have to push my stomach in very hard to evacuate!

@fq this is the story of my life, I do but not even couple of times a day, that's the normal with any time I go to do number 2. Yes maybe some times are easier than others, however the need to push is there and sometimes it's a mission!

I have had my J-Pouch for 5.5 years now, and I sometimes gets inflamation and bleeds, I think it's because the evacuation process is not in full. The actual formation of the stool is not difficult to get out, it feels like it's vey dry and there is no sliding liquid.

@JenniferG I think it's easy not to know the feeling when you haven't experienced it. If I feel like I need to go and go and sit down without pushing, it's like experiencing the pain continuoisly until you give up and decide to start pushing.

I wish there is a solution for that.

Are you pushing with your internal muscles (bearing down) or pushing on your stomach with your hands?

Pushing with my internal muscles (squeezing)

Maybe try massaging your abdomen with your hands to assist in the evacuation.  If you use your internal muscles to push too hard too often it can cause problems like hemorrhoids, prolapse, etc. You can push pretty hard with your hands.  I use this method to help empty the pouch almost every time I go.  It does not hurt, though sometimes there is a little extra pressure that helps push everything through.  It causes mild, brief discomfort when that happens.

I know there is often no way to get around the internal pushing because our J-pouches don't work that well, so I would offer that in order to counter the pushing out, draw up the pelvic floor just as often and with just as much force.  In yoga this is called mula bandha, or root lock.  I find that the directions given by BKS Iyengar in "Light on Yoga" for activating mula bandha while standing to be the easiest to achieve.  There are many seated ways of activating  the root lock as well.

There are also many youtube videos about how to strengthen the pelvic floor.

I have the same issue for probably two years now. I'm having my j-pouch for 20 years this year. During that time I actually had only two examinations done, the last was at the beginning of this year, a few month after the first time this evacuation issue happened. They didn't find anything that could explain why I felt this constipation thing. The only result was that there were a "few minor hemmorhoids". Nothing serious.

When I feel the urge to use the bathroom it often happens, that only little amounts of stool comes out. Sometimes the pushing seems to even close the "door" and I feel as if there is a pressure valve somewhere that is shutting down the more pressure I use. A few moments later after leaving the loo I again feel constipated and the whole thing starts over again.

Only when I'm able to release a portion of gas together with a "plug" of stool, I get rid of the feeling of constipation.

Eating spaghetti (or worse) chocolate makes it even worse.

I haven't found a solution to this problem yet.

@PaulS, you're describing what my mucosal prolapse felt like exactly!  Any straining/ pushing was exactly like "closing the door" since the prolapsed tissue obstructed the opening - in my case by 80%.

Unless the endoscopist tries to emulate evacuation by using air during the procedure, the prolapse isn't obvious.  

I learned to avoid straining altogether by using abdominal and pelvic floor muscles only (the "valsava maneuver" helps with this).  But what fixed it  was an endoscopy procedure with "banding" to remove the prolapsed tissue.  

I hope everyone that posted about this issue and struggles with it will find out what's causing their  problem. In the meantime, keeping well hydrated and using psyllium husk (like Metamucil) and avoiding foods that typically slow down digestion might help.   And some medications, like Cipro, can actually harden the stool, too. So checking out side effects of any meds we're on is always important.

I would like to know more about the "valsava maneuver".  Where did you receive training on this?  It sounds complicated.

Hi fq and everyone, yes familiar with this probably been dealing with it for 15 years. Initially I used to strain which was sometimes productive and sometimes not. Over time I figured out my urgency at these times often comes from gas rather than stool and straining on the gas just moves it around but not necessarily out. I have found that lying down and relaxing will allow the gas to "rise' pouch and I can let it out and remove the urgency feeling. The position I take to do this has sifhted over time. My theory is that my anastomsis is changing (probably with scar tissue and the 2 fistulas I developed), I think my anatmoy is actually twisted now as often tutning to my right on the toilet allows me to evacuate. Its a constant guessing game. If I could figure out one solution I would give up any food to make it consistent. Not many answers for you but a variety of thoughts that most save you some time figuring out if they affect you. Good Luck.

JAS can you please tell me how did you fix the issue with your fistulas?