Rectal Discharge

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josier0811
Posts: 3
Joined: Sun Mar 18, 2018 2:20 pm

Rectal Discharge

Postby josier0811 » Thu Mar 22, 2018 3:23 pm

I am new to this all. I do not have colon cancer (although very strong family history). I ended up with an emergency colostomy almost 2 weeks ago due to an injury from gynecological surgery. They tell me it is only temporary.
I know it is normal to have some mucus (clear) discharge from the rectum. However, twice so far I have had a reddish/brown discharge. The first time it happened I called my doctor and his answer was well it could be normal or it could indicate a pelvic infection. He asked how I was feeling and I said fine. He advised if I feel ill or have pain to go to the ER for a CAT scan.
Anyone experience this?? I am feeling okay, eating okay, off and on a very low grade temp but nothing over 100.
Please any thoughts are appreciated. I am trying so hard to adjust to this and mentally cannot deal with a setback.

Caat55
Posts: 680
Joined: Sat Dec 23, 2017 6:01 pm

Re: Rectal Discharge

Postby Caat55 » Thu Mar 22, 2018 5:55 pm

hi Josier,
Completely understand your worry, concern about setbacks. I did have a couple of small bowel movements after surgery, the first few days but that is it. Any discharge they said would be more mucus like from that point forward.

Susan
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018
PET NED 12/18
Clear Colonoscopy 2/19

josier0811
Posts: 3
Joined: Sun Mar 18, 2018 2:20 pm

Re: Rectal Discharge

Postby josier0811 » Thu Mar 22, 2018 6:30 pm

I know the clear mucus is normal but am still worrying about the reddish/brown. I guess if the doctor is not too concerned I should not be but I cannot help but worry.

NHMike
Posts: 2515
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal Discharge

Postby NHMike » Thu Mar 22, 2018 9:45 pm

josier0811 wrote:I am new to this all. I do not have colon cancer (although very strong family history). I ended up with an emergency colostomy almost 2 weeks ago due to an injury from gynecological surgery. They tell me it is only temporary.
I know it is normal to have some mucus (clear) discharge from the rectum. However, twice so far I have had a reddish/brown discharge. The first time it happened I called my doctor and his answer was well it could be normal or it could indicate a pelvic infection. He asked how I was feeling and I said fine. He advised if I feel ill or have pain to go to the ER for a CAT scan.
Anyone experience this?? I am feeling okay, eating okay, off and on a very low grade temp but nothing over 100.
Please any thoughts are appreciated. I am trying so hard to adjust to this and mentally cannot deal with a setback.


I have a temporary illeostomy so stuff can pass from the bag to the other side of the stoma opening and go into the rectum. I don't think that should happen with a colostomy but I'm not positive of that.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Rectal Discharge

Postby MissMolly » Fri Mar 23, 2018 9:41 am

Josier:
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 -
Last edited by MissMolly on Fri Mar 23, 2018 2:43 pm, edited 2 times in total.
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.

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Robino1
Posts: 463
Joined: Fri Aug 11, 2017 12:09 pm
Facebook Username: Robin.lawthers
Location: Florida

Re: Rectal Discharge

Postby Robino1 » Fri Mar 23, 2018 10:28 am

Thank you for that explanation and in terms a normal person can understand! You rock!

I don't have a colostomy but you're explanation gives a much greater understanding of what others are going through. Very educational.

Again, thank you for what you do here! :)
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217; 219
FOLFOX started 6/17
CEA 202
8/29/17 CT melting of tumor.
Latest CT scan shows 2 new tumors and return of ascites.
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3; 2/1-84.2; 89.2; 89.8; 88.5; 81.8: 93.5; 107; 119
BRAF V600e

josier0811
Posts: 3
Joined: Sun Mar 18, 2018 2:20 pm

Re: Rectal Discharge

Postby josier0811 » Sun Mar 25, 2018 8:48 am

Karen, I cannot thank you enough for your detailed explanation. I never heard the term Hartman's pouch from my surgeon. This made me feel so much better hearing all this. Thankfully, my colostomy is only supposed to be temporary as not due to cancer but from an injury during another surgery. The colored passage comes and goes. However, I am experiencing the feeling of needing to defecate frequently but from your explanation, that kind of makes sense too. I feel for those who half to have this permanently. Mentally this is all such a struggle, but it is also very new to me (only a little over 2 weeks). I have 4 to 6 more weeks until my reversal. The sooner the better.


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