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I've been dealing with an enlarged prostate diagnosed as BPH or prostatitis. Associated with this has been the total inability to pass urine and thus the need to have a Foley Catheter inserted. Not fun.

With the prostate, bladder and pouch being in such close proximity and with one of the common side effect of prostatitis being constipation, there is confusion and difficult about how to approach the management of the pouch output. It's not obvious to us when things are moving along normally but the downward pressure we apply to pass stool is also pressurizing the general location that we want to gently relax in order pass urine, so bearing down has a relationship to urinating. The functioning and the frequency of the pouch just gets turned upside down and backwards due to the constipating nature of prostatitis. Add to that the antibiotics and anti-inflammatory drugs both of which tend to firm things up and you have a trifecta of constipating culprits. So proper management of the output of the pouch becomes a nightmare, a crap shoot if you'll excuse the expression! 

For over a week I had to take Miralax, a wonderful softener, which contrasted with my normal diet of 6 Lomotil and 2 Imodium daily, all of which I had to completely discontinue. Of course when they insert a catheter they want you on a few days of Cipro which works it's magic once again on the pouch and all your calculations have to be reworked over and over and over to prevent the stools from being so hard that you have to bear down too much which then puts pressure on the bladder and prostate and god knows what else.

In any case I kind of got it down after almost 3 weeks but the pouch activity is still 3 times what it was prior to this mess. Everything downstairs has become hypersensitive and I've gone through cases of moist flushable wipes and several tubes of 2.5 percent Lidocaine trying to tamp down the constant sense of urgency from both places. I've totally discontinued all 6 Lomotil and the 2 Imodium in favor of one smallish teaspoon of Miralax once or twice a day. I'm told everyone's reaction is different and there are no instructions on how much or how little Miralax to have. For me it's odorless, tasteless, and easy.

Sleep or lack of it becomes am enormous secondary problem. I cannot overstate how seriously this accompanying symptom effects your life. I was unable to sleep for more than 2 hours in a row or 5 total hours a day for weeks. Even trying some semi-powerful cocktails did not help as one or the other or both evacuation organs overwhelmed the drugs.

I'm honestly not complaining, well maybe a little, but simply providing details. It is unfathomable that there is little or no information on the Internet about this the combo of prostatitis with a j-pouch so I'm posting hoping that someone else out there has some experience to share or that this may help someone in the future.

About 5 weeks in to this I've learned more and things are better. Self-catheterization as needed isn't that difficult, for men as the entrance way is easy to see. It's not fun but it does not hurt at all with the lubricant provided (KY Jelly is similar) and it's a complete game changer when it comes to getting your life back, getting sleep, being able to go out to a movie or dinner, or being able to get on a plane. My urologist, is probably in his 60's and has taught men to do the catheterization hundreds if not thousands of times without one patient failing to learn. I will may well need rotor rooter surgery (TURP) sometime soon but with the J-Pouch I have to be very careful about who I will allow go up and in and router away.



I've mentioned this before but the dramatic change in the function of the pouch is as challenging as any part of dealing with BPH. I assume because of the proximity of the pouch to the prostate and bladder that it complicates the pressures on the urethra. I know if I pee, then I have a little poo, and pass a little gas, that I can then pass more urine. I often repeat this ritual 3 times, anything to relieve the bladder pressure without using the catheter.

It is worth saying again that managing the output consistency, balancing the different meds that tend to bind you up is critical. I firmly believe you want to avoid having any stools so hard that they require bearing down to pass. Bearing down seems to inflame things and put into tension, the whole package, pouch, bladder, prostate, anus. Finding the perfect balance keeps the pouch producing that “easy to pass, without effort, perfectly thick, pancake batter, consistency” makes everything else so much easier and allows the entire area to calm down, to relax.

I'm no expert but there don't seem to be many experts anywhere when it comes to this. My thought is that the pouch when full, or when not as empty as possible, the pouch puts a little additional pressure on the bladder, prostate and the urethra. This might also explain why the mornings are the time when a catheter is the only way to empty the bladder. Everything's full, everything is pressurized, and the connections are all short circuited.

I've always been one of those guys who can pee at will, not waiting for some mental connection to release whatever valve needs to open. I used to feel so superior to those young teenage friends who seemed to take forever to release but no longer,. They could probably wiggle their ears at will which I could never do but alas now I am them, a member of a club I never wanted to join. On the other side of the coin is of course relaxing too much, the lines get crossed or confused when trying to pass urine normally and dropping your payload from both bomb bay doors. It's a Delicate Balance! But I digress.

I am finding that I can urinate normally but with a very weak stream after passing stool. The holy grail is to pass urine, then poo, after which it's possible to urinate some more. If you're lucky enough to then pass gas head directly back to the John and try for that last bit of relief. It silly complicated but it feels like a home run.

My point for the last bit is that I find that the less that's in the pouch the less stool in my gut, the less gas in my gut, the more easily I can pass urine without need of a catheter. My understanding is that our plumbing, small intestine, now averages a little over an inch in diameter as opposed to the 4 inch diameter we had when our colons were doing the job. I think that the stools, the gas, the liquids, all queue up, single file, waiting for a chance to escape. With harder stools, the gas can't find it's way past easily, with the pancake batter it can. The holy grail is a poo, followed by a pee, followed by a huge, wonderful, easy explosion of gas. Ah yes, gas leaving is such a blessing, and then and only then, can a guy like me with a pouch and BPH have a shot at a split pee semi-normal urination.

I'm planning a vacation soon and fully expect a relatively normal time. I'll use the catheter if needed because I can now dribble fairly well on my own at times. Yeah for Baby Steps! I actually used a catheter in a moving, shaking, rattling bus bathroom, so, "if I can make it there I can make it any where ............... NY, NY."


My two week vacation in paradise has ended and I needed to use the catheter only once. It's not Niagara Falls, it's low pressure but once in a while I don't even have “split pea” pee. The one thing I am becoming more convinced of is that there is a connection between how empty the pouch is and my ability to pass urine. The first 10 times I thought it might be coincidence but at this point it's clear that for some reason the emptier the pouch the more easily I can pee. This speaks to my earlier observations about the prostate, bladder, urethra and pouch all being located in such close proximity that small changes in pressure can free up pressure on the prostate, allowing the bladder to expand, freeing up pressure on the urethra etc. Whatever it is I'm going to demand an explanation before considering surgery.

I know I've been repeating myself in spots, maybe lots of spots, but maybe that's because the repeats are important to understanding the issue. I'll edit this again sometime.

I'll continue this pseudo blog for as long as I can in hopes that it will help someone else down the line.
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