This topic is about the experiences and challenges faced by someone who has recently undergone a total proctolectomy, which is the surgical removal of the colon and rectum. The person is dealing with gas pains and sensations that feel like pressure in the rectum, even though it has been removed. Here are some helpful insights and advice for managing these post-surgery experiences:

1. It's common to feel "phantom rectum" or "phantom fart" sensations after a proctolectomy. These feelings usually decrease in intensity and frequency over time.

2. Night-time or positional gas pains often improve within the first 3 to 7 months as the bowel adapts. Patience and allowing time for healing are key.

3. Gentle abdominal massage, coughing, or tensing the abdominal muscles can help move trapped gas into the pouch. Be ready to vent the bag to prevent leaks or blow-outs.

4. Following a low-residue diet in the initial months can protect the newly-operated small intestine and reduce gas. As the swelling decreases and the stoma shrinks, food will pass more easily.

5. Probiotics can help restore gut flora disrupted by antibiotics used around the time of surgery. General health-food probiotics are beneficial, with some people finding specific brands like American Health effective.

6. Occasionally using fiber supplements like Metamucil can firm up output and help move contents through more smoothly, if tolerated.

7. Be aware that medications can affect output. Narcotic painkillers can slow bowel movements and change stool consistency, while antibiotics can increase gas by affecting beneficial bacteria.

8. If you experience unusual, severe, or prolonged pain, it should be investigated, as it could indicate strictures or adhesions that might require surgical correction.

9. Gradually returning to a high-fiber diet is possible. Slowly reintroduce foods like beans, peas, grains, salads, nuts, and seeds once your surgeon gives the go-ahead.

10. Exercise can aid healing and boost immunity, but it should be hernia-safe. Low-impact activities like bicycling are recommended, and wall-pushes can be a safer alternative to floor push-ups to avoid excessive core strain.

11. Nerve-related shooting pains in the pelvic or rectal area are common early on and typically fade by the third or fourth month.