This topic is about a 44-year-old man who is navigating the emotional and physical challenges following a recent subtotal colectomy due to severe ulcerative colitis. He is now living with a new ileostomy and is seeking advice and support as he adjusts to these changes.

- He is struggling with accepting and managing his ileostomy, including tasks like cleaning and changing the pouch.
- He is experiencing persistent inflammation and bleeding from the rectal stump, for which he has been prescribed Prednisolone foam.
- Emotionally, he feels like the surgery has swapped one set of problems for another, leading to feelings of anger, regret, anxiety, grief, and embarrassment. Although he has started counseling, it hasn't provided much relief yet.
- He is considering future options, such as keeping the rectum for a while, opting for a J-pouch, or undergoing a total proctocolectomy. He is hesitant about the J-pouch due to potential complications and is worried that a proctectomy might cause sexual or bladder dysfunction, affecting his dating life.
- He is reaching out for support, encouragement, and alternative viewpoints.

Additional information includes:

- He experiences daily rectal-stump mucus, contrary to his surgeon's prediction of it occurring once or twice a month.
- Initially, Prednisolone foam showed improvement, and he plans to visit his GP to request suppositories, which are easier to use than enemas.
- Five months post-operation, a combination of Prednisolone liquid enema and Pentasa suppositories controlled the proctitis, but bleeding returned after stopping them. He is now starting a biologic treatment (Infliximab) but had an allergic reaction during the second infusion and is questioning the safety of continuing.
- He is considering a total proctectomy if biologics fail, weighing the constant proctitis and medication against surgical risks like sexual or bladder dysfunction.

Advice and insights shared by others include:

1. Emotional turmoil is a normal response after such a surgery. With time, patience, and gradual adjustment, distress usually lessens.
2. Distraction through writing, music, or hobbies can help shift focus away from negative thoughts. Many find creative outlets like poetry or music therapeutic.
3. Adopting a "healing first" mindset can be beneficial. Focus on rest, nutrition, and recovery rather than long-term worries. Many report significant improvement after the initial months.
4. Counseling might feel ineffective at first but contributes to gradual emotional recovery, so it's important to stick with it.
5. For tenesmus and bleeding, Prednisolone foam or enema plus Pentasa suppositories have helped many. Symptoms often diminish as the rectal stump heals, and retaining enemas becomes easier over time. If steroids or mesalamine fail, biologics like Infliximab are the next step, and it's important to assess the benefits versus side effects with a gastro team.
6. Living with an ileostomy becomes easier over time. Routine care becomes second nature, and some find it more sanitary than normal defecation. Experienced ostomates can offer practical tips for leak prevention, emptying, and lifestyle adaptation.
7. Many have gone through severe depression, isolation, and anger but eventually regained quality of life, including pain-free living, social activities, and an unrestricted diet.
8. It's important not to fear expressing anger, sadness, or grief, as acknowledging these feelings can accelerate adjustment.
9. For local support or product issues, contacting manufacturers' nurses can be helpful. ConvaTec’s stoma nurse service is praised for practical help and good humor.
10. If considering further surgery like a J-pouch or proctectomy, consulting a colorectal specialist about individual risk factors is crucial. Many report minimal long-term side effects once all diseased tissue is removed.
11. Remember, you are not alone. Online forums and helplines can provide support when in-person ostomy nurse or support group options are unavailable.