Well, my urogynecologist "didn't feel comfortable" with the results of my MRI which was not exactly clear, so she sent me to see a colorectal surgeon (who, along with another CR doc there, created my jpouch in '93 - talk about full-circle). After spending oh, $5000 or so on ultrasounds, MRIs, office appts., other testing, he did a quick $40 co-pay exam, and knew immediately what the issue was:
"the patient has a chronic fluid collection in the deep pelvis just posterior to the vagina and a little to the right of the midline. This is easily palpable through her vaginal exam. Periodically it discharges its contents probably from the midline sinus in the region of her old incision just behind the introitus.
I gave the patient 2 options. If this does not bother her much it can be left alone but it will probably continue to seep periodically as it has been doing so far. The other option would be to examine her under anesthesia and see if we can drain this collection either transvaginally or transperineally which will entail a drainage catheter placement and some dressing changes and slowly things might heal. There are no guarantees of course. If we leave it alone and it gets infected then we will most certainly have to drain it but the chances of that happening are not very high given that its 3 years from her surgery. She wanted some time to think about her options which is perfectly okay."
So there ya have it. The sporadic leakage is a result of my surgery(ies), and the dr. thought it would continue forever unless drained/healed - and as noted, there are no guarantees there, either. I'm torn as to what to do, but for now, I'm doing nothing, as I've been feeling so much better with the jpouch/fistulas/abscesses gone, and enjoying not having medical issues. On the bladder/urinary issue, I'm currently resigned to living with it as it is, but things could be worse.