FREAOTMU RHEE AFLISTTHUCLAARE E PROFESSIONALS RECTAL STUMP

ch y whi der urger k r Rea ave s r bac Dea hey h thei hen t that ple w ssume be t peo omy a t can Mos olost so i n a c n up, lts i r sew hey resu ved o hen t remo ing w ome ge is ghten ol. S passa e fri s sto quit o pas k and ing t shoc need but a ng of tion feeli sensa hout ve a any e wit ha t get assag ay no ack p the ple m the b ause peo from s bec The Rectal leak his i enly for t hich sudd ason ion w he re perat ng. T an o warni ormed perf Stump n has urgeo tump. s tal s a rec aves Yvette Perston le Clinical Nurse Specialist Functional Bowel Service Queen Elizabeth Hospital Birmingham

people will get what looks like faeces from What is it? Why is it left? the back passage – this is because a Surgeons will often leave a few inches of This operation is performed because percentage of what is passed is made up of the back passage (rectum) behind when removal of the back passage, together with dead cells shed from the inside of the they operate on the bowel. This operation the anal canal, is a major operation which bowel and not just food that has been is called a Hartmann’s procedure , and is can leave a large wound which may takes eaten. Sometimes the urge is not present often done as an emergency. The bowel is some months to heal. Often the operation due to sensation in the back passage being cut and one end is brought out onto the is initially done with the intention of lost following surgery; this may result in surface of the abdomen as a colostomy. The reversing the colostomy. However, in reality mucus just leaking out without warning. other end is the sewn or stapled closed and this is not always possible either due to This may then cause some soreness to the the anus is left intact. This blind-ended further treatment or because of the fitness skin around the back passage. There are piece of redundant bowel is then called the of the person. rectal stump. many barrier creams available on prescription which can help with this. It is best to consult your stoma care nurse or What can I expect? doctor as to which one may be suitable. The rectal stump will continue to live as it Wearing a small panty liner will also help by still has a blood supply. After the operation absorbing the moisture and so preventing there will be a bloody discharge from the chaffing of the skin. back passage because of blood left from the operation. Usually this produces a feeling of urge so that this can be passed Discharge – what’s into the toilet. However, this feeling is not always present and so leakages may occur. normal? With time the discharge becomes mucus Most people get clear mucus or firm lumps. only and again this can be difficult for the Although this can be smelly it does not sphincter muscles to control. The longer the mean that there is an infection. The smell is length of the remaining section of your mainly produced due to the bacteria which bowel, the more likely you are to live in everyone’s bowel and is entirely experience rectal discharge. normal. Most people get the sensation that there is something in the back passage and As the entire bowel produces mucus to are able to pass it into the toilet. Some lubricate itself this will continue to occur people get a permanent feeling that and so an urge to empty the back passage something is in the back passage will be felt occasionally. Most people can (tenesmus) which can be very control this and wait to empty the back uncomfortable. The best way to relieve the Hartmann’s procedure passage when it is convenient. Some feeling is to sit on the toilet and gently bear 46 | TIDINGS | AUTUMN 2014 | HELPLINE: 0800 328 4257 FROM HEALTHCARE PROFESSIONALS RECTAL STUMP down as if you want to open your bowels. are available on prescription or can be This will often expel any mucus. Some bought over the counter. They are very safe What if these don’t people will get the occasional episode of and can be used long term. wind which is passed. Again this is normal work? For most people one or a combination of and probably due to bacterial activity. If the mucus is quite sticky and difficult to the above treatments is successful. pass, small enemas such as Microlax can be However, sometimes they don’t work. The used. The enema liquid inside the back definitive solution is to have the rectum Why do I get it? passage lubricates and softens the mucus. removed. This would mean having the back It is part of the body’s natural function. This helps to remove the plug and prevent passage sewn up. The advantage of this is There are cells in the bowel which produce straining. Again they take 10-15 minutes to that having no rectum means that there is mucus to help lubrication and they work and are safe to be used on a regular nowhere for the mucus to form, and so the continue to do this even though there are basis. They are available on prescription and discharge would stop. no faeces passing through. A proportion of should only be used on the advice of a what is passed in stool is made up of shed healthcare professional. cells from the lining of the bowel and these However, this is a major undertaking and is will continue to be produced. not possible in all cases. In some cases the wound takes a long time to heal and can As the bowel is very efficient at absorbing be very painful. Also very occasionally water from the stool it also absorbs water people still feel as if they need to pass from the mucus. This can result in a very something from the rectum which is no sticky discharge which can become solid longer there. Another risk is that the lumps which are hard and painful to pass operation can cause damage to the nerves (this is called inspissated mucus). in the pelvis which may cause problems with sexual and bladder function. It is important to discuss the risks and benefits d t

L of this operation with the surgeon before

When should e r a

c deciding to proceed. h t l a

I worry? e H

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If the discharge becomes more copious and o g e r

blood stained then it should be checked by G Conclusion c a Many people with a colostomy have a rectal a healthcare professional. This may be M

f o stump left after surgery. This can cause a because a condition called disuse or n o i s s diversion colitis may have developed. This i variety of problems which extend from m r

e minor annoyances to major disruption to is a specific form of colitis which can p

d n

i the quality of life. There are various develop when there is no stool going k

y b through that piece of bowel. It is diagnosed solutions available and if this is a problem d e s to you it should be discussed with your by endoscopy and biopsy. The treatment for U i n disuse colitis can be steroid suppositories i stoma nurse or your surgeon as to which M

a may be suitable. Ultimately most of the or enemas or short chain fatty acid enemas. r o f

These should only be used under the u problems can be eased or eliminated with Q guidance of a healthcare professional and carefully tailored treatments. after an endoscopy has been performed. The ultimate solution to disuse colitis is for Yvette Perston the colostomy to be reversed and the rectal stump to have faeces going through it Device for washing out the rectal stump again. However, this is not always possible Gamgee Tissue depending on the reason for the colostomy If neither of these interventions helps, the This is dressing made by Robinson or the fitness of the person. rectal stump can be washed out using a Healthcare, Chesterfield and is also device which is available on prescription. available from Fittleworth (code What can I do There are two devices currently available on 26290T) Tel: 0800 378 846 . the market – the MacGregor Healthcare about it? Qufora mini and the Oakmed Aquaflush It has been designed as a primary If the discharge is sparse and not very compact system. They both enable the wound dressing for horses and designed frequent and it can be controlled by the instillation of up to 90mls of warm water for wounds that require additional anal sphincter muscles then just going to into the back passage. This is done whilst dressing absorbency, and to give the toilet when the urge is present will sitting on the toilet and enables the rectal cushioned protection. allow it to be passed. If the discharge is stump to be washed out, thus preventing more frequent, hard to pass and/or the the build up of mucus. They should only In comes in 500g rolls of about 50cm muscles are unable to hold it there are be used on the advice of a healthcare wide; you cut of the size that best works various ways of dealing with it. professional and need instruction in how for you. to use them. Suppositories such as glycerine can be used Because of its qualities as a dressing it is on a regular basis to clear the back passage All of these methods can be used on a also ideal for when discharge is a of a build up of mucus. These work by regular basis to prevent the build up of problem and is used by a number of irritating the lining of the bowel and so clear mucus. The frequency of use depends on ostomates already. the back passage. After insertion they the individual and the amount and type of usually work within 10-15 minutes. They mucus produced. | WEBSITE: WWW.COLOSTOMYASSOCIATION.ORG.UK TIDINGS | AUTUMN 2014 | 47