I've been dealing with loose/watery/ diarrhea like stools chronically for years now, and have become dehydrated to the point of kidney failure. I was hospitalized each time. I was initially hospitalized for a heart attack, then was re hospitalized twice for renal failure due to dehydration, then another 5 days from bowel ileus with an NG tube down my throat.
I know that since I have no colon there is no water absorption, hence the watery stools, or is it? I was taking metronizadole because it stopped the loose stools for a couple weeks. I switched to lactobacillus acidophilus after that with psyllium at bedtime. This hasn't helped at all, even though I keep taking it. I have been taking loperasmide for years to help this, but it doesn't help.
I recently had a scope of my ileoanal anastamosis, and was shown the irritated remainder of my colon (the rectal cuff I believe). Was told that this was the likely cause of my loose/diarrrhea like stools. I don't know what to think, if I have the rectal cuff removed I'd lose the pouch, am I stuck with chronic loose stools? Any thoughts?

You could try some metamucil or immodian. Be careful, you do not want to over do it and not be able to pass anything.

Your small intestine extracts some of the water from whatever you ingest. The colon normally completes the job, but a j-pouch can do more than the ileum normally does, since the stool stays there for an extended period of time.

I do not know how good your probiotic or many others are. The reference standard is VSL#3. See the discussion in this thread:

http://j-pouch.org/eve/forums/a/tpc/f/9151071921/m/2811...691025772#4691025772

From your scoping results, it sounds like you have cuffitis. It might respond to drugs like Mesalamine:

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a688021.html

You can have the rectal cuff removed -- the pouch would simply be reconnected closer to the anus. This would be a drastic step, however. First you should try some other strategies for thickening things up:

* Bananas, rice, bagels, applesauce, ...
* Less foods that cause watery stools (what are you eating?)
* Drink fluids 1/2 hour after a meal, not with a meal
* More psyllium
* Imodium

I think I'd look at trying cuffitis medication first before thinking about having the cuff removed. It sounds like nothing has been tried yet and it may be all you need to get on top of the problem.

I was thinking the same thing as Mike. It would seem pretty straight forward to just treat the known inflammation. The standard treatment for cuffitis is mesalamine or hydrocortisone suppositories. I had the same problem, responded well with Flagyl, but knew it was not a long term solution. So what we did was while I was still taking Flagyl, I began the mesalamine suppositories, overlapping treatment by about 5 days. When I stopped the Flagyl, the mesalamine kept things in remission. After a few months of that, I switched to oral (sulfasalazine) for long term maintenance.

If it comes to the point that you find it not manageable, you can have the rectal cuff removed. This is called a pouch advancement procedure. You'd need to find a surgeon experienced and skilled in pouch salvage procedures. I also think it may be time for a new GI, if you have such terrible chronic problems that land you in the hospital, knocking at death's door. You need some better maintenance treatment.

The pouch and part of the ileum are supposed to adapt to the loss of the colon and absorb more water as time goes on. But it is true that some people just don't adapt well. What daily dose of Imodium are you taking?

Jan

I live with chronic loose and watery stools and while I seem to always be on the brink of dehydration I have managed to survive. I know when I take probiotics it helps tremendously. Jan, what if he were to take Welchol to help out??
What i do to keep myslef from drying up like a mummy is drink lots of watered down fruit juice. I know that is not the best and water really is the way to go but darn it I need some flavor!! !
In my surgery I also lost part of my ileum so that makes things a little harder for me as far as absorption is concerned.
Do you have periods of time where the watery stool doesn't bother you? What are you doing different at that time compared to times where you are severely dehydrated?
Julie

Whelchol only serves to bind with the bile, so that the stools are not caustic. It is constipating, so that is a plus, but it really does not increase water absorption. But, it would do nothing for the cuff inflammation.

Jan