International Nurses Day 2020 – Dear Nurse
12 May, 2020
Dear nurse
As readers will know, Colostomy UK produces a whole range of booklets for ostomates. These cover everything from the practical side of day–to–day stoma management to travel advice and returning to sport. Our literature titles are all available in hardcopy and can be downloaded from our website. They are used by ostomates and by stoma care nurses. In 2019, our most popular booklet was on the subject of rectal discharge . We sent out almost 3,000 copies and the rectal discharge page on our website was visited over 8,300 times. Rectal discharge is also a common reason why people phone our 24–hour stoma helpline. With this in mind I thought it would be useful to put some often–asked questions about the issue to a stoma care nurse. I was delighted when Tina Maddams, Nursing Services Manager at Fittleworth Medical Ltd agree to help.
Q: Do all ostomates experience rectal discharge?
A: No, not all ostomates experience rectal discharge. The frequency with which an ostomate has rectal discharge varies too. Some experience it rarely, such as every few weeks or so. Others can have several episodes a day.
Q: What causes rectal discharge?
A: The most common cause of rectal discharge is mucus. Mucus is normally found in the bowel lining and is produced to act as a natural lubricant to help the passage of stools. If your rectum and anus are still intact after your stoma surgery then you may experience a mucus discharge from your bottom. The length of bowel left after surgery is different for each person. The longer the length of redundant bowel left, the more likely that discharge will occur, as there is more production of mucus. This can be worrying, but it is very common.
Q: What does mucus look like?
A: Mucus can vary in colour and consistency, from a clear egg white to a thicker, sticky, glue–like consistency. It may be putty coloured. If you have had a loop colostomy then this can sometimes allow a small amount of faeces into the bowel leading to the anus. This can make rectal discharge brown. Mucus will either leak out of your bottom or build up into a ball or ‘plug’ which can be uncomfortable.
Q: How can rectal discharge be managed?
A: You may find it helps to sit on the toilet every day and push down gently as if passing a stool. This should help to remove any mucus and prevent any build–up. For some people, this is uncomfortable to do, especially if they have had surgery recently or their sensation is reduced. If this is the case, then I suggest a visit to the GP.
Glycerine suppositories can be inserted into your bottom. These dissolve and make the mucus more watery and easier to pass on the toilet. They do, however, need to be prescribed by your GP as the frequency of use varies from person to person.
Pelvic floor exercises have also been reported to strengthen the muscles that control the rectum. Your stoma care nurse will be able to advise.*
Q: What can you do to relieve the anal irritation and itching caused by this discharge?
A: Mucus may cause itching or irritation around the anus. The use of a simple barrier cream can help to alleviate this. You may need to try several different creams to find one that works for you. Your local pharmacist can advise.
Washing the area with plain water or using an alcohol/perfume free baby wipe will help. Dry the area by gently patting the skin to avoid friction or irritation. Apply your barrier cream.
Q: Is it necessary to seek medical advice?
A: As I have already mentioned there are times when you should seek medical advice. In addition, you should consult your GP or stoma care nurse: if you notice blood or pus in the mucus; if you have rectal bleeding or are in severe pain; if you have excessive itching.
*Pelvic floor exercises are also detailed in our Active Ostomates Sport and Fitness after stoma surgery booklet (pictured above). Call 0118 939 1537 to request a copy or visit our website to download one.
