A colostomy is a surgical procedure that creates an opening, known as a stoma, in the abdomen to divert the flow of stool from the colon. This new pathway allows waste to exit the body into a collection pouch, bypassing the lower segments of the large intestine. The intervention’s goal is to allow a diseased or damaged section of the bowel to heal, or to provide a permanent route for waste elimination when lower structures are compromised. This surgical diversion means the anus and the remaining downstream bowel segment no longer serve as the exit point for solid waste. This article focuses on the fate and function of these bypassed structures, including the rectum and the anus.
The Anatomical Status of the Distal Bowel Segment
In most colostomy procedures, the rectum and anus remain physically intact within the body. The surgery reroutes the colon to the abdominal wall, disconnecting the large intestine’s flow from its natural termination point. This remaining lower section of the bowel, often called the rectal stump or a Hartmann’s pouch, is surgically closed at its top end.
The anus and its sphincter muscles are still present but are now functionally bypassed. This surgical approach is distinct from a proctectomy, which involves the complete removal of the rectum and anus, typically for advanced disease. When a colostomy is performed, the integrity of the pelvic floor and anal structures is preserved for the possibility of a future reversal procedure.
Maintaining the distal segment preserves the complex network of nerves and muscles in the pelvic region. Even without the passage of stool, these tissues remain living and active, contributing to the body’s overall structure and function. The remaining segment of the colon and rectum retains its blood supply and cellular lining, continuing its normal biological processes. This anatomical preservation allows the anus to still be the source of certain sensations and discharge, despite the diversion of fecal matter.
Understanding Mucus Discharge
One noticeable change following a colostomy is the continued production and occasional expulsion of mucus from the anus. The lining of the colon and rectum, known as the mucosa, is composed of cells that naturally secrete a lubricating, protective fluid. This mucus is a normal biological product that usually mixes with stool and is passed unnoticed.
Since the flow of stool is diverted through the stoma, the mucus produced by the remaining rectal stump accumulates. This accumulation eventually triggers the natural reflex to evacuate the rectum’s contents. The resulting discharge is typically clear, white, or yellowish, often having a sticky, gelatinous, or egg-white-like consistency.
The frequency of this discharge varies significantly among individuals, ranging from several times a day to once every few weeks or months. Some patients may experience a large, formed expulsion of mucus, which can be initially alarming and mistaken for a bowel movement. Passing this mucus is a healthy sign that the remaining tissue is viable and functioning.
The discharge may appear slightly brownish or discolored, usually due to old, dried blood or residual fecal matter trapped in the segment at the time of surgery. Any significant change in color, such as a green or foul-smelling discharge, or the presence of bright red blood, should be discussed promptly with a healthcare provider. The volume of mucus may also increase if the remaining bowel segment is experiencing mild inflammation.
Managing Post-Surgical Sensations
After surgical diversion, many patients experience sensory phenomena related to the bypassed lower bowel, often called “phantom rectum” sensations. This experience is comparable to the phantom limb sensation reported by amputees, where the brain continues to receive signals from a body part that is no longer functionally connected. The neurological pathways that once relayed the feeling of a full rectum remain active.
These sensations manifest as a strong, sometimes urgent, feeling of needing to pass gas or have a bowel movement, even though no stool can pass through the anus. This feeling is caused by the ongoing activity of the nervous system and the peristaltic contractions of the rectal stump muscles. The accumulation of mucus in the rectum can also heighten feelings of pressure and fullness.
Some individuals may experience cramping or discomfort as the rectal walls stretch to accommodate the accumulating mucus before expulsion. These feelings confirm that the nerves in the pelvic region are still functioning and sending signals to the brain. Over time, these phantom sensations diminish as the brain and nervous system adapt to the new anatomical configuration.
To manage discomfort, sitting on the toilet and gently attempting to pass the sensation can provide relief, even if only mucus is expelled. Understanding that these feelings are normal and not a sign of a problem reduces anxiety. If the sensations are intensely painful or persistent, consult a physician to rule out other possible causes, such as inflammation in the rectal stump.
Practical Care and Hygiene
Proper care for the anus and perineal area following a colostomy maintains comfort and prevents skin irritation. Since the anus is bypassed, the routine of cleaning after a bowel movement is replaced with managing mucus discharge and maintaining skin integrity. The area should be cleaned gently, especially after any mucus is passed, using soft, non-abrasive materials and mild soap and water.
For individuals who experience frequent or unpredictable mucus leakage, using a small, absorbent pad or gauze against the anus helps protect clothing and surrounding skin. Sitting on the toilet once or twice a day encourages the gentle expulsion of accumulated mucus. This simple action reduces the buildup that contributes to feelings of fullness or pressure.
Protecting the perineal skin from constant moisture is a primary concern, as chronic dampness from mucus can lead to irritation and breakdown. Applying a thin layer of a moisture barrier cream or ointment creates a protective layer against the discharge. Patients should avoid vigorous wiping or scrubbing, opting instead for a pat-dry technique to prevent skin trauma.
Any signs of persistent or increasing pain, significant bleeding, or a sudden change in the discharge’s character should prompt consultation with a stoma nurse or physician. These symptoms may suggest inflammation, infection, or other issues within the remaining bowel segment requiring medical evaluation. Regular check-ups allow for continuous monitoring of the distal bowel and surrounding tissue.