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I did a search of posts for having constipation with a J-Pouch.  But I am unsure what to do.

I have gone from having to take meds and Psyllium husk to slow my output frequency/watery output to having an issue with constipation/unable to fully evacuate my pouch with no meds/Psyllium husk. 

Regardless of what I eat in the morning, I end up having multiple trips to the bathroom, unproductive BM's, inability to fully evacuate my pouch, and leakage during the day.  I am on my feet all day at work and bending/twisting can cause leakage as well.  The amount and type of food I eat makes no difference on my ability to fully evacuate when having a BM.

I get days where I get home from work and my output turns to water and I have done nothing to cause it or eaten anything in hours.

I drink upwards of a gallon of water daily.  So dehydration should not be an issue.   Will taking Miralax help?  Even hot sauce didn't help (when I ate it on eggs today).

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I’d guess you might have a stricture rather than constipation. Is there a particular reason you think it’s constipation? Go easy on yourself, and try not to strain. This would be a good time for a pouchoscopy if we weren’t experiencing a pandemic. Maybe try to schedule one with your GI for 8-12 weeks from now, and hopefully it will seem like a good idea as that time approaches. You could also call your GI for some advice.

Thanks Scott.  After I posted, I  thought back and remembered that I was having very similar issues back in January of this year.  I made an appointment with my surgeon and that is what I had, a stricture.  He dilated the stricture and things were much better.

Until I can get in to see my surgeon, can I take Miralax safely to help keep things flowing better?  Or can an individual self dilate their stricture?  

Self-dilation is safest when it’s used to maintain an opening created “professionally.” Some folks here do it all the time, and can give you better advice than I can about how/when/whether to do it. You do have to be careful and understand the proper angle and depth of insertion, and the diameter your stricture will tolerate. It can be very painful to enlarge the opening appreciably, so anesthesia is commonly used by the pros.

It’s certainly worth preventing anything from getting trapped behind the stricture, and solid stools are not your friend. Liquid stools are probably safest, but they are unpleasant and irritating. More important than Miralax, I suspect, is to stay away from insoluble fiber or anything that might still be solid at the outlet: skins, seeds, spinach, etc. Drink plenty of water. If this gets extreme then dilation is no longer elective and you might need to get it done in spite of the inconvenient timing. Stay safe, and good luck!

I also struggle with constipation. My doctor has ruled out inflammation and strictures. After an anorectal manometry test I was diagnosed with IBS which can cause diarrhea, constipation or both (I go back and forth between the two). Occasionally I have severe abdominal pain which is probably from partial obstructions related to adhesions from surgeries. I am taking amitriptyline and MiraLAX for the IBS and constipation. I think taking these helps a bit but they haven't completely solved the problem. I will probably have to wait until we are out of this pandemic to see my doctor and find out what the plan is going forward. 

Parrr, maybe try steel cut or slow cooking oatmeal?  Cook it using a bit more water than directed. But stay away from the instant, microwave packets which are so highly processed and pure sugar that it's not really oatmeal anymore. Also try ripe avocado. You can spread avocado on toast, or in a sandwich in place of butter or mayo. It seems to help ease things along, and it's a good fat. It has fiber, but it is soluble fiber and won't get stuck.

Winterberry posted:

Parrr, maybe try steel cut or slow cooking oatmeal?  Cook it using a bit more water than directed. But stay away from the instant, microwave packets which are so highly processed and pure sugar that it's not really oatmeal anymore. Also try ripe avocado. You can spread avocado on toast, or in a sandwich in place of butter or mayo. It seems to help ease things along, and it's a good fat. It has fiber, but it is soluble fiber and won't get stuck.

Unfortunately, anything like real oats (for oatmeal) causes constipation regardless of the amount of water used to make it.  Same with baked sweet potatoes.  But unbreaded baked fish opens the flood gates because of the oils in it.  But most foods right now cause constipation.  And regardless of the amount of water I drink helps.

I had issues with constipation early on that were not caused by a stricture.  My doctor (Dr. Shen) put me on a prescription of lactulose to help. I've been taking it for almost 10 years now and it continues to work great for me.  The best part is there are no side effects to it.  You may want to look into it.

Last edited by draegs

I had a virtual follow up appointment with my GI doctor today. I learned that the anorectal manometry I did indicated that my anal sphincter is not relaxing as it should and that is why I have to strain so much to have a BM. I think he said this is called anismus. He said it's like trying to blow up a balloon with your mouth closed. He said a normal rectum contracts and helps you have a BM but the j-pouch cannot do this so having a BM can only happen with a combination of gravity, using your abdominal muscles and having the anal sphincter relax but that last part isn't working very well for me. He said this is related to my IBS diagnosis which is being treated with amitriptyline. Sounds like I will probably end up to taking more of that as well as more MiraLAX. He also said I could try biofeedback. My final option is to have a permanent ostomy which seems like what he is pushing me towards. The appointment felt very rushed and I only got to ask a few questions so my head is still kind of spinning, but I wanted to share this update with you guys. 

Last edited by SJAN810
@draegs posted:

I had issues with constipation early on that were not caused by a stricture.  My doctor (Dr. Shen) put me on a prescription of lactulose to help. I've been taking it for almost 10 years now and it continues to work great for me.  The best part is there are no side effects to it.  You may want to look into it.

Shen had me try that for something a very long time ago for something, and I remember it went right through me.

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