Pain and Discomfort Rectum and following Stoma Surgery

1 Freephone helpline:0800 328 4257 pain and Discomfortin the Rectum and Perineumfollowing Stoma and Discomfort in the Rectum and Perineumfollowing Stoma SurgeryFreephone helpline: 0800 328 4257 After this type of operation you may stillexperience the feeling of rectal fullnessand that you need to open your bowelsin the normal way. What causes thepain/ Discomfort ?Muscles in the bowel wall propel foodand waste through the digestive systemby a process called peristalsis. Eventhough waste now passes out of thebody through a Stoma , muscles andnerves in the Rectum still function asbefore, and this may cause the sensationthat you need to pass a bowel produces a lubricant calledmucus, which helps food pass smoothlythrough the system. Even when therectum is redundant it still producesmucus, which can either be passed outthrough the anus or dry up into a balland cause of the population (non-ostomates aswell as ostomates) experience acondition called Proctalgia Fugax, afleeting rectal pain due to uncontrolledmuscle spasms in the pelvis, whichoccurs infrequently and lasts less than 20minutes.

2 The cause is not strategiesSitting on the toilet may provide somerelief. If you gently bear down as if youwere to have your bowels open this mayexpel any mucus. Doing this every daymay help to reduce the build up sProcedureLoopColostomyLoopIleostomy1 The causes and treatment of pain in the rectal and perineal area are not always clearcut and will depend on whether your Rectum is still intact or whether it was removedand your anus closed when your Stoma was formed. If your Rectum has been removedturn to page 3. If your Rectum is still intact read or Discomfort following an operation to form a Stoma withoutremoving the Rectum (Hartmann s procedure, loop Stoma ) treatments are available?If you are unable to pass the mucusnaturally your Stoma care nurse or GPmay suggest using a mini-suppository ora micro-enema at regular intervals toprevent the build-up of mucus. Howoften you need to use them can varybetween twice a week and once a ostomates find haemorrhoidointment may relieve rectal/analdiscomfort.

3 Consult your GP or Stomacare nurse to check whether this wouldbe suitable for you. Colostomates who still havetheir Rectum intact share theirexperience of rectal says: In 2005 I had Surgery toalleviate increasingly serious episodes ofdiverticulitis and returned home with acolostomy. At my first two checkups, Icomplained to my colorectal consultantabout rectal pain . Nothing was found it increasingly uncomfortable andI could not sit on hard chairs. Twenty-one months later when my GPexamined me he felt something insidemy Rectum and I subsequently passedwhat looked like a wax candle. Myconsultant said that this was a build up ofmucus and it does happen: somepatients produce more mucus thanothers. If it is not passed, it graduallybuilds up and becomes solid in the rectalstump. He told me to ask my GP forsuppositories and to use them regularlyas required. Now every time I realise there is a buildup of mucus, I use a 2mg children ssuppository that evening (The 4mg adultversion is too uncomfortable and I havetrouble keeping it in for long enough).

4 This ensures the mucus is removed fromthe rectal stump preventing it frombecoming solid. I still get a dull ache inmy Rectum but nothing like the pain I hadbefore. I can tell when the mucus isbuilding up because I get an urge to cannot pass this liquid mucus withoutusing a suppository, no matter how hard says:I had a colostomy inDecember 2008. The surgeon said Imight have trouble with the rectumabout every fortnight. Not quite fact I get a build up of mucus afterabout two months. It becomesperiodically painful when there ispressure in the abdomen to discharge. At this stage I sit on the loo and putpressure on my sphincter muscles. Withluck I might get a string of mucushanging from the Rectum so that I cangive it a pull by hand. Then I clean upand fix a cotton soft facial wipe over therectum. It then discharges mucus forseveral days. I treat it by regular washingand using a haemorrhoids treatmentprescribed by my GP. As a result the painsubsides says:I had a colostomy formedafter abodominal Surgery for cancer in2005 and subsequently had pain in myrectum.

5 I produce quite a lot of mucusand the pain eases after evacuation butsometimes no mucus is passed evenwhen it feels as though there is some inthe Rectum . I have not had a large hardlump, it is mostly very liquid. The strangething is that I am most uncomfortablewhen I go to bed but it usually settlesdown after 15-20 minutes. There aretimes in the day when I am not aware ofit at all and it really is nothing comparedto having bowel cancer. I have beenirrigating, for around six months, and nowfind that during that procedure I producemore mucus which easily and Discomfort in the Rectum and Perineumfollowing Stoma SurgeryAs your Rectum and anus ( back passage)have been removed there will be awound and stitches in the perineum (thearea between the anus and scrotum orvagina) and for a while it may beuncomfortable to sit down for longperiods. The time it takes for the woundto heal will vary from person to person the scar may appear healed on theoutside but the tissues beneath may may also still get the sensation thatyou need to pass a bowel motion.

6 As itoccurs even though your Rectum hasbeen removed this is sometimes calledPhantom Rectum the majority of ostomates the painwill gradually diminish and disappear butfor some it will persist after the healingprocess is complete or return at a laterdate. If this happens it is advisable toconsult your GP, surgeon or Stoma carenurse to check there is no underlyingproblem a perineal hernia (where thepelvic contents bulge out through aweakness in the perineal wound), anabscess or a recurrence of the originaldisease. For a small number of ostomates thepain may be severe. They describe thepain as sharp, shooting, stabbing, searing,burning, throbbing or like sitting on astone , a red hot poker or toothache inthe bottom . In some cases it comes inwaves. It can be constant or may cause the pain ?The feeling of needing to open yourbowels may be because the nervesupply is still intact even though therectum has been TissueThe surgical scar can become hard andthickened, especially if the wound wasslow to heal or the tissues were damagedby radiotherapy.

7 The bowel or otherorgans within the pelvis pressing downon this scar tissue may result in a feelingof fullness where the Rectum used to Damage (Neuropathic pain )It has been suggested that the pain maybe the result of damage to the nervesduring: - the operation- radiotherapy treatment- chemotherapy treatment- an infectionAbdomino Perineal Excisionof Rectum or APERF reephone helpline: 0800 328 42573 pain following an operation to form a Stoma during which therectum was removed (APER: Abdomino Perineal Excision of Rectum )Coping strategiesSome ostomates have found that sittingon the toilet and going through in theirmind the process of having their bowelsopen can relieve the feeling of wanting topass a more severe or persistent pain ordiscomfort the following may help: Sitting on an ice pack or soaking in awarm bath. Massaging scar tissue with amoisturising cream to make it moresupple. Tilting the pelvis to reduce the pressureon the perineum. To do this:a) Kneel down, then lean forward, restingyour forearms on the floor and your headon your ) Lie on your back and place a pillowunder your bottom Medication: check with your doctor orpharmacist about suitable pain killers;some have the side effect of constipation,which may lead to added problems withyour Stoma .

8 Long term use of pain killerscan result in a build up of tolerance sothat higher dosages are needed to havethe same effect. Exercises:a) To stretch hard and inflexible scartissue gradually lift one leg, or crouchdown, until you reach the point where ithurts b) Pelvic floor exercisesc) Yoga, Tai Chi or Pilates Hypnotherapy, relaxation techniques,acupuncture or reflexology. beginning an exerciseprogramme or complementary therapy itis important to consult your GP, surgeonor Stoma care nurse to ensure that it isappropriate for you. It is important tocheck that any private practitioners aretrained and registered with a recognisedprofessional organisation. What treatments are available?For chronic, severe pain your surgeon orGP may be able to refer you to aspecialist pain clinic where the followingtreatments may be drugs originally developed to treatother conditions Gabapentin (ananticonvulsant) and Amitryptyline (anantidepressant) have been found to beeffective in reducing neuropathic (nerve) pain .

9 However, they do not work in allcases and can have side effects. Nerve BlocksPudendal nerve block: an injection ofanaesthetic or slow release steroid nearthe site of the nerve, carried out under CTscanner , for some ostomates thepain persists even after trying all theabove suggestions. This can be verydisheartening and you may begin to thinkthat no one believes the pain is real. Ifyou find yourself in this situation it mayhelp to attend one of the following : A pain management not a cure for the pain they canhelp to improve your ability to managethe pain , increase your level of physicalactivity and return to your usual activities. A support group for ostomates orchronic pain sufferers where it may helpto share your experiences and concernswith someone else who also sufferssimilar pain . An Expert Patients Programme: coursesrun by tutors who have persistent healthconditions and Discomfort in the Rectum and Perineumfollowing Stoma SurgeryColostomates share theirexperience of pain following anoperation during which theirrectum was removed Anne says: When I first had a colostomy Iexperienced a variety of rectal pain .

10 Itdidn t devastate me or overwhelm withits intensity or remain for long periods oftime, but it did exist. When it arrived (orwhen I recognised its postoperativeexistence as other discomforts clearedup) it did so with the sharpest of red-hotpokers thrust up the area where Ipreviously housed a Rectum . My initial concern was how this new painseemed related to the tumour spasms ofmy pre-op days. My Stoma nurse allayedmy fears. I didn t realise how commonthis after effect was until a discussionwith other ostomates at a support problem shared with others who vebeen there is comforting, if not my red hot pokers there was neverany rhyme or reason and no it happened I d walk and walk. Itdidn t cure it but I was doing somethingand I felt it helped. Then there was asteady throb from the area at the base ofthe spine. This often felt like a growingmass, but it wasn t. There was nothingthere. However, as time went by and lifewith a bag settled down, so too did thepain. It happened less often.