I wanted to put this up here now that I am basically through breast feeding my daughter and I can attribute my pouch problems to that. I am not sure if any of the other mothers here have had issues with their pouches while breast feeding but I did! I was OK for the first month or two until my daughter really ramped up her demand and I went back to work. As soon as she hit two months it was constipation/feeling like I had a stricture/pouchitis for the next 4 months. I basically lived on grape juice and water and drove my husband crazy with my pouch complaints. I went to see my surgeon and got dialated but he thought I looked OK. Then I got pouchitis, then I got it again (only one other bout in 16 years). Finally my daughter started solids and cut back on her nursing and my pouch went back to normal. Long story short, if you are nursing a young baby and you feel like your pouch is failing, it is probably temporary.
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My impression is that pregnancy and breastfeeding and your hormones returning to normal can do crazy things to your immune system. Breast feeding also requires you to eat A LOT and that is terrible for pouches. I think my pouch problems were a combination of struggling to drink enough, eating more than my pouch could handle (I do 16:8 intermittent fasting now and it helps so much), and actual structural issues with my pouch that might have been exacerbated by pregnancy. Have you been tested for an infection like c diff? Do you have any signs of prolapses in your pouch? I was just diagnosed with them and it explains so many of my issues! I have't had a chance to ask Dr Shen if pregnancy makes them worse but straining does.