To push or not to push?

I've had my take down approximately 10 days ago. I have had cronic Diahhreoh but immodium has helped slow things down. With the immodium then  I need to push and I have a very sore backside from the strain.Is it better to have looser more frequent motions and just allow them to rush out or to have less and have to push. Which will give relief?

Does anyone recommend any good creams for a dore backside?

Original Post

Straining is risky, and I suggest you avoid it if at all possible. What frequency were you trying to reduce? What exactly do you mean by “chronic diarrhea?”

A typical J-poucher has 4-6 soft stools per day, neither liquid nor hard. 10 days after take-down things would typically be busier.

It’s easier to prevent a sore backside than to repair one. People have many favorite creams - I had perfectly good results with plain, essentially odorless zinc oxide, applied *after* every BM, to protect the skin from the next one.

You may have an anal fissure, which is a tiny crack of the skin within the anal sphincter,

I experienced the sane sensation around 3 days after takedown, the uncontrollable urge to push and bear down, although I also experienced excruciating pain during BMs, as well as the sensation of wanting to pass a golf ball sized object.

I applied ilex protectant paste to the inside of the anal sphincter; sounds rather unpleasant , but  ir made all the difference.

Within few hours of applying the ilex paste in such a manner and after every BM; the urge and sensation to push stopped and I was able to empty without straining.

Although, it does state on the box and tube, that ilex paste is for External Use Only.

Thanks to both of you. To begin everything was quiet after takedown though I was as bloated as a 6 mth pregnant woman. Then I was having 20-30 movements a day, pretty much every time I got up or urinated. The dr said that was too many so prescribed immodium. This slowed the flow but I still get the sensation I need to go but often have to push to achieve a result. I have been using barrier creams and they have worked ok but now I have inflamation and a little bleeding. An anal fissure sounds likely. I don't have a fever so I'm doubtong its cuffitis.

I really didnt get any toileting advice post surgery so Im a bit in the dark. I believe Im supposed to hold on but when I feel the need to go it is quite uncomfortable. I am not quite sure what to do? Should I just wait until I cant wait any longer or am feeling like Ill have an accident?

Yeah, just after takedown, I was advised to hold it in, to kinda stretch the pouch, that lasted all of a day, maybe only a couple of hours.

Holding it in, not long after takedown, in my opinion is a little too soon, like I said, I did it initially but it was too uncomfortable, through fear of accidents, so I stopped and just went when I had the urge to go.

However, after a couple of months, once you've become accustomed to your new  pouch; that's when you can begin to experiments, within your home, familiar surroundings, creature comforts, whith the toilet close to hand.

To evacuate the pouch, you kind of have no choice but to push, for myself, it's more like a sensation of letting go.

It''s kind of hard to explain; I guess rather than bearing down and pushing to empty, it's more like, when I feel the sensation or urge to go, I'm holding it in; not clenching, resisting or holding it in for longer than necessary and once I'm sat on the toilet and comfortable, I'm able to let go.

There's still an element of  pushing, bearing down but not straining.

Ok thankyou.I'm thinking that if I can reduce the frequency of motions then it will give my backside more time to heal. I guess ill keep going with the immodium and use some calmoseptin cream. I guess there will come a time when I can no longer hold on and that's when I'll use the toilet. Im more comfortable today.Yesterday I couldnt sit.

Hey Felixgust, I'm reading your post and thinking how much it sounds like my own experience. My take down was Nov 2017, so a little over 4 months ago. What helped and continues to help me is a very warm sitz bath and a toilet seat bidet I got on Amazon for $35. While those two tactics provide relief, I still have too much inflammation from 9-12 BMs in a 24-hour period. I still experience some blood spotting on the toilet tissue, which I hate, but my surgeon says to not worry about. As I tried adding more fiber and other foods to my diet--as is recommended--my bottom just never seems to get better. I finally went back to the Cleveland Clinic last month and got scoped. The scope showed I have mild inflammation in the anal transition zone--which I was told is normal--and the recommendation was to try pelvic floor physical therapy. I did that, it helped with my ability to relax so the pelvic floor muscles aren't fighting my sphincter muscles and I can better "let go." However, I still have issues with butt burn, some bleeding and 9 BMs a day. I called my surgeon back and am now trying pramoxine hydrocortisone (1%-1%), which is supposed to reduce inflammation,  pain and itching. So far, it's just OK, not great. As you've no doubt read on this board, everyone's experience is unique. Try the sitz bath and bidet for now. They're simple and cost-effective and you will definitely have some temporary relief.

Sounds like you’re early in the healing/ adjusting process so I’d recommend to avoid straining as much as possible. With time you’ll figure out balance of solids, liquids, immodiom, etc. to get stool to right consistency to avoid both uncontrollable output and straining.  I’d also be careful holding it too long.

As far as how I find ways to reduce the strain and to more completely evacuate the pouch is using squirt bottles with very warm, almost hot water. I often use 2-3 refills, but in the absence of a bidet, it really feels good on the skin/ anus and seems to relax the muscles to release stool. I purchased set if 6 perianal bottles from Amazon for $10 or so. I would love a bidet, but due to issues with my pouch didn’t want to invest in one unless I for sure was gonna keep it. I am now, several years after takedown, working with a Pelvic Floor Therapist who suggests squatting first before going to toilet and leaning forward as evacuating. I also second the idea of Ilex paste, purchased directly online from company- it adheres well to wet skin and really protects, thus promoting healing. I use Vaseline to wipe it off after each BM. I know I would not still have my pouch if not for Ilex Paste! I use now mostly when area is sore/ inflamed or to hold a cotton ball/ pad up there if I’m going out. That absorbs any leakage so it doesn’t sit on skin. Geez- sorry to ramble, but hope to help. Good luck with your new pouch!


Thanks LJZ, its great to hear from you. Im having some better days and some not so good.I imagine that this is common in the beginning and I'll slowly work out what to do. 

I   bought some hand held water spritzers but they had no instructions? I'm assuming you just spray them externally to clean yourself? I almost got the idea that you were using them internally to help the bowel to relax or am I totally making that up? Sorry, totally new to the idea of using wster in any way.


FelixGust, I am 7 years out from my J-pouch surgery and I still have good days and bad days. I seem to have avoided chronic pouchitis, but I have learned to live with feeling like I need to use the toilet more than I actually allow myself to go. (Most of the time, it is gas--that seems to be the real enemy to a J-pouch, aside from pouchitis). I really don't count how often I go, but it is probably 6-9 times a day, including the middle of the night or early morning. I use Calmoseptine after each bowel movement to protect my anus. That seems to help a lot. With time, you will figure out what works best for you. 

As for the straining, keep in mind that with no solid stool coming through your anus, your anus will shrink. I have found that this creates some straining when I go.  I have recently experimented with stretching my anus out by using a device that is used for vaginal stretching (but it needs to be super narrow!!!). I haven't been doing it reliably enough to know if it is effective.

Good luck with everything and stay on here---the people here will help you through!

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