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Hello All,

I feel very blessed to be someone that goes 3-4 times a day. However there are some days where I have no urge to go even after breakfast AND lunch. Today for example, I ate a big breakfast and a heavy lunch as well. Not a single urge to go. I went to go pee and was able to get some out, but I couldn’t tell how much because it was liquid and it came out at the same time I peed (sorry for the gross mental pic). The problem is I felt like it was kind of difficult to get it out. Like I had to strain more than normal. I just went again to try to get something out but it was a bit difficult. I can’t tell if I could go because I just simply don’t have to go yet (like my pouch is literally just empty) or if it’s something else.  

I’m currently menustrating, so I’m not sure if that inflammation has anything to do with it. I don’t have any bloating, nausea, or pain when I go to the bathroom. Thoughts? Am I overthinking like always?

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From reading through many posts here, the medical literature and my own experience,  one thing to keep in the back of your mind is that mucosal prolapse can occur at any point, and it can make evacuation difficult.  Tall thin people with less abdominal wall fat are more prone to it.  It's also referred to as "floppy pouch" in some literature.

This is not something caused by straining, but it will actually make evacuation harder if you have mucosal prolapse.  Basically straining pushes mucosal tissue slightly, which "flops" around enough to tighten the anal opening so you can only pass liquid or strain to pass thin bits of formed stool.

If the problem persists it would be something to check out. There's a very simple (from patient's perspective) banding procedure to address it, but few endoscopists perform it.    My condition was suspected based on clinical picture, diagnosed during a pouchoscopy and confirmed with barium defecogram and anorectal mammography.   Banding by Dr. Bo Shen at Columbia improved things for me.  Some folks have to have the banding periodically if the prolapse symptoms recur.  For me, if it's needed, further banding would be done along with my regular screening pouchoscopy.

It's not the worst problem to deal with, but hoping your symptoms pass and you won't have to think about it!

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