Removal of Rectum 

If you're having the whole of your rectum and back passage removed, because you have a tumour that's very low, or if you've got some other condition that requires that operation, then you will require a permanent colostomy where the large intestine is brought up to the surface of the skin, usually on the left side. This is because the whole of the back passage including the muscles that are used to control your bowels have to be removed to ensure that the tumour has been removed successfully and completely to minimise the chance of it recurring. This only happens in about 20% of patients who have a tumour affecting their back passage. The colostomy is permanent the stool that tends to come out tends to be quite formed and when the bag fills up you tend to just change the bag and place a new bag on on the skin surface. Consistency of the stool can vary it can be quite soft but it can be quite formed and it may be variable from day to day depending on what you've eaten. Most patients get to tolerate and are able to look after the stoma themselves with obviously the support of the stoma care nurses before and after surgery. Also on discharge they'll have access to a community stoma nurse as well as the stoma nurses at their hospital to help with any problems. The problems that can occur sometimes that the bag may leak from time to time and then different stoma bags can be used to minimise that risk. Hernias can occur around the stoma, it may occur in about 30% or more of patients with a stoma, but unless it's causing problems with localised pain or it's getting very large or it's so big that the stoma bag is coming off then it's rare that we have to repair it, but that would require another operation. The bowel can protrude through the stoma and for quite a distance we call that a prolapse. Again it's uncommon but it can cause problems in terms of soreness, it can cause problems in terms of pushing the bag off the skin causing a leakage of the bag. Sometimes that may need further surgery to rectify. The skin can sometimes react to the bag or react to the faeces itself which tends to fall off and drop into the bag but occasionally if it's very soft it can collect around and on top of the skin causing soreness and a term sometimes used is called pancaking. Again different stoma appliances may help with this or changing in diet may change consistency of the bowel and allow it to function more easily. Some patients, although not commonly, learn to irrigate their bowel through the stoma. This allows them to empty the bowel and therefore they know it will unlikely function between 24 and 48 hours after irrigation. This may give them more flexibility in terms of work, travel, and they can also use a smaller bag to cover the stoma which is maybe better hidden under the clothes. Not many patients do this, most patients learn to use a normal stoma bag and just empty it when it functions but this is one option but certainly won't suit everyone. Many patients are very afraid of the thought of having a stoma bag after surgery. The vast majority of patients are able to tolerate it and live a normal life. I have patients who go scuba diving and are very active and are able to manage a stoma bag so it has minimal interference with their normal lifestyle. It can take some time getting used to and it's very rare though patients reject it outright or are unable to tolerate it. When it can be reversed obviously we'll help reverse this as soon as it's possible or it's the right thing to do in terms of your care but lots of patients have for different reasons permanent stomas that they're able to live with without any problems.