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I got my takedown almost 3 years ago and I have struggled since. Bought a of pouchitis, inflammation above the pouch found last year even thought I was told I had ulcerative colitis. I am much better and things look better than last year after rounds of antibiotics. I wasn’t happy with my output and wanted to thicken it up so started Metamucil. I had terrible terrible gas pain and didn’t seem to thicken things up so switched to citrucel. My bowel moments are great looking. Thick like applesauce or mashed potatoes 90% of the time. I still have some gas but nothing like before. Biggest different is even though things look a lot better, my bowel moments have increased. I start the day with 1 tsp of fiber and two bananas. Can this combo make me go more? It looks good but I feel very incomplete.  I can’t seem to win. Less bowel movements but not right consistency. Good consistency but going much more because I can’t get everything out.

I was going about 6-7 times but since switching to citrucel it’s much more because each bowel movement takes 2-3 trips within 45 minute period to get most everything out. It does fill the bottom of the toilet bowel each time so it’s not a small amount. I do take imodium daily as well(6 2mg tablets).  Suggestions or thoughts are welcome!

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Have you experimented carefully with the Citrucel dose? It sounds like it’s working almost right for you but needs some tuning up. If you have more stool in the ileum when the pouch fills up then it will refill the pouch fairly quickly.

Fiber bulks up the stool, so the quantity of output in the toilet will increase with fiber. There can be too much of a good thing, though.

I started at 1 tablespoon in the morning and at night. It was worse then than it is now so I backed it down to a tablespoon and hasn’t completely stopped. I don’t know if two bananas at once with that is too much? It seems like it’s too much of a good thing for sure. Looks great but I’m like “I didn’t eat THAT much to have all this!” So maybe I went too big too fast and that’s why. It’s only been about a week and a half tops since I switched.

You’ll see the results fairly promptly, which is why it’s easy to experiment with. Your innards might adjust a bit over a week or so but most of the effect is within 24 hours in my experience. Perhaps back it down to a teaspoon twice a day and see how that works. If you need more than that you already know your upper limit.

Thank you. Yesterday I backed down my fiber to 1/4 teaspoon 3 times a day and things were a lot better. Consistency wasn’t how it was but I felt more complete than the previous days and still looks pretty good. I am doing half a teaspoon today 3 times today and seeing if that is the sweet spot(seems it should be). I’m also backing down imodium some as well.

It can be very difficult to sort out what’s going on when you change more than one thing at a time. OTOH, if you find a set of things that work for you it’s hard to argue with that.

I think some of us may use bowel slowers excessively. The bulk has to go somewhere, and the small bowel is a poor place to store stool in any quantity. I use Lomotil at bedtime to adjust the timing of my bathroom trips, but I know it won’t change the overall quantity of stool or the number of times per day that my J-pouch fills up. I think there are usually better way to adjust stool consistency than bowel slowers.

Incomplete evacuation to me is a sign of pouchitis. It was once explained to me that the inflamed pouch loses some of its elasticity, becomes more rigid and doesn't work as well to evacuate completely. The solution is to get the pouch healthy and elastic once again so you can evacuate completely. I would suggest a 2 week blitz of 1000 mg cipro and 1000 mg flagyl daily and then see how you are evacuating. Stop the Imodium immediately once you start the antibiotics because they will thicken your stool.

I always have a maintenance stash of Cipro and Flagyl, which my GI doctor trusts me to use as needed when I flare. That isn't often since I started Remicade, but occasionally I do need a short blitz of antibiotics on the last 5 days before my next infusion.

Last edited by CTBarrister

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