J pouch and slow transit time

Hello! So happy to have found this group - my first post! I am about 10 days post takedown and while I know it is still very early days, to same I am struggling would be an understatement. Rather than posting one LONG post with all my questions/gripes, I'll try to limit myself to one or two per post!

my first question..... has anyone ever dealt with slow transit time with their j pouch? When I had my ostomy (for 7 years), my transit time was slow/long. I would eat dinner at 5pm, have to empty my bag at least once per night, and still be having output at 9am the next day. I was afraid I'd be plagued with a similar problem with my J pouch and it would seem it is happening. I know it is normal to have a dozen or more BMs each day after takedown. But this amount of disruption to my sleep is getting Exhausting so I thought I'd try a few things to help. The last few days, I've stopped eating at 2pm. A decent size breakfast, morning snack, large lunch, and another snack around 2:30. Now 'large' is somewhat relative since I haven't regained much of an appetite yet. Anyways... not only am I still up hourly (or more) overnight, I don't usually get any sort of 'break' in my BM frequency until around 9am. That's 18 hours to get my lunch and 3:00pm snack from the previous day through my body! 

Also, my bowels 'woke up' 24 hours after my surgery. After about 3 days of loose, liquid stool, a lot of my poops are somewhat 'formed' already. Sometimes porridge-y, sometimes even former. I can only assume this is a direct result of my prolonged transit time allowing of my small intestine to absorb more of the liquid from my stool. 

Has anyone experienced this? Is there anything I can take to safely speed things up? I drink 2-3 liters of water daily, plus usually a Gatorade and a boost. I even drink lots of water with meals (which I've read to avoid because it can 'push' your food through you quicker... no such luck for me!). I was pretty leery with what foods to eat post op but have started adding a bit more easy to digest fiber to help speed things up to no avail.

Would love to hear from others who have dealt with this and any tips/tricks on flushing things out. I assume it is too early to take any supplements or other meds to help, but if there are any other ways, I'm all ears. I will definitely be bringing it up with my surgeon at my first post op appointment, but that's not for another 2.5 weeks and I'm really not sure how many more sleepless nights I have in me. 

Thanks for listening!

Original Post

Hi, SK. Hopefully you aren't taking any opiates, which are the classic bowel slowers. In any case, I'm not sure that focusing on transit time is necessarily the best focus. None of us can turn off bowel activity at a particular time by scheduling meals, and it's not like the whole meal shows up at once. Those of us who sleep through the night are mainly benefiting from increased pouch capacity, I think. This takes some time and practice, sometimes called "stretching the pouch." Experiment with delaying your bathroom trips a bit (while awake) and getting used to the signals from your body. 

Regardless of how much water you are drinking, use urination as the signal of sufficient hydration. Are you peeing light-colored urine at least 3-4 times per day?

One other thing you might try: Psyllium fiber is mostly used by J-pouchers to thicken up output, but it's worth remembering that it's mostly used by the rest of the population to gently treat constipation. It might not help you, since it bulks things up (and your pouch capacity sounds insufficient already), but if your output gets too firm it can soften bricks as well as thicken liquid.

I echo Scott's suggestion of a fiber supplement, psyllium in particular. For some people psyllium has a mild laxative effect (as opposed to other fibers like methylcellulose). It can be a mild irritant and cause some gas, both of which tend to stimulate the gut. 

Jan

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