Possible blockage with bad sphincter

I’m sorry you’re going through this, Tony. Partial blockages are miserable. It was sounding like a stricture, but the pouchoscopy seems to have ruled that out. Generally blockages clear up on their own. People suggest things like walking and white grape juice to encourage movement. Staying hydrated is key, as is paying attention to signs that you might need hospitalization (vomiting, all output stopping, hydration failing).

Given your long history of difficult emptying, another possibility could be a long-standing pouch prolapse that has gotten worse. It’s a small change from “hard to empty” to “very hard to empty.” If this is what’s going on then it probably won’t clear up on its own, and you’d need a defecography test to get a proper diagnosis. Hopefully you’ll be able to return to your regular GI if anything like that needs to be assessed.

Good luck!

Thanks so much Scott! You are always there to bring a light to someone’s life!

Scott, given my situation - very hard to pass anything - would you suggest that I start on Flagyl - like I said I’ve been on Cipro for 4 days and stools looks okay - but if anything the pain is increasing by the day...so I’m not sure about Cipro efficacy alone...but Given the constipating nature of Flagyl, I’m very scared at the idea that it could actually make things worst...If only I could get a rectal catheter so I could empty the pouch.

I’ve not experienced pouchitis that backs things up, so it’s hard for me to feel confident that pouchitis is a likely cause of your current misery. Maybe others here have had pouchitis resembling a blockage? 

Your wish for a rectal catheter suggests another possibility to me: since you normally use manual abdominal pressure to empty your pouch, and manual abdominal pressure can be intolerably painful during a partial obstruction, maybe you now have a pouch backup in addition to your partial blockage. So why can’t you just buy a rectal catheter and (for now) revert to your old method of pouch emptying?

Thanks Scott! My wife took me to UI Health ED on Thursday evening and I was admitted to the hospital the next morning. A CT scan revealed " acute inflammatory changes to the J-pouch with evidence of perforation and abscess formation anterior to the J-Pouch" the abscess was thought to be only 2-3 cm wide. It was also determined that there was no evidence of a partial blockage. But, when the proverbial flood gate opened yesterday afternoon, I finally was mostly free - still tender at inflammation site - of pain and could sleep at last. Which as you suggested could have meant that there was a backup in the small intestine which was released at last...

Also, yesterday, I had a barium scan.  according to my colorectal surgeon, the scan results didn't show any clear evidence of a leakage of the pouch and he thinks that the 2-3 cm abscess was perhaps part of the pouch instead...In any case, they evidently aren't sure about the diagnostic made so far and therefore, they ordered a flexible sigmoidoscopy and possibly another biopsy of pouch tissues this coming Monday. 

Today I discussed the matter of these contradictory scan results with a Doctor that‘s checking in for my GI and colorectal surgeon this weekend...He mentioned that if indeed there’s no abscess, the inflammation and pain could be related to the pouch folding in a way that narrows the passage of BM. How I understand it is that it would in turn create a backup and accumulation of bad bacterias and then cause inflammation, and so the extreme pain when I push on my stomach. To be clear, I felt such pain in the past but it would clear out in a matter of 24-72 hours and a decent amount of BM could be cleared meanwhile. This time, little or no stool passes and it might trigger the vicious circle described above. The one thing that everyone, resident and lead doctors alike, are agreeing upon, is that the inflammation and the abscess, if indeed there's one, won't be easy to treat.

I was placed on a heavy those of Cipro/Flagyl and a 3rd antibiotic while being kept on IV fluids. I started eating solid today at noon and had 2-3 liquid BM shortly after but haven’t had any for the last 7 hours and the pain is growing again... I tried to pass a BM a little after diner tonight but except for gases, nothing is coming out and the pain is ever increasing when I push on my belly. You’d think the strong course of antibiotics I took so far would have knocked off a lot of the pain caused by inflammation in the past 48 hours but instead it seems that its done very little...I’ll go back to a fluid only diet and aim at passing the accumulated food from today before the sigmoidoscopy Monday.

Despite the pain growing back, I’m grateful that I could test the solid food diet today while I’m still being hospitalized...So I’m cheering up for that...And yet again, I know that a catheter would clear me up in a minute, even if it’s not a long term fix. Just want the catheter as a temporary relief as I write this...BTW, what is the size you’d recommend? 30 FR? And what material rubber or soft silicone?

P.S. Colorectal surgeon at UI Health also talked about the possibility of pouch a revision if pouchitis and abscess were to continue to be an issue...Also, a discussion about wether the UC diagnosis could have been Crohn’s - being active only in the large intestine - instead, took place.

Tony, I’m glad you got some relief, even if it’s only temporary. I don’t think you need anything more than distended bowel to explain all the pain you can imagine. If you aren’t pooping then your bowel will distend. If you have an abscess then that’s a real issue to deal with, and they can hurt like hell, too, but I don’t hear anything in your description to suggest bad bacteria or even inflammation as important factors here. Pouch folding could operate roughly like a prolapse, and probably could be diagnosed with a defecography (if it only occurs when you’re trying to poop). In the meantime a pouchoscopy is probably a good idea.

I don’t know what size catheter, but there are plenty of detailed posts here by folks who empty their pouches that way. Just use the forum’s search function, search for “catheter,” and see what comes up.