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I had UC and a J pouch in 1990. I have never been impressed with my doctor experiences during UC and post surgery. Thank goodness for the internet now! I can't believe it took me this long to hunt online for help. Frowner

I have been reading a lot of posts this morning and I am relieved to find there are reasons for a lot of what I am struggling with, but I am also overwhelmed by all the information. Plus I know this is going to be a trial and error process.

My situation: I am 43, UC for 5 years, J Pouch in 1990 with hernia post surgery, adhesions removed around 1992. I gave vaginal birth in 1999 and tore terribly. Prior to the tear I had trouble passing stool and gas. That stopped after the tear, but I have had day time and night time incontinence ever since.

My temporary ostomy was a nightmare due to large volumes of water output. It continually filled like a balloon and even fell off sometimes bc it would get full/heavy quickly. I still deal with daily dehydration, nausia, watery bowl movements. My skin is regularly irritated and it hurts to sit many times. I regulary "over heat" and take gabapentin for hot flashes (not related to menopause). I am unable to exercise due to the incontinence, except for biking (sitting). My energy has always been low, but has severely plummeted in the last 2 years. I have battled depression since the beginning of my illness but only realized in the last 10 years it was largely due to my illness. I have been on many antidepressants over time.

I have tried a variety of things through my own trial and error. I'll be honest and say I haven't been consistent with most of it because I've had limited success. I have tried drinking more, Imodium, Gas X, Vitamin B and a multivitamin, elimination of carbs. All of these have been helpful (esp elimination of carbs), but the incontinence continues.

My last visit to a specialist was about a year ago. I avoided docs for years bc of bad prior experiences related to UC. The visit a year ago was no better, though she was supposed to be on the cutting edge for people dealing with incontinence. She put a probe in the rectum and it hurt terribly due to irritation so that she couldn't complete the testing. I was given suggestions about how to heal the irritation and was told to take 2 tsp Fiber One/day for two weeks. It was a nightmare with even more frequent BM's and irritation. I called about it and was told to give it more time but that it was important to continue with the Fiber One. I stuck with it until I just couldn't take it anymore. The urgency, increased # of BM's and irritation were intollerable. I never went back to her bc she had no other suggestions to offer.

I just want my life back. I am at a point where I have no energy, have difficulty working and focusing, I am short tempered due to pain and lack of sleep and I still battle depression.

I don't know that I have pouchitis....From what I've read it involves bleeding as a common symptom. I have never had that.

Sorry this is so long. Any suggestions on how to sort all this out would be greatly appreciated.

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quote:
I don't know that I have pouchitis....From what I've read it involves bleeding as a common symptom. I have never had that.


Bleeding is a possible symptom but I would not say it is a common symptom. I have had chronic "simmering" pouchitis for almost 18 years and never once had bleeding, even when it was at its worst on scope which was last June (I posted the pics of that study). The lack of bleeding in no way, shape or form rules out pouchitis.
CTBarrister
Yes, and as a matter of fact, bleeding is nearly always a symptom of cuffitis (inflammation of the rectal cuff), not pouchitis.

In addition, you can have bacterial overgrowth without any actual pouchitis that would be seen on endoscopy. The symptoms are the same with urgency and frequency. A course of Cipro or Flagyl would quickly determine if this was the case. Often even with pouchitis, doctors will prescribe these antibiotics based on symptoms and not scope right away.

It sounds like your recent doctor was treating you as if you had a colon. Sure, if you are having very watery stools, many people do get relief by taking fiber supplements, but for some (myself included), it just increases the trips to the toilet.

Unfortunately, it sounds like you had permanent sphincter damage from your vaginal birth, and that has led to the incontinence problems. That is where stool thickening comes into play. People with a colon can handle sphincter weakness better, because they don't have chronically loose stools. I see that you've tried Imodium, but how about lomotil? If you've tried that, then it may be time to move on to opiates. But first, I'd ask for an Rx for Cipro or Flagyl and see what that does for you.

Oh yeah, welcome to j-pouch.org! Hope we can help you sort this out!

Jan Smiler
Jan Dollar
Kia,

I am sorry to hear of your problems. I am not familiar with the struggles you are facing, but just wanted to welcome you also and let you know the people on this board are AMAZING and will help you in any way possible! Here is to finding such a valuable site that hopefully can offer you some tips/advice to feel better soon. Best wishes to you.
J
Hi Kia,
I am so sorry for what you are going through and for the less than par treatment that you have recieved from the doctors you have dealt with...I am no j pouch expert (I have a k pouch, same pouch, different exit strategy...I empty mine through a stoma with a catheter, meaning I need things watery)...but I am an expert on anal incontinence...I was born without a rectum and 1/2 of my sphincter was destroyed in the surgery trying to create one...what was left of it was definitively destroyed at age 10 when they removed a whole lot of adhesions around the sphincter while trying to rebuild it...I became 95% incontinent by then...Add permanent watery, bloody stools and my life was a nightmare until I got the pouch...But, before that, I met a very nice surgeon in Duke, N.C. who did my first gracillis muscle flap to create a sphincter...in my case it worked great for 2yrs until a severe flare that sent me to ER and destroyed the new muscle...For you, it may just be a possible solution...they remove the gracillis muscle from 1 or your legs, pull it up and create a sling out of it to recreate the sphincter...there are many people for whom this is a real solution...there are others as well depending on how bad your control is...they can implant silicon 'pillows' that tighten the zone up and allow the little control that you have to be enough...and there are thickening agents as well as opiates to slow things down greatly (I had more success with gravol than codine, I liked the effect better...it slowed things down but didn't make me dopy, just sleepy (no I am not a dwarf Big Grin))...
Ask all of the questions that you need to, we are all here to help you.
Sharon
skn69
I would suggest that you keep on trying to find a GI who is familiar with j-pouches. However, the very best thing to do would be to go to Cleveland Clinic because they take care of the problem pouches. If you're not able to go there, you can actually do a remote consult by sending your latest information to them.

What a pain in the arse to have suffered all these years. I would also suggest that you research a permanent ileostomy - it's nothing like the temporary. It might help you get your life back. But even if you don't want to go with a permanent end ileostomy, you could go with one for awhile and let your poor butt get some relief.

Welcome to the site. But sorry you even have to be here.

kathy Big Grin
kathy smith
Don't give up Kia. Some of us have been struggling with issues as well. I agree you need a very qualified jpouch GI or go see Dr Remzi and Dr Shen at Cleveland . I was there last year and they will try sad help you in any way possible. This is a lot of independent trial and werir with medications at times and many if us suck it up many days with pain etc. I have found the advice on this site to be invaluable.
J

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