Emptying pouch

I am having a hard time fully “emptying” my pouch. I have had over 30 small bowel movements in the past 12 hours however I can only seems to squeeze a little bit out each time I have an urgent need to go. Holding it in only causes severe pain and I am releasing TREMENDOUS amounts of vicious gas. Is there a safe laxative for J-Pouchers? I should add that I am taking Beano, Metamucil, & Ryfaxamin( For SIBO), Canasa Suppositories, Hydrocortisone suppositories, and immodium. I started taking activated charcoal yesterday for gas relief. If it is meant to absorb gas and help me pass it than it is definitely  working! I have passed TONS of gas today without a bowel movement. Normally a cup of coffee and a walk does the trick, today it’s not working. I just drank some ginger tea, hopefully that helps. My diet for the last day was pretty normal, ( half of a cheeseburger, pot roast with carrots & potatoes (slow cooked, I don’t really eat the meat I just sip the broth, Reese’s Puff cereal, grilled chicken, Fries)  All I’ve eaten so far today was a bit of reheated pot roast again and white rice. Again the main question here is, is there a safe laxative for J-Pouchers? Or any other methods, meds, or advice on emptying a majority of my pouch? I want my pouch to feel EMPTY (for once)! 

Original Post
Scott F posted:

I don’t have a laxative suggestion, but I would recommend stopping the Imodium if you’re having trouble emptying, and certainly if you’re considering a laxative. 

I usually don't have issues with Imodium. If I don't take it, I tend to have more frequency & very liquid stools. Would you recommend I replace it with anything? Peanut butter, anything else to help keep things thick without causing constipation?

I think the reason you're having to go so many times is because of the gas built up. Imodium does bulk up the output but it produces lot of gas with it. Trying cutting it back. Also for me potatoes are a source of gas though I lie down and pass it but if I cant I have to make extra trips. Whenever my pouch catches a bug , I just fast the entire day and have bananas, brownbreads, oatmeal, in short nothing too high in fats,protein, or fibre. I eat upto 8-9 bananas in a day that I dont feel well and usually upto 2-3 everyday. 

Good luck 👍

Pouchbro, combining a bowel slower (like Imodium) with a laxative is just about never going to be a good idea. If you want to bulk up your stool, the soluble fiber of your choice is a better idea than a bowel slower. People use Imodium all kinds of ways, but I only use a bowel slower to delay toilet visits (e.g. at bedtime or before getting on a boat). 

Lots of things can make it hard to empty a pouch, but possibilities include stool that’s too thick, pouch prolapse, constipation, sphincter spasm, pelvic floor dysfunction. Whatever you do, don’t strain excessively on the toilet. That often doesn’t end well. 

Thank you for the advice. I want to try fasting I am just SO SO hungry! I am trying not to over eat as I know that can cause problems as well. 

Does Immodium actually cause gas? Do you have any links you can share? What I've found is that Imodium is supposed to help with gas. If this is causing me to have more gas I will stop use and see if things improve. Ive gone days without taking it, weeks at times and still had severe gas. 

IMODIUM® Multi-Symptom Relief tablets work quickly to relieve diarrhea, while also soothing painful cramps, uncomfortable bloating and gas. It contains an additional ingredient called Simethicone, which helps to ease excess gas in the intestines and relieves bloating and pain due to gas.

FAQs about Diarrhea Symptoms & Treatment | IMODIUM®


 

I think I have found one culprit and that is Sugar Alcohols.

 

I took Beano "Meltaways" yesterday to prevent further gas from occurring. The first ingredient was "Mannitol" which actually causes severe gas in us pouchers, just as sorbitol does or any sugar alcohol/fake sugar. Even when I avoid it I still have severe gas issues, this tends to make it unbearable. I am literally stuck in bed with gas, I really want to find a solution for the gas relief as well.

 

For now Im going on a very limited sugar, dairy, and gluten diet so see if things improve. I've tried cutting out all 3 completely in the past with no improvements and ended up just becoming malnourished. 

 

I'm now 9 months post takedown and Im determined to figure things out! I've been having these issues ever since takedown. This is definitely the most difficult journey I've endeavored so far! 

Pouchbro, since you’re being treated for SIBO that probably explains most of the gas problem. I’ve not heard of rifaximin being used for that - mine was treated with doxycycline. It can take a few months, which gets tiresome if the first medication doesn’t do the job.

Simethincone doesn’t prevent gas or make it go away. It emulsifies the gas, turning large bubbles into smaller ones. I’m not sure how useful it is for J-pouchers, but some folks here seem to like it.

Beano only works on gas produced by specific vegetables (mainly cruciferous). It does that, and only that, very well.

Sugar alcohols can be a problem with or without a J-pouch, though I don’t know if the tiny amount in a Beano Meltaway is enough to trouble you. Your SIBO probably makes more gas than that.

It’s best to think of sugars and starches as identical foods for our purposes - both are digested to sugar in the gut. So cutting out sugar but eating starch will generally have no effect.

Dairy bothers some people but not others. Cutting out dairy will only help if you are sensitive to it. Most dairy-sensitive folks are lactose intolerant, so any source of lactose (milk sugar) sets them off. A few folks are allergic to (for example) a protein in cow’s milk, and they may do fine with goat’s milk.

Gluten is probably a red herring, IMO. I’d be surprised if it’s causing gas for you.

Do you eat quickly? Swallowing air can cause problems for some folks.

How long have you been on the rifaximin?

Scott F posted:

Pouchbro, since you’re being treated for SIBO that probably explains most of the gas problem. I’ve not heard of rifaximin being used for that - mine was treated with doxycycline. It can take a few months, which gets tiresome if the first medication doesn’t do the job.

Simethincone doesn’t prevent gas or make it go away. It emulsifies the gas, turning large bubbles into smaller ones. I’m not sure how useful it is for J-pouchers, but some folks here seem to like it.

Beano only works on gas produced by specific vegetables (mainly cruciferous). It does that, and only that, very well.

Sugar alcohols can be a problem with or without a J-pouch, though I don’t know if the tiny amount in a Beano Meltaway is enough to trouble you. Your SIBO probably makes more gas than that.

It’s best to think of sugars and starches as identical foods for our purposes - both are digested to sugar in the gut. So cutting out sugar but eating starch will generally have no effect.

Dairy bothers some people but not others. Cutting out dairy will only help if you are sensitive to it. Most dairy-sensitive folks are lactose intolerant, so any source of lactose (milk sugar) sets them off. A few folks are allergic to (for example) a protein in cow’s milk, and they may do fine with goat’s milk.

Gluten is probably a red herring, IMO. I’d be surprised if it’s causing gas for you.

Do you eat quickly? Swallowing air can cause problems for some folks.

How long have you been on the rifaximin?

I try my best to avoid eating quickly however I will try to slow it down and see if that has any effect. 

 

The amount of gas I'm talking about is insane. I stopped counting after the 30th time today however I've expelled tremendous amounts of gas over 30 times today. I usually don't feel bad for myself, however today I feel bad for my body. I really need some help on what to eat and how to stop the SIBO/gas. 

 

As far as starches go, should I stay away from potatoes? How about white rice? Could chicken be the problem?

What am I supposed to eat? I've been trying to do grilled chicken however at this point I'm loosing weight and becoming malnourished. Would fried chicken be easier for my body to digest and therefore cause less gas? I know it comes out liquid however my body needs some fats to absorb. I have extreme fatigue and I literally cannot take this anymore. I need to get rid of this SIBO as fast as I can. 

Did you try Pepto Bismol between antibiotic dosages? A SIBO situation can be brought under control with medications but diet modification is going to be important long term, and you will not see a difference overnight as it takes many months to bring the SIBO count down.

You need to go to emergency dept and get your pouch drained/deflated and then find out what is going on.  I've had to do that a couple of times and I've had my pouch for 39 years (1980 surgery).  You might want to buy a flexible rectal drain tube and keep it on hand in case it happens again.

 

Ross

Just to be clear on one point: I wasn’t telling you to cut out carbohydrates (though CT probably will). I was saying that if you stop sugars and don’t stop starches you haven’t changed much of anything. Potatoes and rice are mainly starch.

I have no food advice. If you’re trying to figure out what foods give you trouble, an elimination diet using *simple* foods is a pretty reliable method.

Pouchbro posted:

Thank you for the advice. I want to try fasting I am just SO SO hungry! I am trying not to over eat as I know that can cause problems as well. 

Does Immodium actually cause gas? Do you have any links you can share? What I've found is that Imodium is supposed to help with gas. If this is causing me to have more gas I will stop use and see if things improve. Ive gone days without taking it, weeks at times and still had severe gas. 

IMODIUM® Multi-Symptom Relief tablets work quickly to relieve diarrhea, while also soothing painful cramps, uncomfortable bloating and gas. It contains an additional ingredient called Simethicone, which helps to ease excess gas in the intestines and relieves bloating and pain due to gas.

FAQs about Diarrhea Symptoms & Treatment | IMODIUM®


 

I think I have found one culprit and that is Sugar Alcohols.

 

I took Beano "Meltaways" yesterday to prevent further gas from occurring. The first ingredient was "Mannitol" which actually causes severe gas in us pouchers, just as sorbitol does or any sugar alcohol/fake sugar. Even when I avoid it I still have severe gas issues, this tends to make it unbearable. I am literally stuck in bed with gas, I really want to find a solution for the gas relief as well.

 

For now Im going on a very limited sugar, dairy, and gluten diet so see if things improve. I've tried cutting out all 3 completely in the past with no improvements and ended up just becoming malnourished. 

 

I'm now 9 months post takedown and Im determined to figure things out! I've been having these issues ever since takedown. This is definitely the most difficult journey I've endeavored so far! 

Its my personal opinion bro, whenever I take imodium the gas build up feels either increased or its just that my output becomes so hard I cant even pass it. For the gas part the few things I do is give myself some rest, never strain on toiler ( once I strain the next time the pressure and gas weirdly increases). I eat plenty of bananas like 6-7 in a day. For me banana and brown bread are the top 2 carb sources that dont bother me or feel gassy. Eggs, meat , dairy ,sugars , potatoes are somethings I avoid when trying to recover from a bad day (pouchwise). Sugar is a disaster to my pouch and big fresh salad bowls.A good sleep recovers my pouch more than anything else. I know these things sound crude but these little things help me. I even treated my pouchitis bout the same way by fasting. You should refer to a good doctor who can sort things out for now but you need to figure out what will help in future to keep things steady in future. 

Remove all your stress, start building postive thoughts they'll go much long way. 

Hi, Pouchbro.

You need to eat something or your blood glucose will drop. White potatoes, white rice, white pasta, white breads, bagels are "simple" carbohydrates. Very starchy, no fibre, and they break down into sugar very, very fast, then you have massive gas and bubbling in your stomach.

Can you try eating "complex" carbohydrates? Complex carbs have soluable fiber so it takes a bit longer to break down, and won't become sugary starch in your body. Look up lists of simple / complex carbohydrate foods so you will know what to avoid, and what to include in your meals. When I eat too much white pasta, white rice, or anything made from white flour, I get gas. When I eat brown basmati rice, or plain basmati rice with meals, I am great. Basmati is a long grain rice, and it takes longer to break down so that might be better for your body. Available at Costco in burlap sacks.

Everyone needs some carbs to function, to think clearly, to move, to use muscles, but it is the type of carbs you eat. Simple carbs are problematic for pouchers, complex carbs are better for us.  If you love potatoes, maybe try a sweet potato?  Sweet potato has more nutrients than white. Mashed sweet potato with a bit of olive oil or butter, some sea salt and pepper tastes good. Look up the food guide for diabetics that lists good complex carbs and see if it appeals to you.

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