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I have a question. My j-pouch surgery was four years ago due ulcerative colitis. I have been taking lomotil since that time. I developed strictures about two years ago and go for dilations about every 6 months. Since that time I only take 1 lomitil and antibiotic in the morning and at night I have to drink prune juice because I find it very difficult to go. I stopped the lomitol I still have difficulty going and gas with pouch pain. could it be that the lomotil was easing my pain some what? I don't know what to do. My surgeon and gastro tells me that I am high risk for surgery. I had many complications during my surgery.Does anyone have any suggestions. Thanks Grace
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Bentyl and levsin are the most common prescription anti-spasmodics. They are taken 45 minutes before meals and at bedtime. They can make you feel a little loopy, but work well when taken as directed. I found donnatal worked well and was a bit milder than the other two, but it was taken off the market.

I had a spasmodic pouch for a year or two after takedown, and these drugs worked well. Eventually I didn't need them.
CT If you don't mind me asking what does a spasmodic pouch feel like? I want to know if my symptoms are the same. I have strictures and have to be dilated about every six months, now it seems sooner. It's very uncomfortable when food passes thru my plumbing bloating and feeling constipated pain from pouch and rectum. I can't explain the pain but I am sure you know what I mean. When that happens I feel sick all over. I drink plenty of water during the day. when ever I start to eat the bloating starts. Thanks to everyone that are giving me answers. I find out more from this site than my doctors. I appreciate every ones input Thanks again Grace
quote:
posted October 23, 2014 09:45 AM Hide Post
CT If you don't mind me asking what does a spasmodic pouch feel like?


For 1-2 years after takedown, whenever I ate a meal, I would be on the toilet 6-7 times in rapid succession right after eating the meal. The pouch would spasm and engage in "excessive peristalsis". Peristalsis can be thrown off after major bowel surgery.

My surgeon immediately identified the issue, and I was given anti-spasmodics which were taken 45 minutes before meals. This treatment completely shut down the problem, although the meds also gave me side effects (light headedness, feeling of being loopy). I dealt with those as they were more tolerable than the spasms.

After 1-2 years, as my surgeon predicted, the problem resolved, on its own, the excessive peristalsis calmed down, and the anti-spsamodics were no longer needed.

More recently, in 2012, after 20 years with the J Pouch, I developed stricture at the J Pouch inlet due to inflammation. This was resolved with a long course of Entocort mixed with antibiotics, and changing of diet to eliminate sugar and carbs. I had SIBO due to the stricture - "fecal stasis", pooling of feces above the J Pouch inlet due to the stricture, will cause SIBO in the ileum. Hence a small pattern of inflammation above the J Pouch inlet which got better with the treatment noted above. I watch my diet carefully and it does make a difference.
CT Thanks so much for all the info. I will talk to my gastro today. I know that sugar and carbs are not good for pouch. I do try to stay away from them. It is very hard for me to gain weight because most foods bother me. I am also careful of what I eat. I do take vitamins to compensate for foods I don't eat. The strictures are making it very difficult for me to go. I also take antibiotic every day. My surgery was 4 years ago and had many complications. I thank you again for any advice that is given to me. Like I said before I learn more from this site than I do from my doctors. Thanks again for the info Grace
Thanks Scott I just went for dilation last month I don't think it really helped. I took myself off of the lomotil for 2 days now and I am feeling pain in pouch and butt which might be from not taking the lomotil. I am going to again try the gluten diet. I will have a light dinner and than take some prune juice tonight and see what happens. I appreciate every ones opinion . I don't really know what else I can try. The doctors don't even know what to tell me. Thanks Grace
Grace-

I am not sure if your issues relate to a spasmodic pouch, especially 4 years out from takedown. It sounds more like issues related to the strictures and meds which may be thickening your stools beyond what is appropriate, if in fact the stricture is not preventing absorption of the meds, as Scott suggested. It also could be SIBO/pouchitis.

However if the spasmodic pouch symptoms I described fit your situation, it definitely should be discussed with your Doctor. I would also ask your Doctor what is available beyond Bentyl and Levsin, and request a mild dosage to start and then work up from there as those drugs can make you loopy/lightheaded. They may have better anti-spasmodics out there now. I have an active prescription for Levsin and only take it at bedtime.

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