This topic is about the challenges someone is facing after having a total colectomy with ileorectal anastomosis (IRA). Originally, a loop ileostomy was planned, but during surgery, the surgeon decided to connect the ileum directly to the rectum instead. Since the operation, the person has been experiencing constant and worsening pain, especially when eating solid foods, and can only find relief with purgatives. The surgeon has suggested that the pain might be "imagined," which has led the person to question whether the initial plan for a loop ileostomy would have been better and what tests could help clarify the situation.

Here are some pieces of advice and insights that might be helpful:

1. If your current surgeon dismisses your symptoms as "imagined," it is important to seek a second or even third opinion from another surgeon or gastroenterologist.

2. Any changes made during surgery, such as not proceeding with a planned loop ileostomy, should be clearly explained and consented to. If you feel that communication and postoperative support are lacking, consider finding a new surgeon.

3. Many surgeons opt to create a temporary loop ileostomy first and delay using the IRA until the anastomosis has healed. Moving directly to a "live" IRA can increase the risk of postoperative complications.

4. Request tests like pelvic-floor/anal manometry to assess sphincter muscle function, rectal compliance, and any outlet obstruction, as these are common issues that can cause pain and difficulty with defecation after an IRA.

5. Factors that can influence outcomes for other patients with an IRA include:
- The length of the rectum that remains after the colectomy.
- The strength and coordination of pelvic-floor muscles.
- Allowing enough healing time between forming the IRA and starting to use it fully.