This topic is about dealing with painful cramps in the rectal stump after having an ileostomy and a de-functioned J-pouch. The person experiencing this issue has no colon, and their rectal stump is still open, leading to intense cramping, especially at night. Here are some insights and advice shared by others who have faced similar challenges:

- The person still experiences small amounts of discharge from the anus.
- Their surgeon believes the cramps are due to low blood flow and prescribed a nitroglycerin-based ointment, which provides brief relief but causes headaches.
- Colifoam, a steroid foam, helps when the area is relaxed enough for insertion, but the anal canal is often too tight.
- A colonoscope cannot be inserted without severe pain, so an MRI has been requested to investigate further.

Additional questions and information include:

- Night-time cramps are the most severe.
- Colifoam is effective if it can be inserted.
- There is concern that something else might be happening internally, and MRI results are awaited.

Advice and insights from others include:

1. Immediate relief techniques:
- Sit on the toilet, relax the anus, and allow any mucus to pass. Light straining can sometimes stop a spasm.
- Take a hot bath or use frequent sitz baths for temporary relaxation and pain relief.

2. Lifestyle and posture adjustments:
- Lean back rather than forward when seated, and avoid long periods hunched over a desk.
- Identify stress as a trigger and practice deep-breathing or other de-stressing exercises.
- Be cautious with heavy lifting or strenuous new activities like yoga or martial arts that may strain pelvic structures.

3. Understanding possible causes:
- "Phantom" rectal sensations may occur, where residual nerves fire even after the rectum is removed, causing cramp-like pain.
- Mucus build-up in the stump, known as proctitis, can trigger spasms. Allowing the mucus to drain when pressure builds often resolves pain. Doctors sometimes prescribe a stool-mimicking suppository for this.
- Left-over barium paste from a past defecogram can irritate the stump if it cannot be expelled.
- Pelvic-floor muscle spasms are another suspected source, and several surgeons have suggested pelvic-floor physical therapy.

4. Professional interventions mentioned:
- MRI imaging to rule out fluid collections or other pathology.
- Pelvic-floor physical therapy and, where appropriate, psychological therapy to address muscle tension and stress.
- Avoid internal anal preparations if the rectum is largely removed or the anus is sealed, to prevent injury.

5. Products referenced in the discussion:
- Proctogensic (nitroglycerin ointment)
- Colifoam / Protofoam (steroid foam preparations)