The topic at hand is about the decision to remove the rectal stump, also known as a proctectomy, after having a total colectomy. This situation arises when reconnection is not possible, and the individual is faced with the prospect of another significant surgery. Here are some insights and advice shared by others who have been through similar experiences:

1. **Seek Multiple Opinions**: It's important to consult more than one specialist. Consider getting opinions from different colorectal or IBD specialists, and for women, a gynecologist, especially to discuss any potential impacts on fertility.

2. **Understand the Medical Necessity**: Surgery should be considered only if there is persistent disease, severe symptoms, complications, or a risk of cancer. If these are not present, it might be possible to delay the surgery.

3. **Recovery and Wound Care**:
- Hospital recovery is similar to the initial colectomy, but full healing can take several months, often six months or more.
- The rectal wound may heal from the inside out, sometimes requiring gauze packing that is gradually reduced. Others may have the wound closed primarily without packing.
- Expect a dull ache rather than sharp pain, and be aware that infections can occur in the early days.

4. **Manage Seepage**:
- Mucus or bloody seepage from the anus or perineum is common and usually decreases over time. Feminine pads or similar products can be helpful.
- A persistent perineal sinus might require minor surgery to reduce leakage.

5. **Surgical Techniques**:
- Some surgeons opt to remove the rectum and completely close the anal opening to minimize future leakage and infection.
- Others may leave the wound open to heal naturally or use muscle/skin flaps if healing is challenging, especially in Crohn’s disease patients.

6. **Healing Challenges in Crohn’s Disease**: Patients with Crohn’s may experience more healing problems, which could necessitate additional procedures or tissue-flap reconstruction.

7. **Fertility Considerations**: There is a risk of scar tissue affecting the uterus, which can impact the ability to carry a pregnancy. Discuss protective measures with your surgeon and consult a reproductive specialist if you plan to have children in the future.

8. **Benefits of Proctectomy**:
- Relief from residual symptoms of ulcerative colitis or Crohn’s, such as cramps, bleeding, and urgency.
- Reduced cancer risk in the rectum.
- Elimination of pain from diseased rectal tissue.

9. **Potential Risks and Downsides**:
- Some may experience chronic perineal pain, sinus issues, repeated infections, or require additional surgeries.
- A minority of patients might have long-term or permanent leakage.

10. **Practical Tips**:
- Keep a written list of questions for your medical appointments.
- Personal blogs and patient experiences can provide additional insights. One such resource is http://mypinkbutton.blogspot.com/.

These points aim to provide a clearer picture of what to expect and how to prepare for the possibility of rectal stump removal after a total colectomy.