Hello 

I’m now 6 months post surgery, and things are generally good alright, compared to having active uc this is much better.

Normally i have about 8-12 bowel movements in a day, depending on What i eat.

However sometimes i feel it’s hard for me to fully empty my pouch, i have to squeeze very hard, and it comes out like a small explosion, if that makes sense.

Then i start to feel pressure down there shortly, and i have to go again 15-30 minutes later, probably because i didn’t fully empty in the first place.

What can i do to make this better? 

Original Post

You’re likely to continue to get to know your new plumbing better as time passes, as long as you’re paying attention. I’ll make the observation that you’re squeezing hard to fully empty, but it’s often not actually accomplishing that, since you have to go again in 15-30 minutes. Since it is harmful to you to squeeze very hard I’d suggest experimenting with not doing that. The key skill, I think, is fully relaxing the outlet while squeezing moderately. Many of us sometimes need a second bathroom trip, since gravity is an important part of pouch filling/emptying. Try to be patient on the toilet, if you can, and experiment with delaying bathroom trips (“stretching the pouch”) to reduce the frequency. Good luck!

I suffer from this from time to time as well..

My wife just got me a squatty potty for Christmas so I've only used it for 2 weeks but it does seem to help me feel more "empty". Another great tip is once I go, I stand up for about 10 seconds, sometimes put some light pressure on my lower abdomen with my hand, and then sit back down. It usually results a little bit more coming out. 

I also started talking Visbiome probiotics and I've noticed a huge decrease in the gas I have daily. Unfortunately they are expensive but they help. They are designed specifically for IBS/J-Pouch. If you go down this route, just a heads up you might have some increased gas for a few days while your gut re-balances. 3 packets of the regular strength packets seems to be my magic number.

You can also experiment with using a fiber supplement such as Metamucil. It will help bulk the stool up and things tend to come out much smoother. 

As you mentioned, diet is probably the biggest key of all. It will take some time and will power but it plays a huge role. I was stubborn and it took me years to finally accept that certain foods just aren't worth it anymore. Sugar, diary and heavier beer trigger that "explosive" feeling you are talking about for me. I'm feeling pretty good I cheat and have a couple light beers from time to time. 

You'll come to find out that every J-Pouch is different and it takes some personal experimenting to find out what works best for you. 

How long are you actually sitting having a bowel movement? I know sometimes I can be done in a couple minutes other times I sit for 20 minutes or longer to feel like I'm empty. I still get the occasional urge to go again shortly after, but I can usually wait and the urge goes away.

Good luck.

I hope this suggestion helps as it helped me a lot . I am seeing a 'Bowel specialist' at Marks hospital, in London.  This recommendation came from them and they told me to sit on the toilet and to have a small foot-stool and to put your feet onto it and after a while i will feel that sensation to extract.

Because it isn't always convenient to have a foot stool, I came up with an idea and that is to - Sit on the toilet and bring your legs up as close to the toilet as possible and then raise them onto tippee toes as if you were squatting. Then i when get this feeling i lean forward slightly and rest my arms on my raised legs. This is putting you into a 'squat' position.  This will work the same way and you will be surprised how much this helps. Be patient though and don't force it - as it will happen - so to speak.

Good luck x

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