If during the course of your surgery, your rectum and anus were removed; you have what is called a Perineal Wound. In layman’s terms, you now have a gap or a wound in your perineum. Since most of the attention is focused on the stoma for patients with colostomies and ileostomies, the perineal wound is very often neglected when it comes to care, management, and even while receiving appropriate discharge information. Doctors and Wound Care nurses have a tendency to explain the ostomy and even the need to remove the rectum at times, however they rarely mention the wound left after the rectum and anus have been removed. As a result many ostomates are not adequately prepared to deal with the perineal wound, what to do with it, or even how to properly take care of it.
The perineal wound is different from other wounds which simply grow together, often with the aid of stitches, as the perineal wound must heal from the inside out and be filled with tissue formed inside the body. As such, perineal wounds may take longer than most other wounds to hea and they need proper wound care. A typical perineal wound can take from as short a time as two months to over a year in some cases to fully heal.
While you are waiting for your perineal wound to heal completely, you may find it more comfortable to use a pad or soft cushion to sit on. Do not use a donut cushion however as they have a tendency to pull the skin outward resulting in more strain on the wound area. This strain will often result in increased pain and slowing the rate of healing. Sitz baths can be very helpful during the healing process as they can often sooth the wound area as well as stimulate the blood circulation, which aids in healing.
Even though the rectum has been removed, it is often reported that ostomates may experience an “urge to evacuate” the rectum. While this can be triggered for many reasons, some ostomates report experiencing these phantom sensations during irrigating. These sensations are merely the result of the nerves that have enervated the rectum and were responsible for rectal continence, continuing to function even after the removal of the rectum. In order to help relieve these symptoms, changing positions in your chair or even sitting on the toilet for a short time may relieve the symptoms or urges temporarily.
As the perineal wound is the type that must heal from the inside, pain may persist after the external wound has appeared to be healed. Sometimes this pain can last as long as a year before it fades completely. It is imperative that the wound site be kept clean as possible during the outer healing. Several products on the market can be used to keep the area clean, moisturized, and to help control odors.
If the pain in the perineal wound area during the first year after surgery is significant, or if the wound area is characterized by swelling, redness, or fever, it could be an indication of infection of the perineal wound. Even though there may be healing at the skin level, infections or abscesses may be forming below in the healing tissue. If you experience persistent pain in your perineal wound, or if other symptoms or signs of infection occur, it is vital that you contact your physician or ET Nurse for an evaluation and professional assistance.