Lovemyfrienchie:
With an end colostomy (also called a Hartman’s pouch/procedure) your mother will have what is referred to as a residual rectal stump.
The rectal stump is the portion of rectum that remains when the resection of her large intestine due to the tumor was closed.
The problem is disuse proctitis. Or otherwise, disuse atrophy of the rectum and it’s deep muscular layers and epithelial lining. The rectum is alive and unaware that it has been disconnected. It continues to produce mucus and intercellular secretions and slough off cells and metabolic byproducts - all of which need to exit via the anus.
Another issue is rectal stump inflammation due to an absence of short chain fatty acids. Fecal matter contains nutrients that are vital to the healthy maintenance of rectal tissue. Yes, “poop” has a physiological purpose. It is the short-chain fatty acids found in fecal matter that provides the rectum with the nutrition that it needs. Absent the passage of fecal matter, the remaining rectal stump becomes inflamed with loss of moisture. Bacterial overgrowth can become an ongoing issue, causing a foul smelling discharge, pelvic pain, and a low grade fever with general malaise.
Cramping and feeling the need to have a bowel movement are common. It is often helpful to quietly sit on the toilet to allow accumulated mucus to pass. Sitting on the toilet engaged the mind-body connection that will allow easier passing of accumulated mucus/secretions/cellular debris.
I am sorry that your mother is receiving less than attentive care for her likely disuse proctitis. Disuse proctitis, left untreated, is very uncomfortable and definitely negatively impacts one’s quality of life.
Your mother’s physicians do have options at hand to aide your mother and make her more comfortable. A few options:
1. Prescription for short-chain fatty acids as either an enema or suppository.
This will be a pharmacy compounding prescription. You will need to go to a compounding pharmacy. The short-chain fatty acid treatment usually lasts for 2-3 weeks, with administration of a 5ml-10ml suspension enema 1-2 times a day. It is helpful to retain the suspension enema for 10-15 minutes before expelling, lying on one’s side.
Short-chain fatty acid prescriptions are not normally covered by commercial insurance. Be prepared to pay out of pocket. About $250-$300 for a 3 week course of treatment.
The benefit of short chain fatty acids is that the treatment acts to corroect the basis of the problem, rather than masking symptoms.
2. Steroid suppositories or foam.
Corticosteroid suppositories or foam (ex. ProctaFoam) is another route to calm rectal stump inflammation. It provides temporary relief (several weeks) and may need to be repeated as symptoms reappear.
Corticosteroids do have negative effects on tissue integrity (tissue thinning). So care and monitoring are important to avoid tissue thinning that may cause bleeding or perforation if used long-term.
3. Antibiotics specific to colon flora
A course of Flagyl or Cipro can be helpful to tame bacterial overgrowth associated with disuse proctitis. 500 mg 2 x a day for 7-10 days, initially. Some people with rectal stumps use Flagyl or Cipro on a prophylatic basis to keep bacterial overgrowth in check (ex. 250 mg Flagyl daily or every other day).
4. Rectal stump irrigation
Regular irrigation of the rectal stump is a good approach to maintain hygiene. It can people to squirm initially at the thought, but it becomes as routine as brushing your teeth.
Get a baby nose irrigator/baby nasal baster used to clear nasal secretions of babies. Nasal basters have a narrow tube with suction bulb, perfect for gentle insertion in an otherwise unhappy recital atump.
Irrigation of a rectal stump is easily done while showering. Fill a plastic cup with warm water and a bit of liquid baby soap or aloe Vera or liquid castelle soap. Fill the nasal baster with the warm/soapy liquid and insert into the anus, compress the suction bulb to irrigate the water upward into the rectum. You can use the nasal blaster to suction the liquid out or allow the liquid to naturally exit the rectum/anus. Repeat 2-3 times.
Your mother’s colon surgeon should be able to perform a quick proctoscope of your mother’s rectal stump in his/her office. A simple 6 minute procedure. To get a visual look of the offended tissues and the degree of inflammation/drying/atrophy.
Disuse proctitis can truly make a person feel “sick” as though having a case of the flu. Passing “mucus poops” can be upsetting and painful, especially when physicians provide no patient education up front as to what is happening. Loving with an ostomy can often entail a lot of self-learning.
Members of the United Ostomy Association of America support forum frequently dispense helpful advice on healthy maintenance of rectal stumps. It is a supportive group of individuals, just as is his forum. Do not hesitate to visit the UOAA ostomy support forum (general section has the most foot traffic).
http://www.uoaa.orgKaren
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.