Off and on I have trouble emptying my pouch...and passing gas unless on my tummy. Will have pressure, go potty and then as I no sooner walk away I have to go again. I do have frequent (recurrent) pouchitis on scopings along with ulceration and wonder if this bathroom inconvenience is related to or a symptom of pouchitis, altho my stools are not watery, no fever, etc or other typical pouchities symptoms. When I take cipro or flagyl courses I feel great but when I stop this symptom returns. I dont know if the antibiotic is actually treating the problem or if the easier, more complete BMs are just a side effect of the antibiotic rather than a treatment for it. What makes matters worse is when I have trouble emptying, the stool backs up and a little bit may come out my usually small and minor vag. fistula (present for 22 years).(No infection or pain here--just slight spillage) After a month course of flagyl doc suggested VSL dose (2 pills)in a.m. and maintainance dose of flagyl once nightly. For a while all was good, now I have the problem of frequently being unable to empty completely. On scoping there was no stricture reported. The problem is particularly bad when flying. Can this type of problem lead to cancer ( I had colon and rectal cancer 23 years ago due to UC, necessiating the J-pouch creation). I do not take lomotil or anything like it. Should I?Is a long term low maintainece dose of flagyl detrimental as far as building up resistence to it for when I may really need it? Advice, Suggestions... Jan... or anyone? Thanks! Hattie

I am sorry the pouch is not behaving like you want it to. I sometimes have trouble with it emptying too. I have heard leaning over, can help, or being sure to sit straight up and legs slightly back can help. I hope this helps.

I actually use small enemas to "flush out" my pouch when I have this problem. I discovered that when I was traveling, as it can prevent surprises when you don't have time for them. It is not a 100% solution to the problem, but often relieves that "just went/gotta go again" feeling. And I mix in a little Maalox with the water, as I learned somewhere that it can help with butt burn and irritation of the anus.

Hi Hattie. I have had my pouch for 10 yrs, and I had this same problem as you for a long time. I ended up in hospital several times with extreme pain from not being able to empty my pouch. To cut a long story short my surgeon suggested I take 2 tsp of epsom salts every morning disolved in boiling water, with a large drink. This is the ONLY way I can go to the toilet, and I have been doing this now for several years. As for flying, I also had big problems with this, but now I empty with the help of epsom salts beforehand and the problem is solved. I still struggle with getting rid of gas, and the only way for me is to lie on the floor, spead my cheeks and wait. Sorry, bit too much info there, but this is my reality.
P.M me if you would like to ask any questions.
Veronique

Low dose maintenance Flagyl should be fine, as long as you are alert for signs of peripheral neuropathy (tingling/numbness in the feet and/or hands). Yes, there can be bacterial resistance, but many people have been on this antibiotic long term without any problem. But, if you can get by without it, that would be better.

If you are taking Flagyl only to get firmer stools, then you are better off taking Imodium or Lomotil for that. They will pose fewer long term issues than antibiotics. But, if your problem is with emptying, they can compound that problem.

There are several issues that can contribute to emptying problems, and you have already ruled out an anal stricture. Hopefully, scoping has also ruled out a stricture at the top of the pouch. You may be better off with looser stools than more formed ones in respect to better emptying. If you still have clinical signs of pouchitis on scoping even when you are on Flagyl, you need to try something else to get this cleared up. You may want to try hydrocortisone or mesalmine enemas. You may even need to try oral mesalamine, or perhaps Imuran. And yes, chronic inflammation can lead to dysplasia, so I definitely would want to get this under control, particularly with your past history.

Jan

I always have an empty cup, fill it up with good toilet water and drain it that way a couple of times, works like a charm

I am sorry some of you are having these issues, doesn't an ileostomy seem like the better way rather then struggling like this.....

Do you eat foods with fiber? Eating foods like apples and salads always gets me going (usually more than I want), but that might be helpful for you.

G'luck!

Don't want to be a bummer, but I had major trouble emptying my pouch with distention, pain and nausea. Took a while, but they determined with a defecagram and exam under anesthesia that my pouch had quadrupled in size and was prolapsing when I would try to go. I had to have that pouch removed and now I am pouch number 2 - that unfortunatly is doing the same thing and so I am scheduled for a perm end ileo. Have they checked you for strictures at the anastamosis both at the pouch inlet and outlet?
-Mikaela