This topic is about someone who has been dealing with severe evacuation problems due to long-standing rectal disorders. These issues have led to chronic constipation and obstruction, and despite trying various conservative treatments like medications, biofeedback, and physiotherapy, nothing has worked. They had a loop ileostomy surgery to help divert the fecal stream away from the colon and rectum, which initially provided relief but only for a short time. Now, they are considering a total proctocolectomy, which involves removing the entire colon and rectum, as a potential solution.

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

1. It might be helpful to repeat or review anorectal physiology studies, such as anal manometry, defecography, and balloon expulsion, before making a decision. Understanding the exact pelvic floor diagnosis is crucial.

2. If pelvic floor dysfunction, specifically pelvic dyssynergia, is the main issue, some suggest keeping the anus in place even if the rectum is removed. Closing the outlet can increase pelvic pressure and pain.

3. Some people have reported excellent results after having an end ileostomy with total proctocolectomy. This procedure can eliminate mucus build-up, rectal spasms, and the need to evacuate through the rectum. However, it's important to note that this surgery is irreversible, meaning there is no possibility of future reversal.

4. For those considering a permanent ileostomy, removing both the rectum and anus, sometimes referred to as "Ken butt," can stop mucus production and improve quality of life.

5. There are limited treatment options for pelvic floor dysfunction beyond biofeedback, pelvic physiotherapy, and Botox injections. It's important to discuss with surgeons the potential for increased pressure problems if the anus is closed.

6. When making a decision, consider factors such as the permanence of the stoma, the severity of pelvic floor dysfunction, tolerance of mucus and pressure, and personal preferences regarding future options.