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You should have been told that you should hold bowel movements as long as possible to stretch out the J Pouch. The J Pouch capacity that you have now isn't what it will be if it expands due to holding BMs. So for the first 6-12 months you should be holding BM as long as possible to stretch capacity. This will result in a bigger pouch and less BMs per day. If you don't do it you will have a tiny pouch, small fecal load capacity and 15-20 BMs per day. When I had my J pouch installed my surgeon (Irwin Gelernt, the best colorectal surgeon in the USA at that time) drilled me on this again and again and again. It's fundamental and will determine the ultimate size and capacity of your pouch and how many BMs you will have per day over the long haul. Anyone who tells you otherwise is essentially saying the best colorectal surgeon in the United States whose group performed more J pouch surgeries 1988-1996 than anyone and had a long waiting list at that time is a knucklehead. BTW he also did the very first K pouch surgery in the United States and studied under Dr. Koch, for whom the K pouch is named.

Regardless of that, it's also the well established medical industry standard for J pouches in the US and as far as I know also in the UK. Anyone telling you otherwise is practicing voodoo J pouch care and maintenance. If you have any doubt, directly ask your surgeon what the medical industry standard is on this point.

As far as wanting to feel empty, that is an irrelevant consideration until after you hold BM as long as possible. Once it is released you will hopefully feel empty but that certainly shouldn't be your goal until after you have experienced and aggressively resisted the urge to go for as long as possible.

Squeeze the butt cheeks and practice your kegel exercises as well. This is another thing you should have been told. Kegel exercises will strengthen your resistance to BMs and prevent leakages down the road. These exercises are also fundamental at this time in your development.

Jaydog not sure if you are a baseball fan but these J pouch fundamentals are like the baseball fundamentals of the pitcher covering first base on a ground ball to first base or backing up the catcher on a throw to the catcher at home plate. You don't execute these fundamentals in baseball, and you lose the game. That's the analogy I would use here.

Last edited by CTBarrister

One person on here was saying quite a bit of judgemental/mean stuff, I hope that stops everywhere.

I am pretty surprised you are not going as often as i thought you would have, pretty interesting. If you do push do not push hard, I do not want you to hurt yourself. Straining can lead to lots of complications like hernias especially and damage to the rectal cuff. If you push and nothing comes out, leave it be. And go when you have the urge too.

I think everything is fine for you right now. How many BMS are you having? Still the same as before???

One person on here was saying quite a bit of judgemental/mean stuff, I hope that stops everywhere.

I am pretty surprised you are not going as often as i thought you would have, pretty interesting. If you do push do not push hard, I do not want you to hurt yourself. Straining can lead to lots of complications like hernias especially and damage to the rectal cuff. If you push and nothing comes out, leave it be. And go when you have the urge too.

I think everything is fine for you right now. How many BMS are you having? Still the same as before???

No I'm down to around 8 or 9 a day

There’s a whole lot of trial and error here. Just about everyone here understands what you’re going through, in one way or another, but working out how to relax exactly the right parts while also contracting the right parts can take lots of experimentation, practice, and patience. Try to be gentle on yourself as you go through the process.

Jay dog,

My surgeon cautioned me against straining and said if I do not feel like the pouch is completely evacuated do the following: stand up from commode; bend over forward as far as possible with arm firmly pressed against abdomen; then sit back down on commode. In addition to that step I have also found through trial and error that when I am reseated on commode if I twist and contort my upper torso sharply to my left while holding lower torso in place on commode, it will promote evacuation of remaining contents of the pouch. These are things that like Scott said are trial and error, and you kind of need to experiment with body movements to come up with what works, which is what I did in adding this second step. In your case it might be a twist to the right, but I have found that the left leaning contortion gets the job done. But I would first try the step my surgeon recommended and see if that helps.

Last edited by CTBarrister

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