Hello everyone,

Just had a quick question for those of you that have had a total colectomy. Have any of you had a proctoscopy performed after a total colectomy? My GI doctor is wanting to "take a look" because he thinks I may have pouchitis even though I'm having only around 4 bowel movements per day. However, my stools are fairly loose at times so this may be why he thinks it is necessary. His nurse also recommended that I use an enema the night before the proctoscope exam which my surgeon originally told me NOT to ever do again after the surgery. I have been feeling progressively better over the past year and so I'm really concerned that something will irritate the pouch (such as the bowel prep or the procedure itself). If anyone has had a proctoscopy after total colectomy I would appreciate you sharing your experience and what kind of prep you did just so I can see if this is pretty typical. I plan on talking to my surgeon about this regardless of your answers but any feedback would help to lead me in the right direction. Thanks!

 

- Brad

Total Colectomy, November 2012 due to Ulcerative Colitis

Original Post

J-pouchers generally have "pouchoscopy" rather than proctoscopy. Pouchoscopy is usually performed with a flexible sigmoidoscope rather than a proctoscope, but that may be what he plans to do. It can be very reasonable to "take a look," particularly if he will take a couple of biopsies of the rectal cuff (the tiny remaining part of the colon that can still develop cancer). If your colectomy was done for cancer or dysplasia (or FAP) such screening is very important. To be honest, I delayed pouchoscopy for years until I had symptoms worth addressing. Some folks have them annually, and some are comfortable with three years or longer between.

 

Loose stools are completely normal for a J-poucher, though ideally they're more like pudding than water. If you want more formed stools then soluble fiber (e.g. Metamucil or Citrucel) is a better idea than antibiotics (IMO).

 

The prep should be very basic - an enema or two prior to the scope. 

 

It is routine to check a pouch (pouchoscopy) annually with biopsies if dysplasia were found in your colectomy pathology report or you had surgery due to this.

 

Four stools a day does not sound like pouchitis to me, especially if you are not experiencing other symptoms (cramps often in waves, urgency, increased frequency, anal burning, night time leakage, sweats, fatigue). You usually know when you have pouchitis, but people can have some inflammation (very common in pouches) and be asymptomatic. My GI says she often has to drag her patients who are feeling well in for an annual scope.

 

If you feel this should be done as a routine check to also biopsy the remaining cuff (which is a very good idea), then I would agree to it. I have had more pouchoscopies than I can count and I do sometimes have issues for a few days after the biopsies are taken, but I also have a dilation done at the scope time due to a re-curing stricture at my anastomosis, so this could be one reason I have some struggles (if you read my prior posts, I have had many complications with my pouch). You should be fine if you opt to have the procedure done.

 

 .  

I agree, periodic scoping is routine, so don't worry about that. However, an enema the night before will do absolutely nothing as a prep. Like spitting in the ocean. Even a few hours before is worthless. My doc just has me do tap water enemas until clear before I leave the house. Not sure why your surgeon told you to never have an enema again. Seems rather extreme to me.

 

Jan

My surgeon and GI basically make me NPO (nothing to eat or drink) at midnight.  However, I, to be "safe" for good, clear photos take a half dose of MOM at night (15mls), and then before the test do one or two tap water enemas (I empty a Fleets and fill with warm water from the tap).  That seems to be plenty, and I've always had no issues with doing things this way. 

 

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