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Hi all, 

I'm new here and and new to a j-pouch. Today, I am 4 weeks post 2nd step of 2-step surgery.  I had a very easy surgery, and for the first week thought I was a miracle. I spent one night in hospital, was out the next day and felt great. After probably a week, I started getting terrible gas that is making my frequency sky rocket. Sometimes 20+ times in 24 hours. I am able to hold it though, which is great, although uncomfortable. If it were not for the gas, especially at night, I think I would be very happy with where I'm at.  

Anyone else have something similar? I wonder if it's pouchitis, although no fever, no blood, no urgency (to the point of accidents anyway).  I'm having some night leakage due to the gas expelling some out. 

Should I be concerned about pouchitis, or is this just normal? Anything I can try to help with gas other than Gas-x and activated charcoal? I took a little fiber for a couple of days, but was afraid it was making things worse. Should I try taking fiber again? 

Thanks for the help! 

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It can take over a year for frequency to settle. I'm sure it will get better sooner and even better as time goes on. I recently went through the same issues and I found that being more active decreased the gas and sitting up when I eat and for a little while thereafter (versus eating in bed or laying down) decreased the gas. I also found I had less gas if I didn't drink shakes in the morning and instead had something more whole like eggs and turkey bacon. My. Surgeon would recommend Imodium once or twice a day to help decrease frequency if it were that high but I found that I would hen have trouble emptying the pouch and sometimes it would lead to cramping but maybe it'll work for you. 

Hello, JTree. My symptoms of pouchitis is also frequency and leakage, never blood, fever, or urgency. See if you can reach your doctor or anyone on call during the holidays and describe your symptoms. I did this the first time I had pouchitis in my third or fourth week post reversal (I didn't know it was pouchitis and I was desperate) and I was given a prescription over the phone, picked it up at the drugstore. By the third pill 36 hours later, I was almost 100%.  Well, as much as a j pouch can be 100%. When I feel the urge, I don't hold it to stretch or expand the pouch size. I think that if it's rumbling and grumbling, it wants to be emptied and clean. I think keeping all that waste inside just leads to other problems, like leaking and bacteria buildup. I hope you find the answer and feel better. 

Hi j tree,

I just had my ileostomy takedown on  December 15th and your post was exactly why I was looking through the forums.  Everything was really not that bad, as far as pain went, but the gas is my main complaint.  I can expel the gas but it sends sharp pains through me and I find myself going to the bathroom a lot.  I don't do fiber,the first time at the hospital it had me throwing up and the last time I took fiber I ended up in the ER for a partial blockage on Christmas eve  I am not even close to 4 weeks out I hope this type of pain goes away soon for you and I...thanks for the post.

Gas isn't really a hallmark of pouchitis, and when gas stretches the gut it's uncomfortable for anyone.  The first step is to avoid gas-producing foods and behaviors. If you do a web search for "flatulence diet" you'll find many suggestions. If the basics don't work then you might have SIBO (small intestinal bacterial overgrowth), usually treated with several months of antibiotics (e.g. Doxycycline). 

I have to respectfully disagree with Winterberry's characterization of pouch contents as unclean. While people may have different preferences and theories about how often to ideally empty a J-pouch, the intestines need stool to function properly. As far as I know there's no evidence for the idea that extra-frequent emptying is good for you.

An on call doctor at the hospital I had my surgery at called in a script for Flagyl and Cipro last night.  I already feel better after not even 24 hours.  There is major warfare going on in my intestine that I can feel and hear, but it's not the gassiness, uneasiness that I have been feeling.

Thanks for the recommendations. Hopefully, I'll continue to improve and figure out a way to manage without the abx.  It does worry me a bit that I'm on abx this early after the surgery, but at least I'm feeling better for now.

I'm glad you called the doctor. For me, extreme gassiness is always associated with too much bacteria. Either bacterial overgrowth or pouchitis, but with the same result. I would find relief within hours of my first dose of Flagyl. I also got more gas from Metamucil.

I am a little surprised the doc gave you a combination of antibiotics right away. They usually go with Cipro or Flagyl and combine only if not effective.

Jan

I was/am too.  It hasn't been ideal with the doc and PA out of the country and trying to explain to the Resident what is going on and getting good direction.  That just brought up an idea... how dumb would it be for me to stop taking the Cipro and continue with the Flagyl?  Then if/when it happens again, I have Cipro available.  When I had UC, I felt much more confident making decisions like this, because I was more educated and had more experience.  Now I'm brand new with a pouch and don't have near the experience or information I had with UC.

Last edited by jtree

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