Is it normal to have bowel movements per rectum after a transverse colostomy?

Bowel Movements After Blowhole Transverse Colostomy

Yes, it is normal for patients to experience bowel movements per rectum after undergoing a blowhole transverse colostomy, as this type of colostomy does not provide complete fecal diversion.

Understanding Transverse Colostomy Function

A blowhole transverse colostomy is a temporary stoma created in the transverse colon that serves to decompress the colon but does not completely divert the fecal stream. This differs from other types of colostomies that may provide more complete diversion.

Mechanism of Incomplete Diversion

• Loop structure: The loop transverse colostomy creates a diversion but not a complete obstruction of the fecal stream
• Anatomical considerations: The proximal limb of the colostomy diverts most fecal matter, but some stool can still pass through the distal limb and reach the rectum
• Competency of the stoma: The degree of diversion depends on the surgical technique and how the stoma was constructed

Evidence for Rectal Output After Colostomy

While historical studies like one from 1978 claimed that temporary skin-level loop transverse colostomies could achieve "complete diversion" 1, more recent clinical experience and evidence contradict this claim.

The 2018 World Society of Emergency Surgery guidelines on colon and rectal cancer emergencies recognize that loop colostomies, including transverse colostomies, are used for fecal diversion but do not specifically address the completeness of diversion 2.

Factors Affecting Rectal Output

Several factors can influence whether and how much stool passes per rectum after a transverse colostomy:

1. Surgical technique: Variations in how the stoma is created affect the degree of diversion
2. Stoma location: Transverse colostomies generally provide less complete diversion than end colostomies
3. Bowel motility: Increased peristalsis can push some stool past the stoma site
4. Stool consistency: Liquid stool is more likely to pass beyond the stoma compared to formed stool

Clinical Implications

For patients with a transverse colostomy:

• Patient education: Patients should be informed that some bowel movements per rectum are normal and expected
• Monitoring: Any significant change in the pattern of rectal output should be reported to healthcare providers
• Hygiene considerations: Patients may need to maintain anal hygiene despite having a colostomy

Potential Complications

While some rectal output is normal, certain symptoms warrant medical attention:

• Excessive rectal output: May indicate stoma dysfunction or partial obstruction
• Pain with rectal passage: Could indicate inflammation or stricture in the distal colon
• Mucus discharge only: Normal protective mucus secretion from the distal bowel segment

Comparison with Other Stoma Types

Different types of stomas provide varying degrees of fecal diversion:

• End colostomy: Provides more complete diversion than loop colostomies
• Loop ileostomy: Often provides more complete diversion than loop transverse colostomy 3
• End ileostomy: Provides nearly complete diversion

Conclusion

Patients with a blowhole transverse colostomy should expect some degree of bowel movement per rectum as this type of stoma does not completely divert the fecal stream. This is a normal finding and should not be cause for alarm unless accompanied by concerning symptoms such as pain, bleeding, or a significant change in output pattern.