I’m sorry. Have any of your doctors expressed an opinion about why you’re unable to pass stool, or are they just shrugging? Since the pouch lacks the muscles of the rectum, external muscles (and gravity) normally do the job. Assuming that there’s no Internal blockage, the stool consistency is reasonable, and your sphincter relaxes properly, I wonder if the muscles have gotten weaker and less coordinated as you’ve used them less and less. If that’s the case then it’s possible that you might get some benefit from pelvic floor physical therapy. Another possibility is pouch prolapse, which can’t be detected with an ordinary exam.