The barrier creams (applied after every BM) help prevent irritation and can enable an existing rash to heal. The “urge to go” is a complicated sensation - it’s important to distinguish between actual urgency (“if I don’t get to the toilet soon stool will be running down my leg”) vs. a misleading sensation of fullness/discomfort that can be safely ignored for some amount of time. Learning to tell those apart (and hopefully the accidents are actually rare or nonexistent) is one of the keys to living a truly full life with a J-pouch. Gradually, gently deferring bathroom trips is called “stretching the pouch,” and most J-pouch surgeons seem to recommend it. I don’t think the pouch actually stretches much, but the sensations start to become more familiar (and less threatening).