nightime incontinence WHY???

Manny-
What are you currently doing to address it (if anything)? Is the stool liquid or thicker than that? People will suggest all kinds of things - kegels, timing of meals, Metamucil, an all-cabbage diet - but it would help to know where you're starting from.

Just kidding about the all-cabbage diet.

Manny -- is this leakage or like a full BM in the bed?

I am having the same issue - small watery BM leakage 4 months post TD.

I did not have this issue 1st-3rd month post TD.

I am trying various dosages / times that I take my 1 lomotil at night and immodium. So far, not much has been long-term successful.

I don't understand why I wake up almost immediately (I guess) after the leakage, but I never wake up with an feeling of urgency prior to my accident.

To try and avoid the nightime "surprise" I do not eat anything after 4-5pm, I take two Imodiums before bed, I do my kegel exercises every day, I have to sleep with a piece of tp tucked inside my bottom to avoid making a mess. I would say more often then not my stools are liquid.. The nightime accidents are not full blown BM but instead little leaks (it almost reminds me of the mucus discharge I had when I was with my ileostomy) I know one big contributer is that I love chocolate and Suger especially late at night (it seems my sweet tooth kicks in more at night) however, I have cut out chocolate and minimized my Suger intake as of late but still have the nightime troubles... Is this normal even after 3 weeks post takedown?

Try not to panic. In my three years reading things on this forum this is one I have read many times from people who are new from takedown. It usually resolves itself in time. Hopefully sooner than later for you. I had some minor leakage for a few weeks at night then it just stopped.

Manny I have some small leakage too, I am three weeks out... I do believe it is normal post takedown. In my experience it is from passing gas in your sleep, it's impossible to pass only gas if your stools are totally liquid. As we get further out from the surgery the stools will thicken and the issue should subside.

I think you might be exacerbating the issue by not eating anything in the evening, I know if I skip a meal my output gets thinner and harder to hold. I try to eat "safe" thickening foods for dinner like rice, yogurt, oatmeal, pasta and use lunch to experiment with new foods.

A few other things to consider/try:
1) Metamucil, to thicken things up
2) A small high-fat snack in the evening (e.g. peanut butter)
3) A high-dose probiotic, like VSL #3 DS
4) Gas reduction methods, since this sounds like a shart rather than full-blown incontinence (simethicone, no carbonated beverages, reduce swallowed air, dietary tinkering)
5) Possible pouchitis (that's what turned out to cause my leakage, now well controlled with Cipro. Others use low carb diet to keep this at bay.)

These won't all be appropriate for you, in all likelihood. Try not to change too many things at once, so you have some chance of figuring out cause and effect. Some of these take a while to work.
--Scott

Do kegels. Night time incontinence is the best type to have because it usually means that your sphincter is relaxed. You need to build muscle tone in the sphincter and doing kegels will help to strengthen it.

Sue

First, I would take more Imodium. You can gradually increase your dose to up to 8 a day. It is safe to take a lot more, but studies show no real advantage to higher doses than 8 a day. I don't know about you, but having a very long fast just made my gut churn and fuss all night, so with holding food in the evening made things worse instead of better. The only thing that did make a difference was eating things like pizza late at night. So, you might try a small meal close to bedtime that is not sweet, spicy, or greasy. Something like toast or a banana, something like that. Some people swear by something a bit fatty, like cheese or peanut butter to slow the gut.

The good news is that this is a common early complication that resolves as the pouch matures. Remember, there is a learning curve for those "unused" muscles that are now being irritated. Also, Imodium is a good choice because it increases rectal sphincter tone.

And, like Scott says, one thing at a time, so you can tell what works and what doesn't.

Jan

I am 3 months post takedown and have struggled with this most of the time. My days have gotten better but I have this problem 6 out of 7 nights a week. I cover the full range of small loose accidents to full thicker bms. I am taking 2 lomotil 3 times a day. Fiber pills twice a day and metamucil I'm the morning. I used to do metamucil twice a day but cut back to try and help the gas I was having at night. The gas has gotten better but not the leakage. I am back to metaMucil at Dinner to so I can see if that helps more that more time has gone by.

So for me I hope this is normal and well resolve itself.

Mike

If Metamucil gives you gas, you can try Citrucel. It does not have psyllium. Sme people (me included) are sensitive to psyllium and it causes excess gas.

Jan

Jan if you don't mind me asking... How long have you had your Jpouch? You seem extremely knowledgeable, thanks for the great tips

18 years this month.

Jan

oh wow, that's great Jan... I'm on forums all the time about j pouches and get terrified because of all the complications i see people reporting.. I had a horrible time with my temp ileostomy.. I just hope my pouch last a long time, at least till i get married and have kids of my own

Manny, there's no reason your pouch shouldn't give you a lifetime of good service. Folks (appropriately) tend to come to support forums when they have a problem.