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Got my j-pouch in Mar 2009 because of UC. Immediately rx 10 lomotil/day and Metamucil by surgeon. Since then I have had 3 GIs and all did scopes. Also, all GIs gave me Lomotil the max of ten per day. Even still I have watery diarrhea or unformed stools. Sometimes I do have a formed stool.
I am 68 yo, live by myself now, and I'm tired of going off mtn to see my GI so I have decided to be followed by my family GP. She agreed but will not rx the lomotil as she thinks it could indicate another problem and said it is not good for me. At first, I was offended but now I have decided to agree with reduction of lomotil to six per day.
I have reviewed notes on this website about lomotil, and learned that i am probably the only person in USA to get the max amt. In fact some people get constipated on just one lomotil! So I'm thinking: why can't i have normal stools?? Is this controlled drug bad for me? Should I go to a 4th GI and demand answers about my stools.
Notes: I have anal fissures which have not yet been treated because my last GI left town. I have leakage during sleep about once/wk but not during day. Surgeon told me right after surgery that my rectum was short, but I did not ask him what this meant so I wonder if he had enough rectum as connective tissue. I was afraid to ask him and now i wonder if this could be cause of my unformed/liquid stools.
Also, I feel fine for old lady and all my scopes have been normal except for the fissures which burn.
Thanks
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Not sure if a short rectum is meaningful in any way. I wonder if your surgeon was just trying to tell you that he left a small amount of rectal cuff in to attach the pouch to. That is the typical setup, so nothing to be concerned with anyway.

Older patients may have a less than optimal chance of great function, but generally do well enough. I have had my j-pouch since 1995 and I am 58 now. I have never had formed stools. They are always loose, and much of the time they are watery. As long as I do not have urgency or incontinence, I do not worry about it, and neither should you.

The main thing is that if you feel well, you should assume that you are well. Is 10 lomotil a day good or bad for you? I don't know for sure, since it depends on your medical history. It is not typical to stay on this dose long term and ordinarily they prescribe loperamide (Imodium), up to 8 a day as needed. They are very similar in how they work, but lomotil is a controlled substance and loperamide is not. But, lomotil is not dangerous for the most part. If you are suffering from a very dry mouth and palpitations, it could be from the atropine that is contained in it, and it would be a good idea to reduce it and/or replace it with loperamide.

Reduce your lomotil gradually, since you have been on it a long time. Or, for every lomotil your drop, you can replace it with a loperamide. I have been on loperamide since my surgery in 1995, but have reduced the dose from the maximum 8 to my current 2. I could not do that until about 4-5 years post op.

For the fissures, your GP could prescribe the creams they use for it, since you already have been diagnosed. Nitroglycerine is one, but has been mostly replaced by nifedipine. Both do the same thing, increasing the blood flow to the area, but nifedipine causes less of a headache. I would think that if your fissures healed, you probably would need less in the way of bowel slowers.

Good luck!

Jan Smiler
If I take too many Loperamide my stools are better formed but are harder to pass. I take it to reduce the number of BM's only. I would say as long as you are not going to the restroom too many times a day you shouldn't worry about how solid your stool is. As Jan said, we no longer have our rectums but just a few centimeters that were left to attach our j-pouches to them so I don't understand what your doctor was referring to. Take care Smiler

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