This topic is about someone who had a total proctocolectomy with J-pouch removal and now has a permanent ileostomy. They are experiencing sudden, severe pain in the area where their rectum was closed, often referred to as "Barbie butt," as well as in their lower back and abdomen. This pain started almost three years after their surgery. They are in a new location, waiting for their health insurance to activate, and are unsure whether to visit the Emergency Room. Here are some helpful insights and advice for their situation:

1. The pain is unlikely to be "phantom rectum" because it spreads to the back and abdomen. It's important to get examined promptly.

2. Don't wait until it becomes an emergency. Try to arrange an office visit with a GI or colorectal/ostomy specialist as soon as your insurance is active.

3. If you don't have a primary-care or GI doctor yet, consider calling specialists directly to avoid extra costs and steps. However, the ER is a reasonable option for a quick evaluation if the pain is severe.

4. Ask about a course of broad-spectrum antibiotics, as similar pain in others was due to abscesses that needed drainage.

5. Persistent heavy pelvic or rectal pain can also be caused by a seroma, which is a fluid-filled sac. CT imaging can identify this, and it can be drained if it causes symptoms.

6. Abdominal or peristomal hernias are common long-term complications for those with an ostomy, and surgical repair might be necessary.

7. Pay attention to ergonomics: consider using a different chair, adding a coccyx or donut cushion, or using a sit-stand desk to reduce pressure on the closure site.

8. It's a good idea to have both a general practitioner and a tertiary-care GI center lined up. UNC-Chapel Hill in North Carolina is recommended by someone who travels there for post-pouch care.

9. Trust your personal experience. After living with an ostomy, you know what feels abnormal. Seek help whenever there is a significant change from your baseline.