specific medical issues, the most notable of which is diversion proctitis. This condition is an inflammation of the rectal lining that occurs after the fecal stream has been diverted. Symptoms can include increased mucus discharge, rectal bleeding, a feeling of urgency, and pelvic or rectal pain.
The condition is thought to be caused by a lack of short-chain fatty acids, which are the main energy source for the cells lining the colon and rectum. These acids are usually produced when stool is present. Treatment often involves topical medications such as suppositories or enemas to reduce inflammation in the rectal stump. If the colostomy is temporary, reversing the procedure and restoring the fecal flow usually resolves the proctitis.
A separate, yet common, experience is the “phantom rectum” sensation, which is similar to phantom limb pain experienced by amputees. This involves the feeling of needing to pass gas or have a bowel movement, even though the bowel has been diverted. The sensation is caused by nerves that once served the rectum continuing to send signals to the brain. This can range from a non-painful pressure to painful cramping or stinging in the perineal area.
Maintaining Distal Health and Hygiene
Proper care of the anus and rectum remains important after a colostomy to prevent irritation and manage mucus discharge. For those who experience leakage, wearing a small, absorbent pad or liner can protect clothing and skin. Regular, gentle cleaning of the area is necessary to remove residual mucus that may cause skin soreness.
Using a barrier cream on the skin around the anus can help protect it from the constant moisture of the mucus discharge. Pelvic floor exercises may be recommended to strengthen the anal sphincter muscles, which can improve control over involuntary mucus leakage. Any persistent symptoms, such as excessive pain, pus, or noticeable blood in the discharge, should be reported to a healthcare team for evaluation.