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10days post up reversal, my anus is really sore like on the inside. And whenever some poop comes there i get really bad urges to use the toilet. And after I've used the toilet the anus still spasms... Like it tries to push out moore poop, but it's empty. And now i have like a pressure in my anus all the time.. I don't see any blood.

So I'm wondering if this is a normal feeling in the beginning? Or should i be worried something is off?

And yeah, i have a big time difficulties to pee when i have this pressure down there.. This worries med big time..

Last edited by Bent-Arne
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Hi, Bent Arne.

I had the same experience you are having now. Your new j pouch is now learning how to work for you. It has never performed the way you and your surgeon expect it to for the rest of your life, so it's a learning curve for you and your j pouch. Remember it used to be a simple small intestine, but now it has to be your colon. My experience in the first few weeks after reversal (or takedown, same thing) was urgency, frequency, a feeling of incomplete emptying, fullness in the anus, the need to use the bathroom but very little comes out. So you get up, wash, and within two minutes you think you need the toilet again. When that happens, just go and sit on the toilet. Don't be frustrated by it. It's a very new and specific thing to learn, and you will. Some bit of stool might come out, or not. Sometimes, for me, it felt like a golf ball rolling around trying to get out. That's the pressure, or gas, or spasms in your pouch. I did whatever my j pouch wanted (sometimes I had no choice). If I felt spasms, I headed for the toilet, just to be safe and not have accidents, which will happen so do not feel bad about that. You and your pouch are learning.

I tried to hold it as long as possible because that is supposed to stretch the size of your pouch. I tried that for a very brief time, then decided I would not follow that policy. To me, it felt like I was holding all the gas, bacteria, stool, liquid, etc., that my j pouch was telling me (screaming at me) it wanted to be rid of. So I did, whenever I had the urge. I didn't want my pouch to hold bacteria for longer than necessary because bacteria is related to inflammation /pouchitis. I had two bouts of pouchitis around this time and took cipro from my doctor and got over the inflammation very, very quickly. After that, I didn't hold on, I just used the toilet whenever I felt the urge. Whatever your condition, drink lots of water and keep your fluids up every single day. I drink water from a 32 ounce Mason jar and straw through the lid. Two bottles per day.

When you get fire bum from the frequent toilet trips, use barrier creams. I used Calmoseptine in the beginning, then preferred Zincofax, a baby cream. You could also try a plastic bidet bottle, or get a bidet that attaches to your toilet. I found that the bidet attachment saved my sanity and my bum. When I'm away from home, I miss my bidet!  I have no pouch issues now, four years later, except when I eat something raw such as salad, or vegetables not fully cooked, or insoluble foods. My pouch can be quiet and calm for five hours with no issues. Give yourself and your j pouch time, maybe a year, to settle in and work for you. Unless you are feverish, dehydrated, malnourished, bleeding profusely, or have severe diarrhea, your frequency and spasms are normal at this early stage. Try not to be afraid or worry. If you have more issues or questions, post them! Someone will help you.

@Bent-Arne posted:

10days post up reversal, my anus is really sore like on the inside. And whenever some poop comes there i get really bad urges to use the toilet. And after I've used the toilet the anus still spasms... Like it tries to push out moore poop, but it's empty. And now i have like a pressure in my anus all the time.. I don't see any blood.

So I'm wondering if this is a normal feeling in the beginning? Or should i be worried something is off?

And yeah, i have a big time difficulties to pee when i have this pressure down there.. This worries med big time..

What medications are you currently taking, or have taken in the past few days? Have you taken any anti spasm drugs? Because when I got my pouch in 2012, the first two weeks after I was home from the hospital I was having this weird issue where my sphincter would spasm. It would get stuck in a squeezing position and I couldn't release it. I also couldn't pee.

Turns out both of these issues were caused by the medication I had taken. I can't remember the name of it now. It was something that the home care nurse suggested to my surgeon to prescribe, after I was home. She thought it would help because I was still having some pain from the surgery and she thought the pouch was cramping up.

I had no idea the medication was causing these issues and I thought I just had a problem related to the surgery. Then I went to a new gastroenterologist, two weeks later, that I hadn't seen before and told him about the peeing problem. He told me to stop taking the medication.

After I did that I could pee normally and the sphincter thing went away too.

Edit: This is another extremely important thing I forgot to mention. Are you taking Metamucil? Did anyone tell you to take it? Because if not, you need to talk to you doctor about it as soon as possible. Metamucil is an extremely important thing for you to have. My surgeon and his team never told me about it, but I got on it because another doctor at a second hospital I went to after my surgery, got me on it. I hate to think of what could've happened if I'd never known about it.

Metamucil just make my pouch function better in every possible way. It makes it so that instead of having to be on the toilet for an hour and have a bunch of little poops, I have one big solid one and get off the toilet in less than thirty seconds. It also makes my butt hurt a lot less and makes me not have to strain to get empty. And it makes me go, overall, less times throughout the day. It makes me feel, almost like I have a healthy colon. When I get lazy about taking the Metamucil, I definitely suffer for it. My pouch and my butt get all irritated and painful.

The dosing is kind of tricky, though. If you take to much, it'll actually make you poop to much and if you take to little, it won't do anything. You have to find just the right amount, a Goldilocks kind of thing. I take one heaping table spoon of it in a 12oz glass of water, as needed, but no more than that in 24 hours.

Last edited by melissa111
@Winterberry posted:

Hi, Bent Arne.

I had the same experience you are having now. Your new j pouch is now learning how to work for you. It has never performed the way you and your surgeon expect it to for the rest of your life, so it's a learning curve for you and your j pouch. Remember it used to be a simple small intestine, but now it has to be your colon. My experience in the first few weeks after reversal (or takedown, same thing) was urgency, frequency, a feeling of incomplete emptying, fullness in the anus, the need to use the bathroom but very little comes out. So you get up, wash, and within two minutes you think you need the toilet again. When that happens, just go and sit on the toilet. Don't be frustrated by it. It's a very new and specific thing to learn, and you will. Some bit of stool might come out, or not. Sometimes, for me, it felt like a golf ball rolling around trying to get out. That's the pressure, or gas, or spasms in your pouch. I did whatever my j pouch wanted (sometimes I had no choice). If I felt spasms, I headed for the toilet, just to be safe and not have accidents, which will happen so do not feel bad about that. You and your pouch are learning.

I tried to hold it as long as possible because that is supposed to stretch the size of your pouch. I tried that for a very brief time, then decided I would not follow that policy. To me, it felt like I was holding all the gas, bacteria, stool, liquid, etc., that my j pouch was telling me (screaming at me) it wanted to be rid of. So I did, whenever I had the urge. I didn't want my pouch to hold bacteria for longer than necessary because bacteria is related to inflammation /pouchitis. I had two bouts of pouchitis around this time and took cipro from my doctor and got over the inflammation very, very quickly. After that, I didn't hold on, I just used the toilet whenever I felt the urge. Whatever your condition, drink lots of water and keep your fluids up every single day. I drink water from a 32 ounce Mason jar and straw through the lid. Two bottles per day.

When you get fire bum from the frequent toilet trips, use barrier creams. I used Calmoseptine in the beginning, then preferred Zincofax, a baby cream. You could also try a plastic bidet bottle, or get a bidet that attaches to your toilet. I found that the bidet attachment saved my sanity and my bum. When I'm away from home, I miss my bidet!  I have no pouch issues now, four years later, except when I eat something raw such as salad, or vegetables not fully cooked, or insoluble foods. My pouch can be quiet and calm for five hours with no issues. Give yourself and your j pouch time, maybe a year, to settle in and work for you. Unless you are feverish, dehydrated, malnourished, bleeding profusely, or have severe diarrhea, your frequency and spasms are normal at this early stage. Try not to be afraid or worry. If you have more issues or questions, post them! Someone will help you.

Thank you so much

@melissa111 posted:

What medications are you currently taking, or have taken in the past few days? Have you taken any anti spasm drugs? Because when I got my pouch in 2012, the first two weeks after I was home from the hospital I was having this weird issue where my sphincter would spasm. It would get stuck in a squeezing position and I couldn't release it. I also couldn't pee.

Turns out both of these issues were caused by the medication I had taken. I can't remember the name of it now. It was something that the home care nurse suggested to my surgeon to prescribe, after I was home. She thought it would help because I was still having some pain from the surgery and she thought the pouch was cramping up.

I had no idea the medication was causing these issues and I thought I just had a problem related to the surgery. Then I went to a new gastroenterologist, two weeks later, that I hadn't seen before and told him about the peeing problem. He told me to stop taking the medication.

After I did that I could pee normally and the sphincter thing went away too.

Edit: This is another extremely important thing I forgot to mention. Are you taking Metamucil? Did anyone tell you to take it? Because if not, you need to talk to you doctor about it as soon as possible. Metamucil is an extremely important thing for you to have. My surgeon and his team never told me about it, but I got on it because another doctor at a second hospital I went to after my surgery, got me on it. I hate to think of what could've happened if I'd never known about it.

Metamucil just make my pouch function better in every possible way. It makes it so that instead of having to be on the toilet for an hour and have a bunch of little poops, I have one big solid one and get off the toilet in less than thirty seconds. It also makes my butt hurt a lot less and makes me not have to strain to get empty. And it makes me go, overall, less times throughout the day. It makes me feel, almost like I have a healthy colon. When I get lazy about taking the Metamucil, I definitely suffer for it. My pouch and my butt get all irritated and painful.

The dosing is kind of tricky, though. If you take to much, it'll actually make you poop to much and if you take to little, it won't do anything. You have to find just the right amount, a Goldilocks kind of thing. I take one heaping table spoon of it in a 12oz glass of water, as needed, but no more than that in 24 hours.

I'm just taking something called Tramadol 50mg and Paracetamol.  When i read about the side effect it states that muscle spasm and trouble urinating is two of them. And they fit my timeperiod. I started using them two days after i got home from the hospital. Day three home i started getting spasms. Like you say, it's like the anus has locked itself in a closed position. I kinda doubt it would be this medication, but I will give it a try. But it's hard when I don't use pain killers...

@Bent-Arne posted:

I'm just taking something called Tramadol 50mg and Paracetamol.  When i read about the side effect it states that muscle spasm and trouble urinating is two of them. And they fit my timeperiod. I started using them two days after i got home from the hospital. Day three home i started getting spasms. Like you say, it's like the anus has locked itself in a closed position. I kinda doubt it would be this medication, but I will give it a try. But it's hard when I don't use pain killers...

Oh, ok. That's not what I took. Are you in the U.K? Because I don't think they prescribe Paracetamol in the U.S, where I live, or if they do, it's called something else. The pain will get better. I know it seems hard to believe that now, but it will. Just hang in there. For me, the worst thing was that nervy weird pain down in the spot where the surgery was done, from the nerves regenerating in that area. It was pretty horrible. But it went away after a few months. Now it's been eight years and I feel and function just like I did back when I had a normal colon. You'll get there.

Also, as far as my comment about the Metamucil, since you appear to be in the U.K, I don't know if they have that there. But it's something you definitely need. It's psyllium husk fiber, made from corn husk. I'm sure they probably sell that in the U.K under some brand name. If not, you're going to have to order it online. 

@melissa111 posted:

Oh, ok. That's not what I took. Are you in the U.K? Because I don't think they prescribe Paracetamol in the U.S, where I live, or if they do, it's called something else. The pain will get better. I know it seems hard to believe that now, but it will. Just hang in there. For me, the worst thing was that nervy weird pain down in the spot where the surgery was done, from the nerves regenerating in that area. It was pretty horrible. But it went away after a few months. Now it's been eight years and I feel and function just like I did back when I had a normal colon. You'll get there.

Also, as far as my comment about the Metamucil, since you appear to be in the U.K, I don't know if they have that there. But it's something you definitely need. It's psyllium husk fiber, made from corn husk. I'm sure they probably sell that in the U.K under some brand name. If not, you're going to have to order it online.

I'm actually in Norway I did find the metamucil here, but the brand name is visiblin  gonna call my doctor tomorrow and ask   ok, so it wasn't tramadol then. Then i will continue to take it. I didn't take anything today and i had a living hell with spasms.

I don't know if it was the tramadol. Maybe that can cause spasms too. I don't know. Talk to your doctor about it.

Do you need your doctor to give you a prescription for things like the Visiblin in Norway? I've heard that in some countries, you need a prescription for pretty much anything. In the U.S, you'd be able to buy the fiber supplements without a prescription at any grocery store.

@Kmiller posted:

Yes, the pressure drove me nuts. I still have it sometimes (almost 8 months] with the pouch but its getting better. I had spasms for awhile, maybe a couple months, but thats a non issue for me now. I found too it was very hard for me to pee, drove me crazy. That is not an issue for me now

This is good to hear in the way I'm not alone

Im going to see my surgeon tomorrow because of this. I'm so super miserable now so i can't wait.

@Winterberry posted:

Hi, Bent Arne.

I had the same experience you are having now. Your new j pouch is now learning how to work for you. It has never performed the way you and your surgeon expect it to for the rest of your life, so it's a learning curve for you and your j pouch. Remember it used to be a simple small intestine, but now it has to be your colon. My experience in the first few weeks after reversal (or takedown, same thing) was urgency, frequency, a feeling of incomplete emptying, fullness in the anus, the need to use the bathroom but very little comes out. So you get up, wash, and within two minutes you think you need the toilet again. When that happens, just go and sit on the toilet. Don't be frustrated by it. It's a very new and specific thing to learn, and you will. Some bit of stool might come out, or not. Sometimes, for me, it felt like a golf ball rolling around trying to get out. That's the pressure, or gas, or spasms in your pouch. I did whatever my j pouch wanted (sometimes I had no choice). If I felt spasms, I headed for the toilet, just to be safe and not have accidents, which will happen so do not feel bad about that. You and your pouch are learning.

I tried to hold it as long as possible because that is supposed to stretch the size of your pouch. I tried that for a very brief time, then decided I would not follow that policy. To me, it felt like I was holding all the gas, bacteria, stool, liquid, etc., that my j pouch was telling me (screaming at me) it wanted to be rid of. So I did, whenever I had the urge. I didn't want my pouch to hold bacteria for longer than necessary because bacteria is related to inflammation /pouchitis. I had two bouts of pouchitis around this time and took cipro from my doctor and got over the inflammation very, very quickly. After that, I didn't hold on, I just used the toilet whenever I felt the urge. Whatever your condition, drink lots of water and keep your fluids up every single day. I drink water from a 32 ounce Mason jar and straw through the lid. Two bottles per day.

When you get fire bum from the frequent toilet trips, use barrier creams. I used Calmoseptine in the beginning, then preferred Zincofax, a baby cream. You could also try a plastic bidet bottle, or get a bidet that attaches to your toilet. I found that the bidet attachment saved my sanity and my bum. When I'm away from home, I miss my bidet!  I have no pouch issues now, four years later, except when I eat something raw such as salad, or vegetables not fully cooked, or insoluble foods. My pouch can be quiet and calm for five hours with no issues. Give yourself and your j pouch time, maybe a year, to settle in and work for you. Unless you are feverish, dehydrated, malnourished, bleeding profusely, or have severe diarrhea, your frequency and spasms are normal at this early stage. Try not to be afraid or worry. If you have more issues or questions, post them! Someone will help you.

Thanks for the long reply

Now i am experiencing really high pressure in my anal area. I barely make it to the toilet, and after I'm done the pressure just keep on getting worse.. And there's so little poop coming out every time.. Just dosent feel right...??

It's completely normal I had my takedown on June, first few weeks I felt same pressure, its like something heavy seating in the anus, when you're empty just wipe and get off the toilet, go back when you feel you need to empty again, pressure won't go away seating position, in the beginning you will have more BM sometimes just gas, it will get better, last month i had 6-8 BM now I'm 5-6 a day, was taking metamucil first few months I stopped 6 weeks ago, good luck!

@Mark234 posted:

It's completely normal I had my takedown on June, first few weeks I felt same pressure, its like something heavy seating in the anus, when you're empty just wipe and get off the toilet, go back when you feel you need to empty again, pressure won't go away seating position, in the beginning you will have more BM sometimes just gas, it will get better, last month i had 6-8 BM now I'm 5-6 a day, was taking metamucil first few months I stopped 6 weeks ago, good luck!

Hi, I had my takedown in 2012. I just want to say there's nothing wrong with continuing to take Metamucil for the rest of your life, if you want to. It doesn't hurt to stay on it. I think it's actually good for the pouch. When I stop taking it for to long, I have difficulty passing stool and my butt gets sore.

@Bent-Arne posted:

Thanks for the long reply

Now i am experiencing really high pressure in my anal area. I barely make it to the toilet, and after I'm done the pressure just keep on getting worse.. And there's so little poop coming out every time.. Just dosent feel right...??

Are you taking the Metamucil yet? It sounds like you need it. It'll make you need to empty less times and have a bigger amount of poop come out when you do.

Also, do you take looperadamide, at all? You said you're in Norway, right? I don't know what they call it there, but in the U.S, it's known by the brand name Immodium. It's an antidiarrhea medicine that helps a lot, especially in the beginning. It's pretty safe and doesn't have a lot of side effects.

I don't know about Norway, but in the U.S, it's available without a prescription.

@melissa111 posted:

Hi, I had my takedown in 2012. I just want to say there's nothing wrong with continuing to take Metamucil for the rest of your life, if you want to. It doesn't hurt to stay on it. I think it's actually good for the pouch. When I stop taking it for to long, I have difficulty passing stool and my butt gets sore.

I do have difficulty passing stool sometimes. i forgot to take Metamucil a  few days and BM was less frequent so i stoped taking it, wasn't aware that it helps for passing as well, will start taking again, thanks for you help.

@melissa111 posted:

Are you taking the Metamucil yet? It sounds like you need it. It'll make you need to empty less times and have a bigger amount of poop come out when you do.

Also, do you take looperadamide, at all? You said you're in Norway, right? I don't know what they call it there, but in the U.S, it's known by the brand name Immodium. It's an antidiarrhea medicine that helps a lot, especially in the beginning. It's pretty safe and doesn't have a lot of side effects.

I don't know about Norway, but in the U.S, it's available without a prescription.

Yepp, i was taking the metamucil but i feel like it made it even harder to go. Like way more straining to get the poop out.

Yes I'm taking loperamide, 6 a day, not so sure it helps though. But the issue is the pressure and everytime some poop touches my anus it's like its gonna be pushed out immediately, even just a little...  This feels exactly like when i had uc, the rectum was inflamed and my anus felt inflamed too.. So now my anus feel inflamed or at least soar and swollen..

@Mark234 posted:

I do have difficulty passing stool sometimes. i forgot to take Metamucil a  few days and BM was less frequent so i stoped taking it, wasn't aware that it helps for passing as well, will start taking again, thanks for you help.

How much were you taking? Because the dosing can be kind of tricky. If you don't take enough, it won't do anything, but if you take to much, then it can actually make you poop to much. You have to find the amount that's just right, like a Goldilocks kind of thing.

For me, I take one heaping tablespoon in a 8-12oz glass of water every day, as needed. Any more than that would be to much. A lot of people would tell you to use less water than that and make it thicker, but I don't think the thickness of the water makes a difference. I find it gross to drink it thick, so I'd rather add more water and just risk that it might not work as well, than drink it thick and not enjoy it.

I find that the Metamucil makes it so that instead of having a bunch of little poops and having to stay on the toilet for an hour, I can just have one big poop and be off the toilet in less than 30 seconds. It's like a broom that sweeps all the little bits down to the bottom.

@Bent-Arne posted:

Yepp, i was taking the metamucil but i feel like it made it even harder to go. Like way more straining to get the poop out.

Yes I'm taking loperamide, 6 a day, not so sure it helps though. But the issue is the pressure and everytime some poop touches my anus it's like its gonna be pushed out immediately, even just a little...  This feels exactly like when i had uc, the rectum was inflamed and my anus felt inflamed too.. So now my anus feel inflamed or at least soar and swollen..

I think you're just still healing from the surgery and the pain and pressure will get better with time. Try not to eat anything with acid or anything spicy. Peanuts can also irritate your pouch, so avoid those to, for now.

I think a lot of the pain comes from the nerves regenerating in the area where the anus was reconstructed. That sensation takes at least a few months to go away. Get checked by your surgeon or gastroenterologist. They might put a camera in your pouch to check for inflammation. If you are inflamed, they may give you an antibiotic like Cipro. 

@melissa111 posted:

How much were you taking? Because the dosing can be kind of tricky. If you don't take enough, it won't do anything, but if you take to much, then it can actually make you poop to much. You have to find the amount that's just right, like a Goldilocks kind of thing.

For me, I take one heaping tablespoon in a 8-12oz glass of water every day, as needed. Any more than that would be to much. A lot of people would tell you to use less water than that and make it thicker, but I don't think the thickness of the water makes a difference. I find it gross to drink it thick, so I'd rather add more water and just risk that it might not work as well, than drink it thick and not enjoy it.

I find that the Metamucil makes it so that instead of having a bunch of little poops and having to stay on the toilet for an hour, I can just have one big poop and be off the toilet in less than 30 seconds. It's like a broom that sweeps all the little bits down to the bottom.

I was just taking one scope a day

He could fee the spot with his finger, but couldn't see it with the scope? That's weird. I've heard of people having ulcers in their pouch before. I wonder if that's what it is. But that's the kind of thing you'd think he'd be able to see on the scope.

Do you have a rectal cuff? A rectal cuff is a small amount of original rectal tissue from the colon, that some surgeons, sometimes leave at the anal opening, to attach the pouch to. I think the amount of tissue that's left can vary, depending on the preferences of each surgeon. I think I've heard of people having as much as one inch of rectal tissue left. (I'm not sure how much that is in centimetres, but it's a lot.)

A lot of people have problems with their rectal cuff and it gets inflamed all the time. It's still part of your colon, so technically, it still has the colitis.

But I'm not sure if most surgeons still leave a rectal cuff, nowadays. My surgeon said I only have like, one milimeter of original rectal tissue left in that area. But when I told other people about that on this site, they were surprised, because they didn't know that's possible.

I got my surgery done by Adrian Greenstein at the Mount Sinai Hospital in New York City in 2012. Based on some things I've seen on this site, I wonder if he did certain things differently than other surgeons because my scars look a lot different than other people's that I've seen pictures of and he said he didn't leave a rectal cuff. And as I said, other people don't seem to be aware that that's possible.

Ask your surgeon if he left a rectal cuff, and if so, how big is it?

I'm note sure if i have a cuff actually, I'm gonna ask about that the next time  but I do remember i was talking with my surgeon before step 2, and that time my rectum was severely inflamed, really bad. So he said they would cut all that's inflamed or bad away.

Well, he didn't see anything during the scope..

@melissa111 posted:

How much were you taking? Because the dosing can be kind of tricky. If you don't take enough, it won't do anything, but if you take to much, then it can actually make you poop to much. You have to find the amount that's just right, like a Goldilocks kind of thing.

For me, I take one heaping tablespoon in a 8-12oz glass of water every day, as needed. Any more than that would be to much. A lot of people would tell you to use less water than that and make it thicker, but I don't think the thickness of the water makes a difference. I find it gross to drink it thick, so I'd rather add more water and just risk that it might not work as well, than drink it thick and not enjoy it.

I find that the Metamucil makes it so that instead of having a bunch of little poops and having to stay on the toilet for an hour, I can just have one big poop and be off the toilet in less than 30 seconds. It's like a broom that sweeps all the little bits down to the bottom.

I was taking a heaping tablespoon with 8 oz water, when i was on Metamucil it was definitely thicker, will start taking it again will see how it goes, i sure need to seat on the toilet for a good 10 min or longer now.

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