What you are experiencing in terms of brownish/red tinged discharge is normal with an end colostomy. Few surgeons take the time or feel compelledto explain the post-operative distal colon/rectum with an colostomy (often referred to as a “Hartman’s pouch”). It can lead to fear and confusion, as you are experiencing.
You likely have what is called an end colostomy, the surgical technique called a Hartman’s pouch (named after the surgeon who perfected this resection technique).
In forming the end colostomy and stoma, the large intestine/colon is respected at a level of the upper sigmoid colon or lower sigmoid colon (and may extend to include the upper 1/3 Of the rectum).
The proximal/upper portion of the sigmoid colon is brought to the surface of your abdomen to create the stoma. The distal portion (lower sigmoid + relevant rectum) is surgically closed with sutures or staples. That is, the colostomy is surgically closed at its upper end while the lower distal sigmoid/rectum remains open at the lower end at the anus (exit portal).
The portion of sigmoid colon + rectum that remains below the resection point is called the “rectal stump.” The rectal stump remains a viable and living segment of intestine - functioning as it has always functioned and with no idea that it has been abruptly resected from the digestive tract. The rectal stump is effectively retired and resting. It no longer actively passes stool out and through the body via the anus, but it will continue to behave as intestinal tissue is intended.
The rectum is a dense, thick muscle with accompanied highly vascularized soft tissue. The rectal tissues normally secret mucus, short-chain fatty acids, and lubricating polymers who secretion normally servesto ease of excreting feces from the body (lubrication).
This is what you are seeing in your “backend” discharge. Mucus, short chain fatty acids, and viscous intracellular fluids. The rectal stump will also shed the cells that line it’s interior, a normal cellular process. People with permanent colostomies humorously refer to rectal stump discharge “mucus poops.” The color can vary from pale gray to light tan/brown to orangish/red - a spectrum. The brown/reddish/orange coloration is from the metabolic breakdown of the short-chain fatty acids. This is the same contributor to the brownish coloration of feces as it makes its way through the digestive tract.
It is all perfectly normal and expected.
Sitting on the toilet can help expel accumulated material that becomes retained in the recital stump.
Rectal stump “mucus poops” = natural secretions of mucus + short-chain fatty acids + fatty polymers + sloughed cells and cellular debris (as part of the normal regeneration process of tissues that line the intestinal lumen).
Sit on the toilet and allow your anal sphincters to naturally relax. Avoid forecfully straining to expel the retained rectal stump material, as the increased abdominal pressure can contribute to an incisional or paristomal hernia. You may pass a large “wad” or “plug” of material. It is typically semi-soft and can me formed much like an expected bowel movement. Material that has been retained in the rectal vault for weeks/months will be hard like a rock and painful to expel. Newly secreted material will a thick liquid consistency and is tacky/sticky. It may have a strong odor (fermenting bacteria).
Many colostomates with a closed Hartman’s pouch choose to irrigate the closed rectal stump with warm water while showering using a baby nose irrigator. Irrigation flushes the rectal stump and can be used to remove mucus/fatty acids/cellular material with regularity - avoiding the excessive buildup of retained waste material.
That your MD queried if you feel poorly or are running a fever is appropriate. The rectal stump can be a site of bacterial overgrowth which can cause flu-like symptoms (low grade fever, chills, lower pelvic pain, general malaise with joint/muscle aches and pains, putrid rectal discharge).
The normal passage of feces/poop serves a valuable role in the body to keep bacterial overgrowth at bay. Without the regular passage of fecal material, the rectal stump becomes an inviting and warm home for bacteria to overpopulate. The term is called “disuse colitis” - inflammation of the resting and unused rectal stump. A short course of the antibiotic Flagyl or Cipro may be needed during a disuse colitis flare.
You may want to visit the United Ostomy Association of America and the support forum. There is ample discussion on rectal stumps and disuse colitis. http://www.ostomy.org
- Karen -
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.