This topic is about managing persistent proctitis-like rectal discharge after having an ileostomy. The person sharing their experience had severe ulcerative colitis, which led to a total colectomy and end-ileostomy. While their overall recovery has been positive, they continue to experience urgent rectal discharge twice a day. Here are some insights and advice shared by others:

- Doctors have described this condition as "normal" residual proctitis in the rectal stump.
- Current treatments include mesalazine suppositories, which can be messy and leave a white residue, and Predfoam (prednisolone foam) enemas, which are easier to apply but may increase urgency. Long-term use of Predfoam carries a risk of rectal perforation.
- These medications help reduce the discharge but do not completely eliminate it.
- The person is seeking advice on whether to continue with these treatments, try something new, or accept the condition as permanent.

Additional insights and advice from others include:

1. Cost and Alternatives to Predfoam:
- In the U.S., Predfoam costs around $175 per small canister with a $75 co-pay.
- Anusol-HC (hydrocortisone) suppositories offer similar relief and cost about $7 for 100.
- Generic cortisone suppositories are a more affordable option if foam is too expensive.

2. Effectiveness and Long-Term Pattern:
- Many people report that rectal discharge often decreases or nearly disappears 12-24 months after surgery without further intervention.
- Flare-ups may still happen but tend to become less frequent and intense over time.

3. Medication Experiences:
- Cortisone (hydrocortisone) suppositories or foams provide symptom control, with usage frequency varying from daily during flares to none once symptoms settle.
- Salofalk/Solfalk (5-ASA) suppositories used after each discharge can help regulate symptoms.
- Formalin (formaldehyde) injections can dry up the rectal stump but are usually avoided due to risks.

4. Dietary Observation:
- High dairy intake can increase mucus production in some individuals; reducing dairy might help.

5. Surgical Options:
- Complete rectal excision (proctectomy) can eliminate both discharge and the risk of future rectal cancer.
- Success depends on having an experienced surgeon, as residual anal mucous cells must be removed to prevent ongoing leakage.
- Some people are very satisfied after proctectomy, while others prefer to manage the condition medically to avoid further surgery.
- If the rectum is removed, local treatments like foams and suppositories are no longer possible if inflammation persists.

6. "Live With It" Perspective:
- Some surgeons recommend non-operative management unless symptoms become unmanageable, as spontaneous improvement is often observed over time.
- It's important to balance quality-of-life factors, such as time lost to discharge versus the risks and recovery associated with further surgery.