Rectal bleeding with ileostomy and future j pouch?!?

UC in the rectum is very common prior to j-pouch creation. If you had your colon removed, the rectum (or some portion of it) is still in there and still prone to UC. It is not necessarily an indication you will have problems such as cuffitis (inflammation in the 1-2 cm of rectum they must leave when attaching the j-pouch).

There are two surgical approaches to the 1-2 cm of rectum that remain. The first is to just leave it and hope for the best. Many of us are in this category and do not have issues with cuffitis. The other approach - which your surgeon says he is wanting to take - is to strip the epitheleal lining in those remaining 1-2 cm which should eliminate the possibility of UC there. If they do it right and get all of the cells in the lining, it should also eliminate any chance of cancer in the rectal cuff. But there is no 100% with either of these options, of course.

I had a lot of bleeding - enough that my surgeon's associates apparently would have had me on low dose prednisone prior to surgery. My surgeon, however, had a real opinion against doing surgery while patients are still on steroids, if possible. So I just put up with the bleeding and when they took out the remaining rectum it was a mess with UC. However, I have had no problems and still have the lining in whatever remains of it.

Steve

Hi sally, I had three steps with a pretty severe flare in the rectum and sigmoid colon that was left in after my step 1 surgery. I ran low grade fevers on and off for the entire time I still had the rectum and sigmoid, passed bloody mucus multiple times per day, etc etc. My GI had me try Canasa (mesalamine suppositories) which did nothing but increase urgency, but my surgeon didn't want me to use topical steroids as he felt it would adversely affect the tissue moreso than active inflammation.

Anyway, I had a successful step 2 procedure to remove the rest of the colon (except for the 1-2cm rectal cuff) and construct the j-pouch. The fevers went away after that. It's normal to have mucus discharge from the newly constructed pouch, and I did, but I also had traces of blood in the mucus due to a small amount of active inflammation.

In any case, my takedown was six weeks ago and since then there has been no blood and (to my knowledge) no or minimal inflammation in the cuff. Some inflammation prior to takedown can be attributed to diversion (the fecal stream normally delivers nutrients to that tissue, so when it's diverted the tissue can become inflamed from a lack of nutrition) and it seems that was the case for me.

So, in short: bleeding from the rectum after Step 1 or even after Step 2 does NOT mean you are doomed to chronic cuffitis. As far as I know, anyway.

Thank you so so much for your help guys I really appreciate it, I've got an appointment with my GI next week lets hope he says I don't need any meds, steriods gave me steriod induced psychosis prior to my surgery with really bad effects so I need to avoid them at all costs, my only downside was I was hoping to hold out with the ileostomy for another 2 years to try and have another baby but if I think realistically I don't think having this remaining bit of the colon in me the way it is is going to do me any favours

I was given hydrocort suppositories and they worked the first few months and then nada. So I just let it be, as I only had 6months to wait for the rectum removal and jpouch creation part. the Canasa might work for you. So be optimistic. I will cross fingers for you. As I know its best to try to get preggers before you have more surgeries. good luck.