Sorry I can’t answer all of your questions because I don’t have all the answers. I had horrible butt pain in the last trimester of my twin pregnancy and it was hemorrhoids that were horrific. I felt like I had a knife sitting up there. I had a hydrocortisone cream that really helped. My Obgyn prescribed that. I also used tucks pads which are basically just witch hazel every time I went to the bathroom. My Obgyn said to not wipe with TP at all get wet wipes and then go in the shower to clean off as frequently as possible. All of these options helped me tremendously. I had bleeding too. I had bad diarrhea towards the end of my pregnancy and my GI seemed to think it was hormones... but once I Got the hemorrhoid situation better I was way more comfortable. You could have pouchitis though... my pouch was 13 years old when I was pregnant and very “established” haha.
My Obgyn would have likely done a vaginal birth IF I only had one baby but did consult with a colorectal surgeon who would have been “on call” to the OR that I delivered in should I have some type of pouch complication. In hindsight I’m almost glad I had a cesarean because I had so much issues with my bottom hurting I just can’t imagine having to deal with a potential vaginal tear on top of it. Plus vaginal tear and having to poop 10 times a day... ugh.
I’d try to ask your Obgyn If you can get a consult with a surgeon beforehand because Lord knows if your pouch has a problem you don’t want your ob fixing it!!!
hope this helps a little bit!