Why Do Patients with Colostomy Still Feel Urgency at the Anus?

Why does a person with a colostomy still experience the urge to defecate from the original anus?

Hello, doctor.
I had surgery on December 1st to remove a tumor near my anus, but it was attached to a blood vessel, so it couldn't be removed.
Instead, I had a colostomy (on the left side) to improve my bowel movements.
Since I was able to eat, I've been passing gas and stool through the colostomy.
However, in the past few days, I've been feeling a persistent urge to have a bowel movement from my original anus, and tonight (the 22nd), I even passed a small amount of formed stool.
Is this normal? Additionally, if I need to have a colonoscopy, will the scope be inserted through the colostomy? Thank you.

Lao Luo, 60~69 year old female. Ask Date: 2023/12/22

Dr. Zhang Shuhao reply Surgery

It is normal to still experience the urge to defecate after undergoing ostomy surgery.
This is because the effectiveness of the ostomy in diverting stool can vary depending on posture or the size of the stoma.
Additionally, the remaining segment of the intestine continues to secrete intestinal fluids, residual stool, or secretions related to tumors.
As long as the majority of the stool is still being expelled through the stoma, it is not a concern.
A colonoscopy can be performed either through the stoma or the anus, depending on the purpose and scope of the examination.

Reply Date: 2023/12/22

More Info

Patients with a colostomy may still experience sensations of urgency at the anus for several reasons, even after the surgical procedure has redirected the flow of waste to an external stoma. This phenomenon can be perplexing and concerning for many patients, especially those who have undergone surgery due to conditions such as tumors or other gastrointestinal issues.

Reasons for Urgency Sensation
1. Residual Rectal Sensation: After a colostomy, the rectum may still retain some sensitivity and nerve function. The nerves that signal the need to defecate can remain intact, leading to sensations of urgency even when the bowel contents are no longer passing through the rectum. This is particularly true if the rectum has not been removed during the surgery.

2. Phantom Sensations: Similar to phantom limb syndrome, where amputees feel sensations in their missing limbs, patients with a colostomy can experience phantom sensations in the rectal area. This can include feelings of urgency or the sensation of needing to pass stool.

3. Psychological Factors: The psychological adjustment to having a colostomy can also play a role. Patients may have ingrained habits and reflexes associated with bowel movements that can trigger sensations of urgency, even if the physiological pathway has changed.

4. Incomplete Removal of Rectal Tissue: If the rectum was not completely removed during the colostomy, any remaining rectal tissue can still produce mucus or small amounts of stool, leading to sensations of urgency or the passage of small amounts of stool.

5. Bowel Habits and Diet: Changes in diet and bowel habits after surgery can also influence bowel function. For instance, certain foods may stimulate the bowel, leading to sensations of urgency.

Is It Normal?
Experiencing sensations of urgency or even passing small amounts of stool from the anus after a colostomy can be considered normal, especially in the early days following surgery. However, it is essential to monitor these sensations and report any significant changes or concerns to your healthcare provider. If the urgency is accompanied by pain, significant changes in bowel habits, or other concerning symptoms, further evaluation may be necessary.

Regarding Colonoscopy
As for performing a colonoscopy after a colostomy, the procedure can be adapted. Typically, a colonoscope can be inserted through the stoma (the artificial opening created during the colostomy) to examine the remaining colon and rectum. This method allows for visualization of the colon and any potential issues that may arise post-surgery. Your healthcare provider will discuss the best approach for your specific situation, including any necessary preparations and what to expect during the procedure.

Conclusion
In summary, feeling urgency at the anus after a colostomy can be attributed to several factors, including residual rectal sensation, psychological factors, and the presence of remaining rectal tissue. While it can be normal, it is crucial to maintain open communication with your healthcare team to ensure that any concerns are addressed promptly. If you have further questions or experience any troubling symptoms, do not hesitate to reach out to your healthcare provider for guidance and support.

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