Many people with an ostomy live with unresolved issues when the rectum is left in place during surgery. This can continue to cause inflammation and symptoms such as:

• Ongoing discharge or mucus (which can be normal as the rectum continues to produce mucus and should be discussed with your provider)
• Rectal bleeding
• Pain or pressure
• A constant feeling of need to pass stool (tenesmus)

What is a Proctectomy?

These symptoms can be physically uncomfortable and emotionally draining over time. If you are experiencing significant issues, a proctectomy (the surgical removal of the rectum) can be an option. It’s often considered after other treatments or procedures haven’t fully resolved ongoing issues. Depending on the individual situation, the surgery may also include removal of the anus. When both the rectum and anus are removed, the procedure is sometimes called a “proctocolectomy with anal closure” or “complete proctectomy”. After healing, the area is a smooth, closed surface of skin. There is no longer an opening, and bowel movements continue to pass through the ostomy. Because a proctectomy removes the rectum, the source of symptoms, it will typically resolve issues like mucus discharge, rectal bleeding, and the ongoing urge to pass stool.

Long-Term Outcomes

While a proctectomy typically brings relief for many symptoms, including discharge, sensation of needing to pass stool, and rectal pain, it also carries long-term considerations. These may include:

• Post-op complications such as infection, pelvic abscess, urinary complications, and sexual dysfunction
  • The nerves that control these functions sit very closely to the rectum.
  • Not everyone experiences these changes, and if they do occur, they can be temporary, mild, or manageable with treatment.
• Changes in sitting comfort due to scar tissue
• Perineal sensitivity or numbness
• Rare but possible chronic wound issues

Recovery can be slow because the perineal wound may take weeks or sometimes longer to heal, and some people need dressings or wound care after discharge. If considering a proctectomy, it’s important to speak to your surgeon both about the benefits of the surgery as well as potential complications and considerations.

Quality of Life

Ultimately, many people consider a proctectomy because they are tired of managing ongoing symptoms. A proctectomy may offer a sense of closure as well; it removes a source of unpredictability and allows people to move forward with more confidence in their everyday lives.

Every situation is different, and the decision is deeply personal. What matters most is having the right information and support needed to choose what’s right for you. 

What to Ask Your Surgeon

• Will my anus be removed or preserved?
• What can I expect in terms of healing time?
• What are the risks of complications?
• How might this affect my daily comfort and activity?
• What are the signs I need to call the surgical team? (fever, increasing pain, heavy bleeding, foul drainage, wound breakdown)