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im wonder if doctor shens diagnosis of paradoxical sphincter contraction is accurate. it would seem that it would be consistent regardless of stool consistently but it isnt. i will strain if its not pure liquid but empty easily when it is. if the sphincter tightens when it should relax it would make sense that it be consistent. it seems like more of a stricture issue. any thoughts?
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Sure, just like UC, inflammation comes and goes, and also comes in degrees. You can have chronic inflammation without significant symptoms (bleeding, diarrhea, etc.). But, it could be inflamed enough to irritate your sphincters. You may be one of those who need maintenance treatment. Have you discussed this with your doctor. Seems easier than doing other extraordinary things.

Jan Smiler
No two people reading this will have the same exact mental model of how to diagnose cuffitis by touch. If I were lucky enough to be examined by Shen and had no obvious cuffitis symptoms, I'd start by assuming he was probably correct, and try his recommended course. If it failed I might go back and ask him why I was feeling bumpiness.
The suture line could be bumpy, particularly if you have staples. The cuff would be between the suture line and the anal canal. I certainly would trust what Dr. Shen tells you, as he definitely is the expert on all things j-pouch. You could easily be mistaking one thing for another, as I am sure that your finger has not been up as many butts as Dr. Shen's (or any GI for that matter).

Pelvic floor dysfunction is no picnic, and topical cuffitis treatment would not likely help in any substantial way.

Jan Smiler

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