This topic is about making a significant decision regarding a permanent ileostomy or colostomy and what to do with the rectum. The person in question currently has an ileostomy and is considering whether to keep it or switch to a colostomy. They are also seeking advice on whether to have the rectum removed. Here are some insights and advice shared by others who have faced similar decisions:

1. General ease of management:
- Many people find a colostomy easier to manage. The stoma is positioned lower, allowing for more relaxed appliance changes and less concern about the pouch detaching when bending.
- An ileostomy typically has more liquid output, requiring stricter diet control and constant attention to hydration.

2. Diet, output, and hydration:
- With an ileostomy, you need to be mindful of your diet, chew food well, and drink plenty of fluids as the output is watery.
- A colostomy usually allows for a more normal diet, with thicker output and reduced gas.

3. Irrigation option:
- Colostomies can be irrigated, which many find liberating. After irrigation, they can wear just a stoma cap for up to 24 hours without worrying about output.
- Although irrigation can be time-consuming initially, it offers significant independence.

4. Leakage and retracted stomas:
- Some people with retracted colostomies experienced frequent leaks until they started irrigating, which resolved the issue.

5. Rectum/rectal stump removal vs. preservation:
- Most people report little ongoing discomfort after rectum removal, though some experience temporary pulling or odd sensations, and sitting can be uncomfortable for a while (a donut cushion can help).
- Keeping the rectum/anus might avoid the "Barbie Butt" incision but can increase cancer risk. In the UK, surgeons often recommend removal within 10 years, especially for conditions like Familial Adenomatous Polyposis.
- It's possible to remove the rectal stump while leaving the anus in place, which some find less troublesome.

6. Pain and recovery after rectal removal:
- Experiences vary, with some people experiencing a few weeks of sitting pain, while others need a donut cushion for longer. Most find that day-to-day life soon returns to normal.

7. Hydration reminder for both stomas:
- It's important to maintain good fluid intake with both types of stomas, but it is especially critical with an ileostomy.