Self Dilation

What was it that was being dilated? Did you have a stricture? If so, where? If the stricture is at the J Pouch inlet I don't know how you would be self dilating it. It's not reachable manually. I think you need to clarify what is under discussion here. Do you have a stricture at the J pouch outlet?

Sorry...the anastomoses...the pouch attachment to the rectum...it can be digitally examined and dilated.

Hi Big DH! WOW! That's all I can say!  How did you figure that out?  How did you reach that far up?  I was told my rectum to my connection point is about 6 inches!  How did you do that? Are you worried about causing an infection?  Didn't it hurt??  You are AMAZING!!!

Do you have a J-Pouch? You're mistaken if you think it can't be reached digitally...an earlier surgeon performed a dilation on me digitally in the clinic...and I did not say that I have done it.

You are saying a stricture at the J Pouch inlet can be reached digitally? I would think you would need some awfully long fingers to be able to pull off that trick. Most J Pouches are at least 6 inches long so that would mean 6" plus fingers to get at the inlet.......average male finger length is 3.72 inches.

Not sure what to say more...yes, the anastomoses (connection between the end of the small intestines and the rectum) can be reached digitally.

My post is about self-dilation...any input on that?

Since my stricture is at the J Pouch inlet, I don't. But it's been dilated by balloon from a semi blockage to 7mm to 11mm to 15mm. You seem to be talking about J pouch outlet strictures, which aren't as common as inlet strictures in long term pouches from what I have read here (due to backsplash stool).

Sure Big DH is talking about the anastomosis suture between pouch outlet and anus. (The term rectum is misleading.)

I heard that self dilation can be done by a kind of conus, but you should ask a specialist about it. I live abroad, so I cannot give advice about a doctor.

Steve, if that's the area I am sure a self dilation can be done, but the concern is what is causing the stricture and the need to dilate in the first place, which this thread has kind of skipped over. Dilation is not correcting the cause of the stricture. Strictures are usually caused by inflammation, and if Big DH has inflammation in the rectal cuff, that is a great concern and you WANT it scoped and biopsied every year, because it is the area where a cancer will start. Rectal cuff is colonic tissue. It is not ileal tissue. In the rare cases of pouch cancers that's where they start. So treatment is needed and you want scopes and biopsies there done on a regular basis if the cuff is inflamed (no less than annually). My rectal cuff isn't inflamed but because of inflammation at my inlet, the cuff gets biopsied annually as well as the inlet.

My treatment regimen changed after my stricture. Entocort was added to Remicade. If a stricture has developed one year after J Pouch surgery I think something needs to change treatment wise.

To CTBarrister,

Narrowing of the opening between the J-Pouch and rectum (the term for that area) is COMMON in many patients. I have been dilated 3 times since my procedure last year...why? Because it began to narrow! Nothing that needed to be biopsied, nothing that needed to be surgically removed, nothing that needed further testing! It's a surgically created opening that can narrow and often does!

Please, with all due respect, reply to this post only if you have something constructive to contribute on the subject of self-dilation and/or know of J-Pouch doctors in the Southern California area who instruct patients in self-dilation...thank you!

Hello I had my j-pouch done in 1995. Afret years of other problems I was told I would have self to self dialate or have to go into the hospital to have it done. I do it maybe 4 times a year.

The tools that you us range in diameter from 10mm to 16mm. I was told by my GI that 15mm is the "target" to get in. I start small with some KY jelly lubricant and work up until I get the 15mm one in.

I put a towels on the bed relax and it really isn't too bad. You are the one doing it which seems to help me.

Good luck If you got this far this is nothing!

Bob

Bob, thanks for your reply! Interestingly my first self-dilation appointment is this morning at 8am! Questions for you: did your doctor provide all the dilators 10mm--16mm? I was under the impression that 15mm was the goal as you said, but have read about others where 18mm dilators have been used? I'm hoping to get to a place where dilation is infrequent similar to your four times a year...that would be outstanding.

Last question...how is traveling with the J-Pouch been...my wife wants to travel and I'm very apprehensive due to the frequency of bowel activity.

i think they came from the surgeon. They ordered them through insurance.

I don't know about 18mm. The ones I have are three tools double ended 10mm through 16.

1995...that is a long time...26 years to my 17 months! Thanks for the info on the dilators...will ask the Dr. about different sizes. At the appt now...will post about my experience.

So here's the update...no dilation occurred!!! The dilation training was to be done by a nurse...ok. But...she would only do the dilation IF she could reach the anastomoses with her finger! So the dilation, as I strongly pointed out, was "dependent upon the length of her finger?" And she could not reach the anastomoses! I pointed out that two doctors, including a female doctor, could and did reach the anastomoses with their finger, one of whom, the female doctor, performed a digital dilation in this clinic! So now I'm being scheduled for dilation under anesthesia...all because a nurse's finger was too short! I'm tempted to buy dilators off Amazon and follow instructions I've read off the Internet.

FYI...the finger thing was to determine the dilator size to begin with... information that the doctor should have provided since he had been there twice in the last two weeks!

I have to admit I’m as confused as CTBarrister.  Not trying to argue with you, just trying to understand…. is the constricted point the connection of your pouch to anus, or your pouch to small intestine?  Or somewhere else?  I’m just really curious about the self-dilation.  I have strictures at the connection between pouch and small intestine, that I have dilated twice a year by balloon attached to a scope.  

Pretty sure what you have dilated by balloon is the attachment between the pouch and the rectum... technically the "anastomoses". Self-dilation is an option using Hegar dialators. Apparently strictures can commonly form there or the opening can gradually become smaller needing dilation one way or another.

Interesting.  I'll have to ask my GI about self dilation options.  I get the scope currently for stretching the anastomosis, but also to check for the state of my chronic inflammation in that area, so I'm not sure I'd do self-dilation anyway.   BUT - I'm curious about it as an option for blockages, as that's the point that I have blockages due to stricture at the anastamosis where the pouch connects to the rest of the small intestine.

Thanks.