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I'm seeing lines of blood in my stool and not sure why. Can blood be normal for someone with a J-Pouch?

Ever since I got my J-Pouch in 2017 I've been seeing blood in my stool, however at first it was very infrequent, maybe once a month and over time it became more and more frequent. Now I am seeing it multiple times a day. However, the amount of blood isn't a lot unless I'm having a flare up.

I was recently diagnosed with Pouchitis. Had 2 flare ups this year in June and November. Both times had a 4 week course of Metronidazole and Ciprofloxacin - they helped however on both occasions still saw blood during and after the course however it was a lot less than when I was having the flare-ups. During flare-ups I see a lot of blood, sometimes the blood is more than the stool. And it isn't lines, it's a lot of bright red blood and on the tissue too.

I've been taking VSL#3 since the start of December. After my last course of anti-biotics just ended. Having 1 sachet every night. However I am still seeing blood in my stool.

Has anyone been in a similar position to me and maybe has some advice? I know bleeding isn't always a sign of pouchitis however I've had 2 sigmoidoscopies since having the pouch. The first in 2019 showed nothing and biopsies didn't show any inflammation. The second was this year August and showed mild erythema and inflammation on the biopsy taken from the pouch. I asked my Gastroenterologist if he thinks it might be cuffitis, but he said there was no inflammation shown from biopsies taken from that area.

Any advice or guidance would be greatly appreciated.

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Hi Scott,

I haven't ever asked if it could be haemorrhoids as I thought that would have been seen during the sigmoidoscopies. However I will mention this to my doctor tomorrow as it's worth getting that clarification.

Something I noticed was that I tend to see blood more often when my stool is thicker. But this could be just that the blood is more diluted and harder to see when it isn't thick.

Sounds like hemorrhoids based on my own experience. The bright blood is common as it’s near the exit. The increase in blood you see with harder stools could be that you’re straining to push the stool out and causing the hemorrhoid to get inflamed. If you have high frequency- such as in a flare- the increased movements can also cause inflammation. Interestingly, my hemorrhoid wasn’t identified on my last pouchoscopy but I know it will “rear up” if I strain.

Hi Rikke,

I have not yet, I spoke to my GP and he said that because nothing was found during my sigmoidoscopy in terms of haemorrhoids, he doesn't think it is this. So he had me do a blood test and send a stool sample for tests. I've not heard anything back from those tests yet, so kind of waiting for that.

I saw lots of blood this morning too, wasn't streaks, it was a lot on the tissue and in the toilet. I can't figure out what is causing it, I don't think its my diet because I've tried so many things and changed it up. I've also been super careful to not strain and to try not to hold in stool for too long. Also don't feel unwell, so don't think it's a flare-up - It really is a mystery.

But I think you should talk to your doctor and see what they say.

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