You say this bleeding is your only symptom, but the straining is a major symptom. Have you been checked for an anal stricture or cuffitis? You should not need to strain. Constant straining can damage your pouch, causing it to dislodge and prolapse. Maybe your stools are too formed! For me, a little loose is always best.

Jan

I agree with you, too formed is not very well, but I always strain and I don't think is an anal-related problem as it seems I have feel I strain the upper part of the pouch, to let descend all the stools...
I supposed is a low-intake fiber related problem so I introduced some apples in my diet, but (perhaps because of Cipro) still too much formed and "hard" to pass.

Do you know any remedy to loose?

If I recall you eat a ton of thickening foods like banana and oatmeal... You can try reducing those in quantity, or add foods that thin output like fruit juice (or wine) and hot liquids like soup, coffee, or tea.

It's better to not empty every last bit from your pouch than to strain.

It is typical for the pouch to empty in stages, as it largely empties by gravity. Some bearing down is necessary to get things going and the sphincters to relax, but you should not be seeing stars and making yourself dizzy.

Ideally, after the first "pass," you sit there a few minutes or even stand up and sit back down, and more will drop down. For me, once I get to the gas, things are pretty much empty.

And yes, Cipro can make things too thick. You probably don't need it if you did not have pouchitis symptoms. Bleeding is seldom associated with pouchitis. I am unclear why you resumed taking it, unless you had pouchitis recently diagnosed.

Jan

I'll try to "educate" myself in the correct way to empty...
In any case I resumed cipro as my doctor had said that if I notice "too much " blood I should do it... and there are times I see too much blood; still I don't know if it's really pouchitis, I'm supposing some bruise in the anastomosis site (the upper) where the stoma was.

Too much? Isn't any blood too much? Yeah a bit here and there from time to time may be OK (especially if you know where it is from), but bright red bleeding is not likely from the stoma site, as it would darken significantly by the time it exits and would be mixed with stool.

You don't treat cuffitis with antibiotics, generally.

Jan

Bright red blood it usually is associated with cuffitis, which is residual UC at the bottom/cuff of the pouch.

If you are straining and have thick stools could you be experiencing internal hemorrhoids? They would be painful.

When I have a cuffitis flare it is not only painful it has a burning feeling. I also get diarrhea.

I had both diarrhea and constipation at times when I had UC so who knows - you might have cuffitis, which is UC, at the cuff/bottom of the pouch where there is some remaining rectum. In the U.S. there is usually around 2 cm of rectum left at the cuff.

Since your surgery was in July it is highly unlikely that there is bleeding from anywhere else in your pouch.

I have no cuff, my surgeon said he performed a particular stapling and managed to remove all the rectal cuff (0 cm);
it's a strange situation; tomorrow I'll see my latest bloodwork, but they anticipated me my iron levels are low, I'm hoping I'm not anemic.
I feel good, but today I still saw blood, a bit more than yesterday... I really can't see how this could be pouchitis, or cuffitis, as I feel good and am having only 4-5 bms with no pain and no urgency.
It could be a stricture? I'm still straining . I'm trying not to strain, but I can't empty without.

If not cuffitis or pouchitis, then anal stricture is most likely culprit. You need to be examined...really, you do! Could be hemorrhoids, but I would expect more symptoms.

Blind treatment of bleeding is not good.

Jan

I am interested in hearing more about your surgery that used stapling without a rectal cuff. Is there a paper on-line in English about it that we could read? I'm serious, this would be the best procedure yet.

Ok, I took my bloodwork results, and to my surprise it was good! CRP was indeed under the limit (although when I did the bloodwork I was bleeding a bit, and three days before more), and hemoglobin, although lower than perfect, was 2,5 points more than when I exited the hospital. I am happy with the results, just need to regain my iron levels, as they extensively dropped out...

@Te Marie, well, my surgeon always told me that news, and said I was the second or third (can't remember) in his carreer (first male) to whom he managed to cut out the whole rectum (0 cm); I asked him "How much cms of rectum will you leave me?" and he said that through the new stapler he would have been able to cut out all, and he repeated that after my surgery, he told it also to his students, so I believe it's true... In fact I don't think I suffer of cuffitis, as never had urgency.
I researched for some paper, but found nothing. It's interesting indeed that noone other, neither here, never mentioned those "new technique" using "new staplers".
But, perhaps, the majority of people doesn't care and just go through surgery?

Regardless, all it would take is a tiny amount to become inflamed, or even just the suture line. Blood tests will not indicate this unless you are deficient. CRP is not an accurate measure of inflammation. You simply need to be examined. If not a scope, then at least a digital exam, feeling for signs of inflammation or stricture. The fact that you are bleeding on a regular basis means there is something amiss.

Jan

Jan you're right, but considering that when I was hospitalized one month ago, my CRP levels were 36, and 22 days ago (when I came back home) they were 14, and I was really haveing massive bleeding, I expected that, if still bleeding a bit, the CRP wasn't normalized, indeed they are.
I think that CRP is the best inflammation marker, in my case never failed, when I'm good CRP is good, when I'm not good CRP is not good, and at the moment I'm good, apart for this small bleeding.
Moreover I was digitally examined when I was in hospital, two times, and they excluded emhorroids, but not excluded some problem in the suture line; I'm pretty sure I have some problem in the anal zone, which make me bleed in some way.
hopefully it will definitely disappear, there are days when I don't see any blood some other just some drops, someetimes a bit drop. It depends also from what I eat, I'm sticking to a some-fiber diet as I'd like to minimize my straining (it seems to work at least a bit).

Ah, that makes sense. Thanks for clarifying. CRP is good for monitoring treatment effectiveness. I did mot know you had serial readings. If you had a rectal exam in the recent past, then I think you can rely on it. Like you say, this may well be residual from that time, and just taking longer than you expected to resolve. As long as it is trending in the right direction, it is OK if it is slow.

Good luck!

Jan