I was diagnosed with UC 8 years ago. This past year, I had a total colectomy and construction of a J-Pouch. My ileostomy closure was done November 14, 2007 (a little over 3 months ago). The first few weeks I was home, I had a bad kidney infection and spent most of the time in bed with no appetite. However, in the last 2 and a half months, my appetite has increased and I have gained 18 lbs, which is great because I was underweight prior. I have found now that I am eating more throughout the day that I have a BIG problem with night time incontinence, that I didn't have when I first came home probably due to not eating much. I have an anal stricture at the top of the anus which has been dilated once. I read another post that this could be causing the incontinence. Does anyone else have problems with incontinence this late after takedown? Is it food related, or stricture related? Also, I have been taking Immodium and Lomotil both 4 times a day with no relief. My stools are very very watery (another problem I did not have earlier). I have tried diet and medication modifications with no luck. Please help!!

-Kery

Sounds like too much immodium and lomotil which can cause many issues. Could be pouchitis. I have never had it so not really sure.

Kery,
I am 2 years post subtotal colectomy and still deal with occasional night time incontinence. If it is for only one night i chalk it up to whatever I had for lunch or dinner. If it last several days I will have to go back to the basics and start building again. Toast or bagels with a banana for breakfast rice and chicken for lunch and dinner. After a day or two my system gets back to "normal" and I start adding foods slowly. For me it has been a trial and error system. I am never sure what sets me off, but once I start it is very hard to get it to stop. I don't have a problem with the time I eat but for many they make sure they eat dinner early. I now take immodium twice a day. in the morning and before dinner, it works for me but every one is different.

I hope it gets better, I know how frustrating it is to wake up with poopy underwear.

Norma

*Holly* FLA I am curious about what you meant about too much Immodium or Lomitil causing issues? What sort of issues?
Nancy

Constipation.

I don't think it is pouchitis because I am only 3 months post takedown and I was on Flagyl and Cipro for a month and a half following surgery due to a few abdominal abcesses. Flagyl is the main antibiotic used to treat pouchitis so if I did have it, it shoudl have cleared up after that. Also, I didn't know that too much immodium and lomotil can cause constipation. I take 2 of each 4 times per day and I am still going to the bathroom about 10 times per day and the consistency is completely watery. As far as foods go, sauces and spices bother me a lot. That is the only trouble I have had with food to this point. I have tried diet modifications to help, such as eating more fiber, or things like mashed potatoes, but nothing is helping. I don't have any issues with incontinence during the day, only at night and it is EVERY night, not matter what I do. My surgeon said it is to be expected but my only concern is that I didn't have this problem initially and I just want to know when it will stop.

Kery, Immodium and lomotil simply slow down peristalsis which can mean food hangs about inside the intestines for a longer time then usually. When do you eat the most volume wise?..I find that i eat light breakfast, then medium size lunch and no main meal now when i get home from work but snacks. I stir in fibre powder into all my drinks usually when i remember and when i dont eat vegetables. I think you coulld try to reduce volume gradually in the evenings . No more food after 7 pm and a snack perhaps just some toast , oatmeal works for me best, with butter and jam before bedtime. I wait 20-30 min ,,the last meal stimulates the intestines and i can empty well before bedtime. I sit there 10 minutes .
To thicken your output but with it still being soft you need to eat things like bananas, oat buiscuits, metamucil wafers, potaotes, chips (called crisps in UK)stewed apples, rice and carrots well cooked. Experiment.Dont eat anything that could cause waterry output,,toatoes sauces, spicey food, sugary things liek sweets cakes etc( sugar draws water into intestines i think) , chocolate, lettuce or nuts. If you dont have pouchitis diet should do it and lay off meds for now,,let your intestines empty properly before bedtime.Let us know how you get on. Good luck!.

Absolutely fabulous advice Martiangirl! I agree that a fatty snack before bedtime (even some spaghetti with cheese) may help.

Are you taking probiotics?

Incontinence in the first 6 months is pretty common. If it continues getting worse, your surgeon needs to take your concerns more seriously.

Kery, Has your doctor checked to see if your stricture has tightened up again? I was dilated at takedown and when it started getting really tight again I noticed that I leaked a little bit at night. I was confused because before that I had never had any leakage. After dilation the leakage went away.

I have only been dilated once which was right after my takedown. It has been a good 2 and a half months since. How is that a stricture causes leakage? I would think it would cause the opposite? The leakage I have at night is almost a full BM, and I do empty every night and follow with imodium and lomotil immediately before bed. But, still no luck. I will check into being dilated again. How often should this be done and is there ever a point where it will just stay open and dilation is no longer needed?

Kery, does it hurt when you pass anything?
A stricture like that makes it difficult to pass much solid material,
and it can get very irritated, swollen, and possibly ulcerated near
the sphincter, which decreases continence just like it does when
you have UC.

The small intestine tries to remove blockages by
passing watery stool as fast as possible.
You could see your doctor to check the stricture and
possibly try antibiotics again. You may have pouchitis -- it comes back
immediately in some people when they go off of antibiotics. You might
also consider trying heavy-duty probiotics (VSL#3), since you have
terrible diarrhea despite taking a huge amount of medication.

A stricture can cause leakage if you are not emptying fully and liquid can leak around formed stool, especially at night when your sphincters naturally relax a bit.

In most cases, one dilation is all it takes. But it is not too uncommon for the stricture to reform. If this happens, it is quite variable on how long before it permanently stays open.

Jan