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I have a 40 year old J-Pouch for UC and ultimately colon and rectal cancer. For many many years I have been told on occasion by my doctor I have a stricture which some doctors assumed was impeding my ability to empty completely, Sometimes Laying on my stomach  would help me expel some  gas and then perhaps more emptying would be facilitated.  This pattern of feeling of urgency but unable to empty completely has existed most the lifetime of my pouch but when I would take courses of cipro or endocort I would improve significantly to the extent that I have been able to  live pretty much a relatively normal life. To me, I felt like I was having pouchitis flares because it was so responsive to these medications, though strictures and inflammation have been noted on pouchoscopies.  Last year's scoping noted stricture and my GI said she dialated me somewhat at that time. However, I still had the issue whenever off meds and lately I have been having significantly more leakage of stool. Colon Rectal surgeon's office exam by anal scope again indicated a stricture which Doc said would best be dilated under anesthesia. He said he felt the stricture was causing the leakage because he could see stool above/beyond  the stricture .  Apparently only a little stool at a time could empty past the stricture, thus my symptoms. But this doesn't explain why I would improve with the meds. Also, to me, it doesnt make sense that my very watery stools would not be able to get through the stricture.  I am now scheduled  for my next annual scope and am concerned that by my GI doc dilating me, I will leak even more rectally because I got "stretched out ".  Recently I am taking more levsin and have added cholestyramine once daily to my regimen and am taking cipro again. i do feel significantly better and dont have to go to the bathroom as often, and am more comfortable but I am still leaking more than I used to. Questions: What is causing the extra leakage?  Will dilation only cause more seepage? What  other advice is there for controlling the seepage? Thank you in advance for any info or thoughts.




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Hattie, have you asked your doctor why antibiotics are making things better for you? It’s an important question, ideally to help get your doctor on the same page as you. One possibility is that the antibiotics tend to thicken the stool, which would be less prone to leakage. Did you get any improvement last time your stricture was dilated? 

Scott F, Thanks for your reply. No, I have not asked my Dr. why antibiotics make things better for me, but I will when I see her for my pouchoscopy  next month. I assumed it was because I attributed my symptoms to pouchitis and the antibiotics are often used for this.  I did not notice any changes after the dilation I had last year, but that maybe because my Doc seemed to imply it wasn't a "major" dilation.  Is there a possibility that a stronger dilation would cause me to have more leakage rather than less?

Scott F,  I was reading an earlier post of yours about dilation in which you mentioned that treatment for stricture depends on its location.  My pouchoscopy report states, "....a relative narrowing at the pouch inlet with inflammation, I can pass it but there is a pop through. I used an EGD scope to do a proper turnaround".  What does this imply as far as treatment of the stricture?


Dilation of a pouch inlet stricture shouldn’t have any effect on leakage. Heck, I don’t think your leakage has anything to do with that stricture, either, but it could give you trouble if something gets trapped behind it or it narrows further. A dilation (generally with a balloon) is probably worth doing. At the same time, the problem you care most about - the leakage - needs to get proper attention, and not treated as less important than the stricture. It sounds like pouchitis, either incompletely treated or, unfortunately, antibiotic-dependent, is causing your leakage. There’s a possibility that in addition to causing the leakage pouchitis is what caused your stricture in the first place. I don’t remember how many courses of antibiotics I went through before I admitted to myself that I had to stay on them continuously, but my life has been much better since I got effective pouchitis treatment.

Here’s a link to an article about pouch strictures. Even if the text seems impenetrable the diagrams may be helpful in visualizing what’s going on:

In your situation I might suggest to my doctor that I wanted to get the pouchitis under solid control before tackling the stricture. Alternately they can be addressed at the same time. Good luck!

Last edited by Scott F

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