Pouch Function

Have you had a pouchoscopy recently? That might help narrow down the possibilities.

Scott,

Im not sure what a pouchoscopy is.  I know back June my GI performed a illeoscopy with a scope and determined there wasn't any immflamation.  I'm not sure if that's the same thing but I do have a follow-up appointment with him on Friday which I will ask him if he can do a pouchoscopy. 

It sounds like your doc took a proper look. Since the pouch is constructed from the ileum (the last part of the small intestine), passing a scope into the pouch (pouchoscopy) is technically also passing a scope into the ileum (ileoscopy). The billing systems often lack a proper code for pouchoscopy. There are still a number of possible causes. He's probably ruled out accessible (near the anus) strictures, but some structural pouch issues, like prolapse, can be invisible on a simple scope. Partial obstructions, perhaps due to adhesions, can cause pain and leakage.

After the events you describe, is your stool consistency the same as usual? Is it formed or soft? Even simple constipation can behave the way you've described, and our tricky water absorption can dry us out with troublesome consequences. This can change over time, as our bodies change.

Hopefully your doctor will methodically figure out what's going on. In the meantime, as frustrating as this is I think it's most likely diagnosable and fixable, with the right doctor and some persistence. 

Consistency of stool is the same. I asked him after he did the scoping if there was any physical issues that could be causing the problem like strictures and he said no. 

When I had pancreatitis I did have to undergo surgery to remove abscesses and a portion of the necrotic pancreatic tissue.  It was a general surgeon who performed the procedure.  He mentioned there was a great deal of scar tissue and it was even difficult for him to locate the pancreas. I was opened wide up and I also wonder if the ileum went back in naturally.  I know it may sound absurd but I would imagine it could end up routed slightly differently.

You probably have more adhesions than before the pancreas procedure, and one or more of them could be hanging up, kinking, or twisting the bowel. This is hard to fix, since any procedure to cut them also risks creating more. 

Yeah.  I've had enough surgeries on my belly.  I don't wish to be opened up again especially since I don't know for sure if that's the problem.  

I coded twice in recovery with the pancreas surgery. 

I greatly appreciate your responses and insight.  Keep it coming. 

So does the pouch loose function with age?

Pouches age just fine.  They can be damaged in various ways, but why do you think anything is wrong with your pouch?

Because of the problems I've been having.  I'm just trying to troubleshoot things. Also I'll have movement contractions and feel like I need to go but the contractions will subside and nothing happens. 

Fair enough. Maybe back up the troubleshooting one step, though? If you feel an urge to go (or a sensation that simulates it), but nothing comes out, a key question is whether the pouch is full or empty (or somewhere in between). A temporary or partial blockage upstream can create plenty of cramping without a full pouch, and have nothing to do with a pouch problem. There are plenty of possible pouch problems, too, of course.

If you want to get fancy/aggressive you could try irrigating your pouch when this happens again, to see what's in there. Or just work it through with your doctor.

I will say this.  Up until recently I would have a movement an hour after I ate.  You could almost set a watch to it.  If I ate four small meals, I'd have four movements.  I never was incontinant at night.  Now I'm doing good to have two good movements and I have leakage during the day.  I'm having to wear underwear guards during the day and depends at night.  Maybe it's a kink or a slight blockage.  I hope not because it sounds like surgery is the only way to correct a kink and my last surgery almost killed me.