What happens to your bum after a stoma?

A common question asked by ostomates, future, well-versed or new, “what happens to your bum after a stoma?” has a few answers, depending on the surgery objective and what organs can be saved from things such as disease or trauma and/or not taken away.

How I ended up with no bum after my ileostomy surgery

In August 2011, I had my panproctocolectomy surgery which left me with my permanent ileostomy, “Stacey Stoma”.

 My surgery saved my life. Why did it save my life? I needed to have surgery due to severe Crohn’s Disease in my colon, rectum and anus and also, when surgeons operated, they found a tumour (thankfully benign - non-cancerous) attached to my colon, the size of a watermelon, which if, I was told by one of my surgeons, had been left just a few more hours, I wouldn’t have been here to write this today. Surgery was a lot longer than anticipated and very touch and go. However, I’m here to tell my story.

Is your stoma temporary or permanent? 

Permanent ileostomy

When I had my surgery, surgeons had no choice but to take away my large intestine (colon), appendix, rectum & anus to make my ileostomy permanent. This surgical procedure is also

known as a “Panproctocolectomy” and surgeons carried out my operation in the “traditional” way of opening me up after discovering doing it laparoscopically (keyhole surgery) would not be possible due to what they found and the extent of my disease and the tumour. It wouldn’t have been safe to carry out surgery laparoscopically for me.

After the removal of my rectum and anus, my back passage was permanently stitched up as I’d no longer be able to use it, and my stitches were removed a good few weeks after surgery once my team was happy with my healing. By sewing my back passage up and having my rectum and anus taken away, this means that my ileostomy is permanent, so it cannot be reversed. Sitting did feel tender for a good few months whilst I was healing but my stoma nurse loaned me a “Valley cushion” which helped hugely.

Temporary ileostomy

 Surgeons can create a temporary ileostomy if your rectum and anus stay intact but your large intestine has been removed or disconnected to give the bowel a chance to heal. If surgeons remove a ruptured or diseased part of the colon but leave the rest intact, this is called an Anterior Resection. The ileostomy that is formed from this surgery is known as a Loop Ileostomy and normally is reversed later down the line when surgeons deem it right.

If your rectus or anus remains, you can expect to pass mucus for the first few weeks after surgery and this is normal. This type of stoma is usually reversible and is also known as a Total Colectomy.

If the ileostomy is temporary to allow the disconnected bowel to heal, gas and mucus are still produced by that disconnected bowel. To allow these to escape the body, a mucus fistula is often formed. This stoma is often smaller than an ileostomy and can pass mucus frequently after surgery, reducing frequency and amount as recovery goes on.

J Pouch Surgery

Often used for patients with Ulcerative Colitis, this surgery is also known as Ileal pouch-anal anastomosis (IPAA). Surgeons remove the colon and rectum and use the end of the small intestine (ileum) to form a pouch within the body to allow waste to exit this way.

The surgery can be done in three stages but is most commonly done in two.

In the first stage, surgeons remove the colon and rectum and preserve the anus and the anal muscles. The end of the intestine (ileum) is then connected to the top of the anal canal. In order to give the pouch a chance to heal, a temporary ileostomy is created, where a loop of small intestine is brought out via the abdomen to allow faeces to pass into a bag which can be drained and changed when needed (an ostomy bag). 

Around 12 weeks on from this, the second stage of surgery is performed, so long as the pouch has healed. This will reverse the temporary ileostomy and surgeons will then reconnect the small intestine, enabling waste to pass back out the anus, as it used to. Recovery is different for everyone but it is deemed common to expect to need to pass a

bowel movement around and up to 12 times a day after this surgery, with this hopefully decreasing in time, depending on a number of factors. 

How long does it take to recover from rectum and anus removal? 

Also known as “barbie butt” or “ken butt” surgery, lots of things can impact how well recovery goes and the duration of it. There is no set time of recovery for anyone but thankfully for me it went quite smoothly barring a little hiccup before I left hospital. I can’t remember fully but it was around 4-6 weeks after surgery when I had both my stitches from my bum and from around my stoma removed.

Things that can impact rectum removal recovery are infections, general health (ie how poorly you were before surgery), certain medications such as steroids can reduce healing, how you exercise and how well in general your body heals.

How does your bum look after stoma surgery? 

 

I can’t speak for everyone, but in my experience, my bum looks just like any other bum apart from it has no hole and a scar in its place from top to bottom. I don’t have any feeling along the scar itself, just the same as the one on my abdomen.

What happens to the rest of your organs?

In my experience, the remaining organs in my pelvis and surrounding it have almost spaced out to fill the space which was left from surgery. I do have scar tissue in my pelvis and also on my ovaries from surgery and some of my organs such as my reproductive organs have fallen back into the empty space and curved on themselves. This is common after stoma surgery as time goes on but it’s important to discuss this with your doctor before surgery if you can as certain things can impact fertility etc.

Please note that this is not medical advice and that it’s just from my own experience and research only. As always, if you have any medical questions or concerns, it’s always best to speak to a medical professional.

Until next time,