hello everyone

had my pouch for 11 years with minimal problems - a few fissures and IPS.

for the past month ive been getting blood when i empty the pouch maybe 1-2 times a week, it's probably more bright than dark red and sometimes an inbewtween medium colour.

i have no other symptoms whatsoever, no urgency or pain before going, in fact my pouch is functioning great and i generally feel well in myself. 

The amount of blood can vary from a bit in the stool and toilet paper and then to the toilet water turning red which is what i had this morning (it does seem to be worse in the mornings when the pouch is at its emptiest)

the strange thing is that the very next BM's i have after having the blood are completely fine no blood to be seen, for example this morning i had the blood and when i go to the toilet again when i get home from work the chances are there will be no blood, and the same for the next several BM's

The only thing that i changed in my routine that i can link it to is that i take Amitriptyline for IPS pains, and about a month ago i gave Nortriptyline a try to see if it was less sedating, it was but unfortunately it wasn't anywhere near as good as the Ami for the pain so switched back after a month, the blood started when i started the Nortriptyline so i dont know if this could have caised any irritation?

i should point out that i randomly became anemic last year but my surgeon couldnt find any source of bleeding after scopes and a CT scan so put it down to absorbtion issues stating that it can sometimes happen to us pouchies. I'm wondering if the bleeding now has got anything to do with that?

Yesterday i  regrettably cancelled an appointment i had made last week with my surgeon as over the weekend and Monday / Tuesday there was no blood so i thought it was disappearing, only to have the blood again this morning so i have re booked it for next week.

Naturally im worrying myself over this and what it could possibly be, i have read about cuffitis and pouchitis but dont display any of the additonal symptoms associated with them, so i'm wondering if it might be internal piles? Or an ulcer? Or would and ulcer give me other symptoms like urgency?

i'm hoping to get some insight into what it might be to tide me over until my appointment with my surgeon next week, in my 11 years of having the pouch i would get a bit of blood once every 4-5 months which my surgeon said is normal and that it can get irritated quite easily with certain foods. But no it's happening every week i know i should be trying to get to the route of it.

Thank you

Original Post

It certainly could be internal piles (hemorrhoids), and that seems more likely to me than an ulcer in your pouch. The anemia is probably just caused by the bleeding, so there's no need to blame absorption issues. Do you tend to strain on the toilet? That can cause (and worsen) hemorrhoids.

Hi Scott, thanks for the reply

The anemia was found last year from a blood test due to stomach pains that have since been diagnosed as IPS, as all other avenues had been dismissed due to pouchoscopy which came back clear, CT scan clear, and there visually being no blood present in any BM. Started on Amitriptyline in October 2016 and has since worked well for the stomach pains.

So essentially the blood is a new thing (it may have been bleeding a year ago but it wasn't seen by me or the surgeon).

I guess I do strain at times but no more than in the last 11 years, I can't really find a pattern with it other than it's more likely to bleed in the morning when the pouch is emptyish, but again it's not always in the morning.

I'm a hypochondriac and have generalised anxiety which I think brought on the IPS symptoms, so I'm obviously worried about this bleeding, but given the fact I feel fine and have zero urgency or other noticeable symptoms, and the fact that the next BM that day usually has no blood - I'm wondering if it is something on the less serious side?

Is there any part of the pouch anatomy that can get irritated easily but not inflamed or infected?

Regards

Well i had a BM after work and it was quite formed with zero blood! 

It's relieving but frustrating at the same time, you might be right with your suggestions of a doc and gastroenterologist Scott i'll look into it.

I'm wondering if it might be an energy flapjack i have every night as a snack, it's got alot of oats in and you can feel them not being the easiest food to digest whilst chewing them...

Thanks again for the advice!

Hi Debra

yes i have exercised for many years so it would be classed out of the ordinary for that to suddenly be a factor.

I didn't have any blood since Tuesday and have just had a BM now with the blood mixed in with the stool creating a very brown / red colour but definitely on the red side.

I stopped having the oat energy bar sonce Tuesday so naturally was thinking that was the culprit until now..

Got the appointment with the Surgeon this Tuesday.

Thanks

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