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Hi, I had my take down about 7 years ago now and straight after I was really good with my diet (high in soluble fibre, not drinking during meals, no coffee etc). Fast forward to today and I've let my diet slip... and I've forgotten what a good day looks like.

Is it normal to be passing watery stools at this stage? And what are people doing to get a firmer stool? I've just started taking immodium again but it slows things down rather than thickening things up. I've also stopped drinking coffee.

Currently I'm passing 6-8 BMs a day which is having a knock on effect on my bladder, it looks like going so often (and straining to get everything out) may have resulted in Overactive Bladder.

All advice/information is greatly welcomed. I've never met anyone with a j-pouch and don't really know what I should be doing and/or aiming for.

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I’d echo what dlewicki wrote. If you want to add bulk to the stool ( I agree that watery stool is unpleasant), then psyllium fiber (like Metamucil or Konsyl) is often the best way to do that. I use a bowel slower (Lomotil, like Imodium) when I actually want to slow things down (e.g. at bedtime or before getting on a boat).

Straining can do you some real harm, so it’s best to avoid it if at all possible.

The word “diarrhea” means so many different things to different people that I find it just confuses things. As long as I’m not having urgency or excessive  frequency I only pay a little attention to stool consistency, but the ideal consistency for most J-pouchers is something like pudding or applesauce.

Thank you @dlewicki and @Scott F, I have picked up some Metamucil. I'm try it before breakfast only at first to see how I tolerate it then add it to before dinner 😊 These tips are really useful.

@Scott F good point about the term 'diarrhea'. When I wrote the post I was initially thinking of texture only vs. urgency or frequency. I'm OK with urgency but think I'd like to get the frequency down a wee bit to help with the Overactive Bladder.

@CTBarrister I hadn't actually even thought about pouchitis. At the moment I'm fluctuating between loose and watery. I'll monitor to see if watery is the norm. If it was pouchitis would you generally contact your GP?

My pouchitis issues were all treated by my gastroenterologist. But consistent watery stools was a sign of pouchitis as was increased urgency, increased frequency of stools, incomplete evacuation or the sensation of same, nighttime incontinence and spotting. Your posts hint at a couple of possible symptoms. These would be treatable with antibiotics which would also thicken up the stool. But in my case consistent watery stools, as opposed to loose stools, almost always meant Mr. Pouchitis was paying a visit.

Last edited by CTBarrister

I don’t know if a New Zealand GP would be familiar with pouchitis. In the US only a fraction of gastroenterologists seem to know much about it.

Lowering frequency may be as simple as gradually, gently delaying bathroom trips (if you can). If you don’t have pouchitis you might be able to train your pouch to comfortably hold more stool. I’d also suggest trying to uncouple peeing and pooping. This takes practice and may never get perfect, but I find it helps with fine muscle control, makes it easier to ensure that I’m well hydrated, and helps me lower my pouch emptying frequency (sometimes after I pee my pouch doesn’t feel so full any more).

It sounds like I've been missing a trick by not taking Metamucil. I've started taking it over the last few days and the difference in output is crazy. @dlewicki it is similar to pre-pouch days!

@Scott F I love your idea of uncoupling peeing & pooing so I'm also going to try that! And good point about doctors probably not knowing. I think now might be a good time to touch base with the Familial Gastrointestinal Cancer Service group here.

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