Question:

I had my ileostomy in November 2024. Recently, I’ve been having the sensation that I need to have a bowel movement, and I’ve passed small amounts of gas. This usually happens in the morning. Is this normal?

Answer:

Thanks for your question. It sounds like you may have a loopileostomy, which can explain the sensations you’re experiencing. These feelings can be concerning at first, but what you’re describing may be a normal part of life after ileostomy surgery—especially if the rectum has not been removed.

Why You Might Feel the Need to Have a Bowel Movement

If you still have your rectum (or part of your large intestine), the body continues to produce rectalmucous. This mucous is generated by the lining of the bowel and serves as lubrication. Even though stool no longer passes through the colon or rectum, the tissue continues its normal function. Over time, this mucous can build up and may need to be released.

Key points about rectal mucous:

• It is normal after both loop and end ileostomies, unless the rectum has been surgically removed.
• The mucous may be clear, white, or yellow and may resemble stool if it sits in the rectum for a while.
• You may feel pressure, cramping, or the urge to “go” before mucous is expelled.
• This discharge often happens in the morning, when the body is more active after rest.

Can Gas Escape From the Rectum After an Ileostomy?

Yes—but only in certain cases.

If you have a loop ileostomy, it is possible for a small amount of gas to pass from the functioning small bowel into the bypassed section of bowel and exit through the rectum.

• This is uncommon, but anatomically possible.
• It should not occur if you have an end ileostomy or if the distal bowel has been completely disconnected or removed.

When to Seek Medical Advice

While these symptoms may be normal, you should contact your surgeon or an NSWOC (Nurse Specialized in Wound, Ostomy, and Continence) if:

• You experience new or persistent gas that feels different than usual.
• You don’t have a loop ileostomy, but still experience rectal gas or mucous.
• You have bleeding, pain, fever, or signs of infection.
• You’re unsure whether the sensations are part of normal healing or something that needs investigation.

You can find a NSWOC in your area here: Find a NSWOC – Ostomy Canada Society

In conclusion, feeling the urge to have a bowel movement and passing small amounts of gas or mucous after an ileostomy is usually normal, particularly if the rectum is still in place. However, if you’re unsure or your symptoms are new, it’s a good idea to reach out to your care team for a personalized assessment.

Answered by

Lauren Wolfe, MClSc-WH, BSN, RN, NSWOC, CWOCN