Hi All - 

I've spent the better part of the last month or so struggling with some moderate to sometimes severe pain/cramps in the abdomen and associated bloating and distended stomach.  I often feel very full, very quickly.  Some times the pain is a dull, achy uncomfortable sensation, and other times it is much sharper where I need to sit still.  It continually feels as though a good bowel movement would relieve all these symptoms but it hasn't come yet.  I didn't really notice until recently that my BMs have lessened a bit and the output also isn't what it was (less gas, less everything).

Last week, I saw my surgeon for a quick checkup and scope and he said all looked great....suggested I give it a few weeks and see how I felt.  After feeling awful this weekend, I saw my regular doctor yesterday and went for a sonogram to check the whole area - came back clean.  Frustrated, I called my surgeon again, who sent me for a CT scan with/without contrast and initial reports from the scan are that all looks good.  While this is good news, I can't help but think what is going on??  

I've had the pouch since 2004 and never had to deal with any type of constipation or slowness in transit.  My # of BMs hasn't changed, just that they aren't as productive as usual, and I show no other symptoms.  Since all testing and scopes were clean - does anyone have any advice?  

I read on a previous post regarding constipation or thickening of output or even portions of the intestine slowing down, perhaps I'm experiencing something similar?  Maybe a night of stool softener and/or miralax might help?

Thanks in advance!
Ken

Original Post

Ken, you've been looked over high and low, so that suggests that some basic experimentation is likely to be safe. Why not try some things, one at a time, and see what helps? Assuming you aren't using any Lomotil or Imodium, you could try various doses of psyllium (Metamucil, Konsyl) and other soluble fibers (Benefiber, Citrucel). You could try a stool softener or MiraLax. You could try a probiotic.

The pouch changes a bit over time, and becomes a bit more like a little colon. Perhaps it's absorbing water better than you want it to. Are you peeing enough (at least 3-4 times per day) and is it light-colored?

Thanks Scott,

I don't take anything like Lomotil or Immodium (never have).  I have also never taken any type of soluble fiber - what purpose what that serve?  To 'keep me regular'?  I also decided to try a laxative to see if it helps things move along.  

I not sure if I pee enough - I've never really paid much attention.  I'm sure I do 3-4x daily, but I will pay closer attention and note the color; I'll also keep up with the water, though it's not my favorite.

-Ken

The fiber will bulk up the stool, and (if you're well hydrated) keep it at a texture that's easy to move along. If you've never tried it, it's likely to be a better place to start than laxatives. I've used Metamucil every day since my surgery 15 years ago. These are easy experiments to do, and you'll know pretty quickly how they're working. Good luck!

Interesting - I was starting to operate under the impression that things were a bit too bulky and not really moving at all...like my gut's slowed to a grinding halt.  Would the fiber help or perhaps hurt that?  I, unfortunately, had to cancel a vacation this week...just trying to feel more comfortable!

-Ken

Ken, I'm sorry your vacation was prevented by this! 

My guess is that fiber will help (with enough water!), but it's just a guess. A couple of doses a day are very unlikely to harm you. In any case, I suggest you move on to the experimental stage without further delay, whatever you choose to try first.

Hi Scott,

I ended up going on vacation after all and just dealt with the unpleasantness.  As it stands now, I've been utilizing some laxatives, which don't seem to have much of an effect.  Either there's nothing to move along, or there's something squeezing my guts (adhesion?), as the cramping is very uncomfortable and comes with/without eating.  At times, it literally feels like I have to blow out some major gas, but it just never happens.

I'm a bit concerned to start fiber - if there really is gas (or something else) stuck up there, I don't know how the guts would react to the fiber.  Thoughts?

Hey Scott - I know you were following my other thread about which GI to see....I did see the local GI this morning.  He did spend some time in NYC so was familiar with some of my physicians and also the procedures (and the pouch).  He doesn't seem to think there is anything wrong structurally (except possible adhesion) and also agrees there's no inflammation.  His 1st instinct was bacterial overgrowth, so I'm going to try an AB and have some labwork done.

Thanks for the continued support!

Hi Scott and Kenny.  I am having, literally, the same symptoms as Scott.   I can take his words, as I'm doing here:  "I've spent the better part of the last year or so struggling with some moderate to sometimes severe pain/cramps in the abdomen and associated bloating and distended stomach.  I often feel very full, very quickly.  Some times the pain is a dull, achy uncomfortable sensation, and other times it is much sharper where I need to sit still or stop and hold myself in from the pain.  It continually feels as though a good bowel movement would relieve all these symptoms but it hasn't come yet.  I didn't really notice until recently that my BMs have lessened a bit and the output also isn't what it was (less gas, less everything).

I've started the psylllium husk and will look for Konsyl tonight.  Never realized that would help.  I am longing to go to the bathroom and evacuate completely.  That's my discomfort.  That I cannot evacuate completely, they way I used to.

Help!

JAGirl

 

I haven't had any symptoms, but Kenny has. Konsyl (original) is just unflavored, unsweetened psyllium husk, so I only use it to help reduce my sugar intake.

Incomplete emptying can be caused by several things, some of which require treatment, but finding your most comfortable stool consistency makes sense regardless of the cause.

Hi JA - welcome to the board....sorry to hear you've been struggling a bit lately (year?)!  Usually the first suggestion for a lower frequency of BMs and some pain is a stricture at the anastomosis site....have you had any issues like this in the past?  I've been extremely lucky in the 13+ years since my surgery - very few issues.  It's been strange for me to have these pains but no associated changes in BMs or frequency.  

Scott (and some others here) have suggested fiber for me, though at this point I've kind of backed off my belief that I'm backed up a bit.  I'd be interested to hear how it works for you.  

 Have you seen anyone about this lately?  Maybe it might be a good idea to have your pouch checked for strictures?  My gastro today, considering all symptoms and tests, thinks I might have an instance of SIBO, which apparently also causes pain and cramps.

Hope the fiber gives you a good start - let me know!

This might be something totally different but I had somewhat similar issues a few years ago.  Long story short, it ended up that my anal sphincter was incredibly tight.  It had been a gradual onset over a number of years.  I required pelvic floor physical therapy for a while and now I dilate regularly.  Besides that, I take Metamucil (I knew about Metamucil from my doc but learned a tactic on this website that was helpful).  Anyway, adding a bit of bulk to my bm's helps keep my sphincter a bit less rigid, which keeps my bowels moving more regularly and gives me the feeling of "completeness" more frequently.   

 

Hi Mary - that is interesting, I had never heard of tightening before.  Its usually just the stricture talk at the anastomosis site that people mention and have issues with.  I am surprised overtime I hear that fiber is being used by one of us pouchers.  I guess I have the wrong impression - I always assumed it was a bulking agent in which case would make it more difficult for us to move things along, not easier.

Maybe I should try it as well....is Metamucil the gold standard?  I haven't read much related to fiber...perhaps a search will help.  A more complete empty feeling is always a welcome site!

I have to say that I don't feel as up to date as some others on this site so take what I offer with a grain of salt.  I had my surgery 25 years ago and was symptom free until a few years ago.  

I couldn't muster a bowel movement, pushed so hard that I ended up in the hospital on vacation for a couple of days.  I started in pelvic floor p/t after that, which lasted quite a while.  I've been in and out of p/t ever since, although I've gone 9 months without it, which has been great.  I credit the Metamucil and self dilation for that.

From a recommendation on this site, I use Metamucil orange flavour, full sugar formula and only add a bit of water to the 2 tablespoon dose (not the 8 oz recommended on the canister).  I recommend that you aren't sedentary immediately afterward (i.e., don't lie down to watch tv or kick back in the recliner).  I tend to drink some additional water fairly soon after drinking it to help it work through my system.  (Early on, I drank some, reclined on the coach to watch tv and it felt like it was expanding in my chest.  It was pretty scary.  I stood up, drank some water and was totally fine a few minutes later.  I don't want a repeat of that so I drink it, clean up my kitchen or whatever for a few minutes and then I can go about my day.

My stools have a bit of substance now, which is remarkable.  

An anal sphincter is meant to have flexibility and be able to handle a full size bowel movement.  Mine has only dealt with fluid for 30 years, which is why my GI hypothesised that it had "shrunk" (my term, not hers!).

Hope that makes sense.  Trying the Metamucil can't hurt you ... and may make you significantly more comfortable.

Good luck!

25 years septum free - god bless!  I had always been hesitant about the fiber, but I suppose it is worth a shot.  I have been feeling pretty decent for the past 4-5 days, but, as you said, it can't hurt (hopefully!).  I'll do some quick research on this site and see how people usually start with fiber.

Thanks!

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