You make me laugh, Sara Marie!
I use the Digestive Advantage ‘daily probiotic’ for ‘digestive and immune support’ gummy probiotic they sell at Costco. I found it helped to take 3-4 per day, all at once was fine, to stay ‘balanced’. It helped pouchitis, but not cuffitis. Worked a lot better when I had pouchitis with the J-pouch; less good with an S-pouch because of the different mechanics.
Cuffitis is likely to be the problem when it hurts badly to both feel the urge to defecate, and to actually go. With pouchitis, it feels crampy and miserable in your abdomen/pelvis whether you’re on the toilet or not; cuffitis for me was a feeling of internal discomfort right around the anal area that became the ‘ring of fire’ when trying to evacuate. It hurt to sit, bled when I pooped, and was rather like my UC flares felt (minus watery diarrhea), just localized to my derriere. I do wonder if it’s worse because it doesn’t cause watery stools, which makes them easier to pass, frankly…
That’s the other thing. Cuffitis can be mistaken for a stricture, because the rectal cuff is so irritated and swollen that it blocks the normally easy passage of stool from the pouch. The caliber of the stools (if they’re formed) is decreased, and it hurts much worse the harder/firmer the stools are, because it’s so hard to pass them without miserable burning. I couldn’t get suppositories to go up there when I had cuffitis—and that’s what they tell you to use to treat it. (Ugh.) You might need help to get them in, if you have to use those. It would be absolute misery to introduce anything, a finger, an enema nozzle, suppository…
I’ve also had anal fissures from going so much and wiping and the usual suspects. Those hurt like Hades when actually defecating, but otherwise are less noticeable to me. I found that barrier cream helped a ton with those and with diaper rash—the one we haven’t talked about here that much.
All that diarrhea, and the gut imbalance of bacteria, favors excess Candida yeast in the gut and stool. Just like babies, when I have an accident and I can’t get it off my skin fast enough, the acid, bile, and yeast combine to create bright red fiery irritation between the cheeks. There is blistering as well, when that happens. Calmoseptine is my best pal when that happens, just like with the fissures…
Oh, and then there’s the vaginal candidiasis that happens when the runs are bad… not butt pain specifically, but it’s plenty to deal with anyway!
So, yeah, been there with the butt-pains of various sorts! The one that makes you want to jump off the table during the rectal exam is usually cuffitis, at least for me, and that needs help from the professionals. Anal fissures are sharp external pain usually in the most posterior part of the anal ring, feels like a bit of tearing when you evacuate, and can be made better with the Calmo and softer stools/using water or wipes instead of tissue/sitz baths. I think if it’s worse than that, it‘s worth a look for cuffitis!