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For many of you who spend lots of time here, have you ever seen someone mention that they strained and strained all the time when going to the bathroom.. to either try and empty more out of their pouch or.. to get rid of gas and then wound up causing themselves a lot of pain on their left side/back and also possible causing a hernia or something else due to that pushing??? Thank you... It's happening to me (the pain and such and I have strained for eons and always worry about it.. it's not good, I strain and sometimes hold my breath and then feel faint and see stars110


Debra

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I’ve had my jpouch for almost 10 years and within the past year or so I’ve noticed I’ve had to do a lot more straining during bowel movements. In March 2020 I noticed something protruding out of my vagina when defecating. It was told I have a rectocele and had surgery in June to make my pelvic floor and vaginal walls stronger. During this process, my colorectal surgeon told me my anal canal is narrowing. After the surgery I tried to strain less often which seemed to help, at least for a little bit. Now for the past 3 months or so, I’ve had to strain more again and noticing the “bulge” which is the rectocele again. I don’t know if this is a sign that my pouch is failing or has moved, but I would recommend to not strain. If you don’t give yourself hernia you may cause a rectocele.

Straining can cause a variety of problems, and it’s well worth the time and nuisance to find a way to avoid it. Pain in the side or back isn’t likely to be a hernia, but that doesn’t mean it isn’t an injury of some sort.

If your stool is solid then that’s likely to be a source of (or contributor to) the problem. J-poucher’s stool should be soft, with a texture something like pudding. It can be made softer by eliminating bowel slowers like Imodium, drinking more water, and/or using soluble fiber (like Psyllium or Citrucel) as good, simple steps.

If your stool is already soft then other causes have to be considered: strictures, sphincter issues, pouch prolapse, pouch malpositioning, and perhaps a few others. The exact cause needs to get figured out so an appropriate treatment can be devised. Until that’s resolved an alternate method of pouch emptying could be helpful, generally emptying the pouch through a catheter, sometimes with the contents loosened up with an enema.

You likely need a good gastroenterologist to help with this. Good luck!

Hernia is less of a risk than damage to the pouch through prolapse or even the circulation to the pouch. Straining is a sign of either stool that is too solid, anal or pouch inlet stricture, or even prolapse that already exists. The first two issues are easy to diagnose. Prolapse is more difficult, since it cannot be seen by regular examination or scoping. Prolapse is only seen during defecation and is where the pouch structure collapses on itself. Surgical repair is possible, but not always successful.

Straining until you see stars is always a sign of poor function.

Jan

I see you are pretty lucky.

To answer your question: Yes I have seen it. I have also seen people mention prolapse as well. Prolapse with the J-pouch and prolapse with the bladder.

How much water do you drink???

I drink TONS of water. I keep a jug in the car to refill my water thermos which sits in the car. I refill the jug all the time and have extra bottles of water in my car. I am constantly drinking water at home. I have a soda stream because I love bubbly water and  have a few containers for the bubbly water and extra carbonation cartridges so I never run out. I have a brita filter pitcher and am always changing the filter so I have filtered water. So that's not the issue.



I will look up prolapse and see what that's about. Thanks.

@kta posted:

Just had surgery Thursday to remove a 3/4 inch polyp that my new gastro. thinks has been blocking my anal canal. Hopefully, that will stop the straining and enemas needed to empty fully.

Oh my!! Good luck with that and I do hope that solves your issue. How did you even know to  look for the polyp in the first place?



Also, I was under the impression that FULLY EMPTYING one's pouch was pretty near impossible. Hmm. I thought that came with the territory.

@Jan Dollar posted:

Hernia is less of a risk than damage to the pouch through prolapse or even the circulation to the pouch. Straining is a sign of either stool that is too solid, anal or pouch inlet stricture, or even prolapse that already exists. The first two issues are easy to diagnose. Prolapse is more difficult, since it cannot be seen by regular examination or scoping. Prolapse is only seen during defecation and is where the pouch structure collapses on itself. Surgical repair is possible, but not always successful.

Straining until you see stars is always a sign of poor function.

Jan

Uh oh.. I've seen stars  for  over two years!! I don't see it everytime, but sometimes I do. sometimes I feel a bit faint/weak when I strain. It's been going on for so long, I thought it was normal.. the straining...

The stool is Not too solid.. I mean, once in a while it is, if I eat too much cheese.. but many times the stool is in little bits.. like little curly shapes.  Oh, it really varies. Sometimes it's loose... etc. etc. It really does vary.

I haven't been to my colo-rectal surgeon in two years.. I was thinking of contacting him but have not due to covid.. but maybe I should. I don't have a gastro.. I had been to many gastros before getting really really ill/almost dying and at that point, a team of two  colo-rectal surgeons came into my life as an emergency situation and removed my colon and then I only saw them for a few years after that. Then one of them moved so I started going to the other, then he moved and I started seeing another colo-rectal surgeon who said I didn't need to see a gastro. He has done two pouchoscopies over the years and stretched things out once. He's very good.. so were the other two colo rectal surgeons. So perhaps I should call his office this coming week instead of just wondering what the heck is going on. If I recall though, I think he knew I strained. Well, it wouldn't hurt to call the office.



So how do they see if you have a prolapse?? Do they put a camera up you and then you poop???   Mind boggling to think how they would see.

@Jess623 posted:

I’ve had my jpouch for almost 10 years and within the past year or so I’ve noticed I’ve had to do a lot more straining during bowel movements. In March 2020 I noticed something protruding out of my vagina when defecating. It was told I have a rectocele and had surgery in June to make my pelvic floor and vaginal walls stronger. During this process, my colorectal surgeon told me my anal canal is narrowing. After the surgery I tried to strain less often which seemed to help, at least for a little bit. Now for the past 3 months or so, I’ve had to strain more again and noticing the “bulge” which is the rectocele again. I don’t know if this is a sign that my pouch is failing or has moved, but I would recommend to not strain. If you don’t give yourself hernia you may cause a rectocele.

I will look up that word.. I never heard of that.



I have had my pouch longer than ten years. Wow, sorry you had to go through that.



I hate that feeling when you have a lot of gas and you know if you just gave it ONE MORE PUSH, a big burst of gas would come out along with some poop! I know I shouldn't strain but I feel like I just want to  EMPTY  as much as I can, especially if I am going out for long walk or outing or going back to sleep.



Good luck with your situation!!

@Midnight Lady Since you’ve now told us that your surgeon once had to “stretch things out,” it’s very, very likely that you have a stricture that needs to be stretched out (dilated) again. They can sometimes require repeated dilations to get them under control, and can definitely recur.

You bubbly water might be giving you more gas than is comfortable, but you get to choose that.

I agree with Scott that it is most likely that your stricture has returned, particularly with your additional history and the description of your current stool quality. Stricture is also the more common issue and easier to diagnose.

Some prolapse is visible on exam, but others are not. For that they need to do a defagram. It is similar to a small bowel series in that it is flouroscopy of the real-time activity of the gut. Essentially, you get an enema of thick barium and they do x-ray while you expel it.

Jan

@Scott F posted:

@Midnight Lady Since you’ve now told us that your surgeon once had to “stretch things out,” it’s very, very likely that you have a stricture that needs to be stretched out (dilated) again. They can sometimes require repeated dilations to get them under control, and can definitely recur.

You bubbly water might be giving you more gas than is comfortable, but you get to choose that.

the dilation was years and years ago, soon after I switched to him. I don't think the bubbly water GIVES me gas. It makes me BELCH so relieves gas. Without it, I often feel nauseous!!!!

@Jan Dollar posted:

I agree with Scott that it is most likely that your stricture has returned, particularly with your additional history and the description of your current stool quality. Stricture is also the more common issue and easier to diagnose.

Some prolapse is visible on exam, but others are not. For that they need to do a defagram. It is similar to a small bowel series in that it is flouroscopy of the real-time activity of the gut. Essentially, you get an enema of thick barium and they do x-ray while you expel it.

Jan

Thank you!

I drink TONS of water. I keep a jug in the car to refill my water thermos which sits in the car. I refill the jug all the time and have extra bottles of water in my car. I am constantly drinking water at home. I have a soda stream because I love bubbly water and  have a few containers for the bubbly water and extra carbonation cartridges so I never run out. I have a brita filter pitcher and am always changing the filter so I have filtered water. So that's not the issue.



I will look up prolapse and see what that's about. Thanks.

Your welcome dear Good job on the fluids

Scott... I appreciate that you reply but so many of your replies seem to indicate that something medically is wrong with me and that I need to do such and such. YOU ARE NOT A DOCTOR. I have had nausea forever and before the J pouch and was put on so many horrible medicines that then made me have to take more horrible medicines and see so many doctors and specialists that you know what?? I  HIGHLY doubt I have GASTRITIS and I LOVE MY BUBBLY WATER so STOP already.  And don't tell me I should figure out a way to get my fecal matter out with a syringe. I don't want to start doing that!! Not after all I have been through. Please think twice by suggestion outlandish things. It's one thing to say perhaps I might want to consider this or that but I have seen you suggest things to others too.. many times they are over the top and outlandish!! And too specific without you REALLY knowing what's what. Okay, that is all. Think before you write. Thank you.

Okay thanks. I am actually okay in that I still go out and hike around outside etc. etc.  I have been told (by that colo rectal surgeon that I was doing great in comparison to  what my situation was before the j pouch!) Yes, I agree with you and Jan and Lauren that a call to him may be very well warranted. But  I am not in a panic over my situation. I was just wondering a few things and wanted to run it by this group. Take care.

Okay thanks. I am actually okay in that I still go out and hike around outside etc. etc.  I have been told (by that colo rectal surgeon that I was doing great in comparison to  what my situation was before the j pouch!) Yes, I agree with you and Jan and Lauren that a call to him may be very well warranted. But  I am not in a panic over my situation. I was just wondering a few things and wanted to run it by this group. Take care.

You take care too! And continue to keep us updated

I love your name by the way!

In response to, "How did I find the polyp?"

My last gastro noted it on two scopes. Then I changed my gastro. I had been having a lot of trouble emptying the pouch and she did a scope. She said she thought the polyp was blocking stool and also said it was black and red and gnarly looking (not her word.) I still don't know if that is the issue because this was a hard surgery. The polyp was right where my pouch was connected and things are taking a while to heal.

I hope you find your solution. If nothing, we become pretty good problem solvers and learn how to advocate.

Wow what an ordeal. I wonder how often something like that happens. Hopefully never again to you! Enough is enough.



I am on hold with the colo rectal surgeon now. I'll go for a check in.. and chat.. it's been awhile.



Thanks for writing back. Hope you are healing well and feeling better. And yeah, we are good advocates for ourselves. We have to be!!



all best,

@kta posted:

In response to, "How did I find the polyp?"

My last gastro noted it on two scopes. Then I changed my gastro. I had been having a lot of trouble emptying the pouch and she did a scope. She said she thought the polyp was blocking stool and also said it was black and red and gnarly looking (not her word.) I still don't know if that is the issue because this was a hard surgery. The polyp was right where my pouch was connected and things are taking a while to heal.

I hope you find your solution. If nothing, we become pretty good problem solvers and learn how to advocate.

So happy you are okay

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