This topic is about a 59-year-old woman who has been living with an ileostomy for 40 years after having her rectum removed at age 18. Recently, she has started experiencing unexpected bleeding and discharge from the rectal area, which is concerning because she believed the rectal stump was completely removed or closed. A pelvic exam suggested there might be a small fistula, but no clear diagnosis or treatment plan was provided. She has never needed medical care related to her ostomy before and is now worried about these new symptoms.

Here are some helpful steps and advice for her situation:

1. It is important to seek a prompt evaluation by a specialist, such as a colorectal surgeon or a gastrointestinal (GI) doctor. Bleeding from a surgically closed rectal area is not normal after a proctectomy.

2. Request diagnostic imaging like an MRI, CT scan, or fistulogram. These tests can help confirm the presence, location, and cause of any fistula or other abnormal tract.

3. Be aware that persistent drainage can indicate infection or inflammation. If left untreated, fistulas may lead to serious complications such as abscesses or peritonitis.

4. Early antibiotic therapy can be effective once an infection is identified. Delaying treatment increases the risk of complications.

5. Clarify with the gynecologist what follow-up was recommended. If no follow-up was suggested, consider obtaining a second opinion from a GI or colorectal specialist.