This topic is about making a decision regarding a loop ileostomy reversal after an ultra-low anterior resection for low rectal cancer. The person is trying to decide whether to go through with the reversal or keep the ileostomy, or even consider a permanent colostomy. They are concerned about potential issues like loss of bowel control and quality of life, particularly incontinence and frequent bathroom visits, which are symptoms of Low Anterior Resection Syndrome (LARS).

Here are some insights and advice to consider:

- Clarify with your surgeon the exact length of the remaining rectum and the status of the sphincter. The length is crucial for continence, as a longer rectum can significantly improve control.

- If the external sphincter is intact, there is a better chance of regaining reasonable bowel control. If it was removed, expect more significant continence challenges.

- Be prepared for the possibility of LARS, which includes symptoms like urgency, clustering, frequency, and possible accidents. Some people choose a permanent colostomy to avoid these issues.

- Remember that a permanent colostomy is irreversible. Keeping the current ileostomy allows for more options: attempting a reversal, converting to a permanent colostomy later if necessary, or benefiting from future treatments.

- Consider the implications for future medical surveillance. An unused rectal stump can complicate endoscopic monitoring due to mucus buildup, which might make reversal more favorable if regular checks for new tumors are needed.

- Weigh the quality-of-life trade-offs. Some people with very short rectums choose not to have a reversal to avoid incontinence, while others with longer rectums manage well with limited storage.

- To manage hydration and output with an ileostomy, use oral rehydration solutions like Dioralyte instead of just water to prevent dehydration. Take loperamide 30–60 minutes before meals to thicken the output, and finish eating by early evening to reduce nighttime pouch emptying.

- If you have had prior small-bowel resections, be aware that bile-acid malabsorption can cause liquid output, and medication for bile-acid binding might still be necessary after any diversion.

- When making your decision, define your personal priorities, such as continence versus stoma management. Ask your colorectal surgeon and stoma nurse team for detailed functional predictions. Consider a temporary reversal trial, knowing that the ileostomy can be reinstated if needed.