This topic is about managing ulcerative colitis (UC) in the rectal stump after ileostomy surgery. After such surgery, some people may still experience UC symptoms in the remaining part of the rectum, known as the rectal stump. Here are some insights and advice on dealing with this situation:

- Rectal stump anatomy:
- After surgery, a portion of the rectum is left in place, usually about 6-9 inches long, and is sewn shut, forming a closed-off pocket.
- Mucus and inflammatory discharge can still accumulate in this area if UC is active, and it needs to be cleared out.

- Why enemas are used:
- Since the rectal stump is no longer connected to the rest of the digestive system, using topical treatments like Pentasa (mesalamine) enemas is a direct way to address inflammation without needing systemic steroid tablets.
- The medication from the enema exits through the anus, similar to a normal bowel movement, and does not come out of the ostomy bag.

- Practical tips for administration:
- Many people find liquid enemas uncomfortable and difficult to retain.
- Hydrocortisone Foam (Cortifoam) is a steroid-based alternative that is easier to hold because it expands as a foam rather than a liquid.
- If retaining enemas or suppositories is challenging, some patients use a catheter to irrigate the stump, which helps flush out mucus and reduce irritation. Once inflammation decreases, many only need to manage occasional clear discharge with an incontinence pad.

- Possible long-term options:
- If UC in the stump remains highly active and persistent, a complete proctectomy (removal of the rectum) might be necessary to permanently eliminate symptoms.