Medical Oncologist
CION Cancer Clinics
Phantom rectum after APR: why you still feel the urge to go | CION Cancer Clinics
Phantom rectum is the feeling that you need to open your bowels in the usual way, even though the rectum and anus have been removed. It is common after an abdominoperineal resection, it comes from the nerves and the brain rather than anything left behind, and for most people it fades over the months. This page explains what it feels like, what helps in the moment, and which feelings need a check. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is phantom rectum, and why does it happen?
- What can phantom rectum feel like?
- Which feelings are phantom rectum, and which need a check?
- What can you do when the feeling comes?
- Words you may hear, in plain language
- Three things people fear about phantom rectum, and what is actually true
- What can this page not tell you?
- Common questions about phantom rectum after APR
The short answer
What is phantom rectum, and why does it happen?
Phantom rectum is the feeling that you need to open your bowels in the usual way, or that the back passage is still there, after it has been removed. It is common after an abdominoperineal resection (APR), it is not a sign that anything has gone wrong, and it usually fades with time.
Why the feeling is there when the rectum is not
The rectum and anus were served by a dense set of nerves that told the brain when the bowel was full, when wind was moving and when it was time to go. The operation removes the organ, but the cut nerve endings, and the part of the brain that listened to them, are still in place. The brain keeps its old map for a while and reads signals from the scar and the pelvis as if the rectum were still sending them.
How long it lasts
For most people it is strongest in the early months and then becomes rarer and fainter. Some notice it for years, usually as a brief odd feeling rather than a problem. A smaller number have a painful version that needs treatment in its own right. Nobody can tell you which you will have.
Phantom rectum happens whether or not the cancer has been fully removed. It tells you nothing about the cancer.Recognising it
What can phantom rectum feel like?
People describe it in very different ways. All of these are the same thing.
An urge to go
The most common form. A sudden sense that you must get to the toilet, strong enough to make you hurry, even though the stoma is doing that job now. It often comes at the times you used to go, such as after breakfast.
Fullness or pressure
A feeling that something is sitting in the back passage, or that wind is trapped and cannot come out. Some people feel it when the stoma is about to work, as if the two were still connected.
Itching, tingling or wetness
An itch or a tingle where the anus used to be, or a sense of moisture that is not there when you check. These are nerve signals with no skin to explain them.
Cramp or pain
A gripping or burning pain deep in the pelvis, sometimes coming in waves. This is the version that most needs treating, because it can wake you at night and wear you down. It is real pain, not imagined, and it responds to nerve-pain treatments.
Not sure whether this applies to you?
Ask an oncologistTelling them apart
Which feelings are phantom rectum, and which need a check?
Usually phantom rectum
Needs a look from your team
An urge to go that passes on its own within minutes
Fresh blood, pus or a bad-smelling discharge from the perineal wound
A tingle, itch or sense of fullness with nothing to see
A new lump, swelling or bulge in the perineum or the buttock
Feelings that are slowly becoming rarer over the months
Pain that is clearly building week on week, or new pain after a quiet period
A brief cramp at the times you used to open your bowels
Fever, feeling unwell, or pain that stops you sleeping most nights
In the moment
What can you do when the feeling comes?
Name it
Say to yourself that this is phantom rectum. The urge is real, but there is nothing to pass. Knowing that takes most of the fear out of it, and fear makes the feeling grow.
Sit on the toilet if it helps
Some people find that sitting on the commode for a minute, and breathing out slowly as if they were going, lets the feeling pass. There is no harm in this once the perineal wound has healed enough to sit.
Change what you are doing
Stand up, walk to another room, drink some water or start a small task. The signal usually fades once your attention moves elsewhere.
Keep a note
Write down when it happens, what it feels like and how long it lasts. If it is painful or frequent, that note is what your team will use to choose a treatment. Bring it to your review.
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In the clinic
Words you may hear, in plain language
- Phantom rectum
- The medical name for exactly what this page describes. Your team will recognise it straight away; you do not need to explain it.
- Nerve pain
- Pain coming from damaged or cut nerves rather than from an injury to tissue. It is treated with different medicines from ordinary pain relief, which is why paracetamol often does little for it.
- Amitriptyline, gabapentin, pregabalin
- Medicines commonly used for nerve pain. They are started at a low level and adjusted by the prescribing doctor. Do not start, stop or change any of them on your own.
- Pelvic floor physiotherapy
- Exercises and hands-on treatment for the muscles that surround the operation site. It can ease cramping and the sense of pressure for some people.
- Pain clinic
- A specialist team for pain that has not settled. They can offer nerve blocks and other treatments that a surgical clinic does not provide.
Commonly believed
Three things people fear about phantom rectum, and what is actually true
"If I can still feel it, the surgeon must have left something behind."
The feeling comes from the nerves and the brain, not from leftover tissue. It happens to people whose operation went exactly to plan. The pathology report describes what was removed; the sensation does not.
"It means the cancer has come back."
Phantom rectum is expected after APR and has no link to the cancer returning. Your follow-up scans and examinations are what check for that. A feeling that is slowly fading is not a warning sign. A new, steadily growing pain is worth reporting, and your team will look, but that is a different thing.
"It is in my head, so there is nothing anyone can do."
It is in the nervous system, which is not the same as imagined. Nerve-pain medicines, physiotherapy and pain-clinic treatments all help, and so does simply understanding it. Telling your team is the first step, and they will not think you are making it up.
Being straight with you
What can this page not tell you?
It cannot tell you whether a particular feeling in your pelvis is phantom rectum or something else. The pattern above is a guide for deciding whether to ring, not a diagnosis. A surgeon who examines the perineum can usually settle the question quickly, and that is the right answer when you are unsure.
Who this advice does not suit
If your wound is still open or being packed, if you had a flap, or if you are still on strong pain relief from the operation, new sensations in the pelvis need reporting rather than self-management. Phantom rectum is a diagnosis for a settled wound. Before that point, let the team decide what is what.
For the son or daughter reading this
Your parent may not tell you about this. An urge to open the bowels after the anus has been removed feels absurd, and many people keep it to themselves out of embarrassment or fear. If you notice them hurrying to the bathroom, or looking distressed for no clear reason, ask gently. Naming it, and hearing that it is expected, helps more than anything else.
If pain is stopping sleep, that alone is reason to ring. Do not wait for the next appointment.Questions we are asked
Common questions about phantom rectum after APR
Is phantom rectum dangerous?
No. It is a nerve signal without an organ to act on, and it does not damage anything. The only harm is the worry it causes and, in the painful form, the loss of sleep and energy. Both can be helped, so tell your team rather than putting up with it.
How common is it after APR?
Common enough that your surgical team expects it and will not be surprised when you mention it. Most people notice at least the mild form, the urge to go, in the first months. The painful form is less common. If you have it, you are not unusual and you are not imagining it.
Will it ever go away completely?
For many people it fades to nothing, or to a rare odd moment they barely notice. For some it stays as a faint background feeling for years. A painful version that does not settle should be treated, not waited out. Your team cannot promise a date, but the direction is usually towards less, not more.
Should I go and sit on the toilet when I feel it?
You can, once your perineal wound is healed enough to sit. Some people find that sitting and breathing out slowly lets the feeling pass. Others find it better to stand and walk. Try both and keep whichever works. Neither does any harm.
Are there medicines for it?
For the painful form, yes. Medicines used for nerve pain, such as amitriptyline, gabapentin or pregabalin, are the usual first choices. They are prescribed and adjusted by your doctor, and they take time to work. Ordinary painkillers often do little, so do not judge the pain by whether paracetamol helped.
Is it related to the stoma working?
Sometimes. Some people feel the urge just before or as the stoma passes stool, because the bowel is moving and the old nerve pathways still respond. That link can even be useful, as a warning that the bag is about to fill. It does not mean the two are connected inside.
Could it be the cancer coming back instead?
Phantom rectum itself is not a sign of the cancer returning. What your team wants to hear about is a new pain that is steadily getting worse, a lump, bleeding or discharge. If you have any of those, ring and be seen. If it is the familiar urge that passes, it is the nerves, and your scheduled follow-up is enough.
Who should I tell, and when?
Mention it at your next review even if it is mild, so it is on your notes. Ring sooner if it is painful, if it is waking you, or if it is getting worse rather than better. Your stoma nurse is a good first contact and will pass you on to the surgeon or a pain clinic if needed.
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Sources
- NHS — Colostomy
- Macmillan Cancer Support — Colostomy
- Cancer Research UK — Surgery for bowel cancer
- National Cancer Institute — Colorectal cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
The Perineal Wound After APRThe wound that phantom rectum is sometimes confused withAccepting a Permanent ColostomyThe emotional side of the same operationPain After Cancer SurgeryNerve pain, ordinary pain and what is used for eachFollow-Up After APRThe checks that actually look for the cancer returningAbdominoperineal Resection (APR)Every page in this guide, in order
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Not sure whether a feeling needs checking?
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