This topic is about someone who has been living with an ileostomy for 18 years due to Crohn’s disease. They are used to seeing some mucus from their inactive rectal stump, but recently, they have started noticing bright-red blood. They are not fond of visiting doctors but are curious if others have faced this issue and what it might mean.

Here are some pieces of advice and insights shared by others:

1. Seek professional evaluation immediately:
- Many people emphasize that any new bleeding, especially in long-term Crohn’s or ulcerative disease, should be checked by a colorectal surgeon or gastroenterologist as soon as possible.
- Regular check-ups can help rule out serious issues like rectal or colon cancer, abscesses, fissures, hernias around the stoma, and other complications that might develop quickly.

2. Possible causes mentioned:
- A hernia around the stoma that has filled with blood.
- Fistulas forming in the rectal stump, which can be difficult to detect.
- Hemorrhoids, which might be mistaken for stump bleeding.
- Stump colitis or infection, as the unused rectal mucosa can thin over time and bleed more easily.

3. Medical and surgical management options:
- Topical treatments like Cortifoam or 5-ASA products such as Salofalk suppositories can help reduce inflammation and minor bleeding in the stump.
- Oral medications and medicated enemas can manage active disease in the stump.
- A completion proctectomy, which involves removing the rectum and anus, can eliminate discharge, fistulas, cancer risk, and anxiety. Many have reported good outcomes, with a healing period of 6-8 weeks and a return to full activities, though there is a rare risk of bladder-nerve damage.
- Temporary use of catheter and drainage-bag systems can relieve painful pressure from mucus build-up for those who wish to avoid further surgery.

4. Cancer-risk emphasis:
- Having a chronic inflammatory disease along with an unresected rectal stump increases the risk of cancer. Some people, including a retired CWOCN, have shared personal or second-hand stories of late-stage colorectal cancer being discovered after ignoring rectal bleeding.
- Free online second opinions, such as those from the Cleveland Clinic, are available and can be valuable if local expertise is limited.

5. Practical advice:
- It’s important to find a colorectal surgeon with extensive experience in ileostomy and proctectomy procedures, even if it means traveling.
- General practitioners may not have specific knowledge about ostomies, so it’s crucial to insist on a referral to a specialist.
- Keep track of any changes in the volume, color, and odor of discharge. Use pads if necessary and do not delay reporting any worsening symptoms.