This topic is about finding ways to relieve severe pain in the anal and perineal area after having a total colectomy and rectum removal, often referred to as a "Barbie Bum." The person experiencing this pain is looking for recommendations, particularly for topical creams, to help ease their discomfort. The surgical site is the only area causing pain, as everything else has healed well. Here are some suggestions and insights that might help:

1. First and foremost, it's important to consult with your surgeon, stoma nurse, or general practitioner to ensure there is no postoperative infection or other complications. Intense pain that doesn't respond to oral pain relief could be a sign of infection.

2. If infection is ruled out, consider cold therapy. You can put ice cubes in a medical glove, wrap it in a tea towel, and apply it briefly to the area to numb the pain.

3. For seating and pressure relief:
- Some people suggest using a soft cushion, while others recommend a doughnut ring to take pressure off the wound.
- However, be aware that a doughnut pillow might spread the buttocks and increase discomfort for some, so it might be worth experimenting to see which cushion shape works best for you.

4. Warm sitz baths or full-tub baths with Epsom salts can be soothing and promote healing, but only do this if your surgeon advises it and once stitches are out.

5. Try to avoid sitting on hard surfaces. Instead, lie down or gently elevate your legs and hips to shift gravitational pressure away from the wound.

6. Mind-body techniques can also be helpful. Engaging in mental distractions, focused activities, or exploring specialist pain-management options like psychology, acupuncture, yoga, or even experimental electrical brain-stimulation methods might reduce the perception of pain.

7. Dietary and herbal suggestions include eating pineapple, which contains the anti-inflammatory enzyme bromelain, and incorporating other anti-inflammatory herbs and spices into your diet for mild systemic pain relief.