This topic is about making a decision between having a colostomy or an ileostomy for someone dealing with rectal dyssynergia, pelvic floor disorders, and gastroparesis. The person is preparing for ostomy surgery and is weighing the pros and cons of each option. Here are some insights and advice shared by others who have faced similar decisions:

- It's important to get multiple opinions from colorectal specialists before making a decision, as reversing the surgery can be difficult.
- Remember that you have the right to choose the procedure you feel is best for your body, whether it's a colostomy or an ileostomy.
- Some people start with a colostomy and later switch to an ileostomy if the colostomy doesn't work out. This approach can help avoid removing a functioning colon too soon.
- For those with colonic inertia or non-functioning colons, an ileostomy might be the only solution that provides relief, as Sitz-marker tests can sometimes be misleading.
- Compare the potential complications of each option:
- Colostomy generally has fewer issues with dehydration and electrolyte imbalance, and the output is thicker, which can make managing the pouch easier.
- Ileostomy may have higher risks of blockages, skin irritation, and requires careful hydration management, but it bypasses the colon and pelvic floor entirely.
- If a rectal stump is left after an ileostomy, it can still cause issues. A full colectomy, sometimes called a "Barbie/Ken bum," removes this risk but is a more extensive surgery.
- An ileostomy can still allow for the creation of a J-pouch later, though J-pouches sometimes fail and revert back to an ileostomy.
- It's beneficial to have the surgery at a high-volume colorectal center, where specialized care and knowledgeable staff are available. Cleveland Clinic and Beaumont Troy Hospital are recommended.
- Expect a learning curve after surgery. Online communities can be a great resource for tips on managing your pouch, staying hydrated, and adjusting your diet.
- If imaging shows only segmental disease, a limited colectomy with a colostomy might be enough. Comprehensive testing is crucial to identify the exact problem.
- Pain and pelvic floor symptoms alone don't necessarily indicate total colonic failure. Consider the benefits of preserving colon function against the potential quality-of-life improvements from an ileostomy.
- Ultimately, advocate for yourself and make a decision based on a combination of test results, expert opinions, and your personal quality-of-life priorities.