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From what you know, what are the signs and symptoms of cuffitis? A lot of the symptoms seem to cross over between pouchitis and any other potential complication we face. However, certain symptoms are hallmarks of non-pouchitis complications, right? Though if we're having symptoms like increased frequency and inability to empty, pouchitis is likely involved, right?

I haven't had as much urgency this past year. In fact things have been pretty good. Lately though, there are times when I know I need to empty because I feel a burning in my rectal area. Not an urgency, just a burning. Is this a pouchitis thing or a cuffitis type thing or something else? Also, there are times when I am about to finish wiping and more stool comes out...diarrhea-ish. Lots of times, more stool will empty multiple wipes in a row. Very frustrating and painful. After that I'll often see blood on the tissue and my rectal area will feel like it has broken glass in it. Even the bidet hurts, but it still helps more than the TP.

I do self-dilate for a stricture at the rectal hook-up on a regular basis. I am on Cipro because my frequency was going up and the not being able to empty was happening more frequently. Wish I knew what was to blame. 

This next thing may be normal, but I'd like to hear from others: sometimes I'll go and then again 20-30 minutes later. It usually happens in the morning. After that, I'll usually be done for at least a few hours. Weird, but thought I'd throw that in there. 

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Bleeding is the hallmark of cuffitis, but you can have minor inflammation without it. Otherwise, the symptoms are the same as pouchitis. There are no pain receptors in the rectal or ileal tissue, so that "broken glass" pain is due to damage in the anal canal. There are a lot of pain receptors in the anal canal. Fissures are the likely culprit of pain with bowel movements and minor bleeding. 

The discomfort associated with pouchitis is due to stimulation of stretch receptors (like gas pain/cramps due to distention). 

Your emptying issues are consistent with anal stricture, and also with cuffitis (from the swollen mucosa narrowing the outlet). But, even without anything being wrong, periodic emptying issues can be normal, based on dietary inconsistencies.

Jan

Thanks for the reply! That makes sense. I can add cuffitis to my other issues.

I recently read that before fistulas open, they often feel like a bump, boil, bubble, or zit. I've definitely felt what I would describe as a bubble on the right side of my anus when having issues emptying. I've probably felt this bubble 6-7 times over the past year. Not typically painful to sit down or touch, but it burns once it's open. I thought it was an inflamed hemorrhoid and maybe it is.  When I notice the bubble, it usually opens/bursts during that wiping session, and I'll see blood on the tissue. I'll also have more of a difficult time cleaning up. I've never seen what I'd describe as pus though. Any thoughts on that? Is that likely an abscess leading to a fistula. 

I know I need to get a pouchoscopy scheduled asap with all these questions I have. Planning to get that in the books soon. It's tough to do that, because weirdly, things aren't that bad. 

Thanks!

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