Living with a rectal stump after a permanent ileostomy can be challenging, especially when dealing with ongoing ulcerative colitis (UC) flares and discharge. Here's a look at what this situation involves and some advice from others who have been through it.

One person shared their experience of having moderate-to-heavy anal discharge and active UC flares in the rectal stump just a month after their ileostomy. They were using Salofalk (mesalamine) suppositories and needed a heavy menstrual pad daily. The surgeon had left the rectal stump for several reasons:

- It shortened the emergency operation, which was life-saving.
- It avoided potential pelvic-floor risks associated with removing the rectum.
- It kept the option open for a future J-pouch, although the surgeon doubted this would be pursued.

The person had hoped UC would be "gone forever" and was now worried about unpredictable flares and the possibility of more surgery. They sought reassurance and practical advice from others in similar situations.

Here are some insights and advice shared by others:

1. Reasons for Leaving a Stump:
- In emergencies, especially when the patient is fragile or on steroids, removing the rectum can lengthen surgery and healing time.
- Keeping the stump preserves the option for an ileal-pouch (J-pouch) later.

2. Medical Management:
- Mesalamine (Salofalk) suppositories or enemas and cortico-steroid foam are standard treatments for stump inflammation.
- Systemic steroids like Prednisone can help control flares, but bleeding may worsen during tapering. It's important to monitor haemoglobin levels and consider transfusions if necessary.
- Infliximab (Remicade) infusions have helped some people, so it's worth discussing with a gastroenterologist before considering surgery.

3. When to Consider Stump Removal:
- Persistent bleeding, pain, abscess, pyoderma, anemia, or repeated infections despite medication.
- Concerns about long-term cancer risk in the remaining rectal tissue.
- Quality-of-life issues such as constant use of pads, frequent bathroom trips for mucus, and inability to resume normal activities.

4. Surgical Tips and Experiences:
- Choose a colorectal surgeon experienced in laparoscopic or minimally invasive completion proctectomy for easier recovery.
- Open surgery is more common but involves larger wounds, longer healing, and greater risk of complications.
- Expect possible "phantom" sensations or mild twinges, which usually fade over time.
- Post-op infection is a concern, so some people choose to leave the hospital early to minimize exposure.

5. Life After Stump Removal:
- Many people experience dramatic relief with no discharge, no pads, no urgency, and no fear of flares.
- Some autoimmune symptoms like joint pain and fatigue may persist, as the underlying disease process can remain active.
- Once healed, regular activities, sports, and travel are possible.

6. General Encouragement and Peer Support:
- It's normal to feel frustrated when UC symptoms continue after an ileostomy.
- Online forums can provide valuable emotional support and practical tips for living with or without the rectal stump.