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Hello. I am almost 4 months post takedown and I have been on here posting a couple of times about my issues with straining, incomplete emptying etc and it continues to be a problem for me.

A few weeks ago I ended up at the er due to all the pain I was having with straining. They did a few tests and sent me home. The results came through my chart, no one actually discussed them with me. They did a ct scan (normal), pouchoscopy (normal) and barium X-ray. The barium X-ray was normal except it does say “a short segment of narrowing is noted at the illeoanal anastomosis that approximately measures .8 cm in diameter. This is non obstructing and contrast moves through this area without delay or holdup.”

I thought maybe this was the cause of my issues found finally, but no one called me. I called them (my surgeon, they are not good at getting back to me ever) and they called me back 5 days later to say that since I’m no longer in pain and this is non obstructing they don’t need to do anything.

Well that was a week and a half ago and the issues have continued, and the discomfort is returning. I did call them first thing this morning but who knows when I will hear back.

Does anyone with any knowledge know if that is enough to be causing my issues? If the stool is liquid I can pass it no problem, but anything thicker and it’s a huge problem! If it’s not the answer, I am at a loss as to what to do next and they seem to not really care

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The diameter of 8 mm at the anastomosis is very little. You experience those problems with straining yourself if stool consistency gets "better".

I once had a training device for pelvic floor training that came with a probe head of about 20 mm diameter, and I could insert it through the anal channel.

You should ask a gastroenterologist or proctologist for an appropriate tool to do self dilatation of that narrowing. I know there are such conical looking tools but I never used one myself. Your surgeon probably won't feel responsible for that kind of problems.

Thank you Scott. I do need to get a gi! If my surgeons office gets back to me, I will ask for a referral. I really want to find someone who knows j pouches. It’s too bad because other than this emptying issues, my pouch is great! I just need to know if this narrowing is causing the issue or if I need to move on to something else. I would think it wouldn’t be that difficult to let me know one way or the other!

Steve thank you for the information. Are you saying that my opening is only 8mm when it should be 20mm? I wasn’t sure how to read the test.
I would be fine with self dilation if they would just give me some guidance! Right now I have tried doing an enema for some relief and I can barely get the tip of that in which is really small. And even that I have to push through and it’s uncomfortable.

Hi Cb2009, I'd say that 20 mm is not so much either. Just remember how formed stool of a healthy person with a colon looks like. It's important that the tissue is flexible enough to widen up if necessary.

I have chronic pouchitis / ileitis for 18 years now with too soft or partially liquid stool most of the time. That's why flexibility is getting worse over time.

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