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Please help: Difficulty Evacuating Pouch

Hi all,

I need urgent advice. I posted a question about fertility in the Women's tag a few weeks ago...and I will delete it soon because I am pregnant. I found out a few days ago, but I only tested because I had a sudden onslaught of terrible symptoms with my Jpouch, and I wanted to make sure I wasn't pregnant so I could try to medicate myself.

About 4 days ago I started having sudden difficulty evacuating the pouch. I've had great pouch function since my takedown almost two years ago. (I had one bout of C-diff right after, which was treated with a Vancomycin taper that cleared it up.) I had eaten cooked mushrooms in pasta before the difficulty started, so at first I assumed I had a partial blockage caused by a mushroom. I have never had a real blockage before, but I do occasionally struggle a bit to get things moving after eating mushrooms.

But then, as things continued, I was able to get...things out? Including several big pieces of mushroom. I strained a lot to do it though, and I noticed that I felt like there was gas inside that I couldn't relieve while on the toilet. I could only get the gas out from one position, on my back with my legs curled up, and I started to have stomach cramps every couple of minutes like I needed to go when I couldn't--this was a big sign of inflammation in the pouch to me because the only other time I experienced these symptoms was when I had C-diff post-takedown. The consistency of what was coming out was not hard and I think all the mushrooms were gone...so it didn't make sense for me to struggle to push things out. At first I thought maybe it was pouchitis because it didn't seem as painful as C-diff had been before....but then

As the symptoms continued, I thought that it had to be C-diff because it was similar. I had lots of Vanco left from my very long taper after my last bout of C-diff and it was the only drug I had here (I also had flagyl that I had to stop taking because of nausea and a few doses of an oral steroid) that was pregnancy safe. I started taking the Vanco that night...and have probably taken one whole day of 125 mg/4x, plus two doses the first night, and one dose this morning...

and I got a bit better. The stomach cramps stopped, and the gas eased up. I still can't pass it on the toilet like usual, but there isn't as much of it. I hoped that meant I was right about the C-diff and was treating it. I took a pregnancy test yesterday to rule it out--we have been trying to get pregnant, but obviously I thought it would be negative and would help me ease my mind about taking meds...we got wonderful news, except now my worrying about all this is quadrupled.

I have had rectal and pelvic pressure since this...whatever it is...started. I also had that when I had C-diff with a colon (I have had C-diff twice, before and after surgery. It nearly killed me the first time.) But I don't remember it taking this long to treat that symptom before. I am still having rectal and pelvic pressure--I cannot...feel when I go to evacuate the pouch. It feels heavy, like something is inside, and I can push out some...but I cannot tell how much or if the pouch is full or empty really. It is almost like my nerves back there are messed up.

I am very scared. I tried calling my GI here (who is not my old GI with me when I had surgery, I've moved since then. I have only had one telehealth appointment with this GI when I was healthy during my last pregnancy in 2020.) But they say they cannot get me on the schedule sooner than two weeks from now. Then I called back and talked to the nurses, who promised to pass on my questions to the doctor...the doctor still hasn't called back. I tried scheduling with another GI to see if they could see me sooner, and they also had a wait time of 2-3 weeks (plus also basically said their doctors don't "steal" other doctors' patients. Which I found very belittling since I am scared and in pain looking for help, not a commodity to be sold and stolen back and forth.)

I don't know what is going on. I thought maybe it is C-diff and is taking longer to respond to the meds? Or maybe pouchitis and I need different meds? I have never had pouchitis before, so I am not sure what it feels like. But at this point I am also very concerned that I damaged something straining, in which case I would think that could be life threatening if untreated. Best case scenario...I gave myself a terrible anal fissure or internal hemmorroid? I'm not having any stomach pain, just the rectal pressure and difficulty passing stool.

Does anyone have any ideas about what's going on? Should I go to the ER so I can get some sort of care? I have put off trying that because they usually don't know how to help me until the GI on call shows up (and they usually don't have a great understanding of Jpouches) and everything is full here because of Covid. I'm afraid I will go in, sit for 10 hours, catch covid while pregnant, and still not get any help. Alternatively, I could keep calling around to other GIs or local colorectal surgeons to see if they would see me instead? Or I could try to drive outside the city...(I am in the US, Dallas-FortWorth area) or I could call my surgeon who is in another state and try to get a plane ticket to go see him? Should I call my OB about the pressure and see if they will do something? I don't think the rectal pressure is related to the pregnancy, but my OB is much more responsive than this GI doctor.

Please help...

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