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John95
Has anyone ever heard of a physician using a K-pouch catheter to remove the remaining contents from the j-pouch just prior to a pouchoscopy?

I'm asking because my doctor here did this about six weeks ago. It was quite painful and felt like the catheter was scraping my anal canal. Ever since I have been having intermittent pain around the right side of my anus and even extending into the perineum and genitals. It is usually a throbbing pain, but sometimes it burns and occasionally there is tingling/slight numbness. I have much more urgency to go to the bathroom even where there's not much there. Sometimes the pain is unbearable and other times it is manageable. But it always feels like some is off now.

I had a routine pouchoscopy that confirmed no pouchitis or cuffitis. In general, I was feeling pretty good. Now I have to deal with this, which I feel was caused by the doctor using the K-pouch catheter. Could this have caused nerve damage?? I am 5 years out from my last surgery and haven't had any such issues until recently.

I'm quite anxious to figure out what is going on. I've called my doctor but haven't heard anything back.

Jan or anyone, do you have any ideas what this could be? How can this be treated?

Thanks in advance. I'd really appreciate some support because this is so frustrating because I was FINE.

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skn69skn69Member
I am so sorry John that things are not going well for you...a lot of j pouchers who have difficulty emptying their pouches use k pouch catheters to clear out the contents of their pouches so technically it should not be problematic...I use mine 10xs a day inside my valve/pouch without any pain, irritation or problems...
That said, anything can go wrong at any time.
The catheter could have irritated the lining of the pouch or the scope may be the culprit...it could have hooked onto something in there too.
I would maybe go on a 'light' diet for a few days so that your pouch can rest a bit and see if it gets any better.
If you are allowed (ask your doctor first) you might want to take an inflamatory for a few days and see if the irritation goes away or not.
Sharon
skn69
John95John95Member
Sharon, thanks for your reply. It was interesting to find out that some j-pouchers use k-pouch catheters to clean themselves out.

When this all started about six weeks ago, the pain went away completely after about five days. I felt fine for about four weeks. Then last week it just came back out of the blue, and this time the pain was worse, more diffuse, and there was numbness for a day or two. It started to improve gradually, but it came roaring back again yesterday. I'm not sure what the significance of this back-and-forth is.

It's all very puzzling!!
John95
John95John95Member
Jan, if it were a nerve issue, would it not have gone away and then come roaring back? If there is a fissure, could it be located farther in so as not to be visible without using some sort of scope?

When I went back to the doctor a few days after my scope, he checked it out and said everything looked normal. It's quite painful if I press on the skin surrounding the anus, but the pain is located to about the 10-11 o'clock position if one is examining it. It feels inflamed and like there's something hard under there.
John95
Jan DollarJan DollarModerator, RN, retired
It may have appeared normal a few days after scope, but ovbiously that is not the case now, since you have localized pain AND a lump! This may have advanced from a fissure to an anal abscess. You need to return to your doctor.

It is possible there is some nerve trauma, but that is the remote possibility. Fissure/abscess makes more sense.

Jan Smiler
Jan Dollar
Jan DollarJan DollarModerator, RN, retired
Abscesses take time to localize and may not be evident at first. It is only after they "ripen" and are really causing a lot of pain that the diagnosis is clear. If it is deep, then it is even harder to diagnose.

Good luck and I am glad you did not give up. Sometimes you just have to be a squeakly wheel to get the attention you need.

Jan Smiler
Jan Dollar
John95John95Member
Well, I had my EUA today, and a small perianal abscess was confirmed. The doctor said he saw that one of the anal glands was infected; he saw no evidence of Crohn's and thinks this was either a fluke or maybe even due to the catheter.

Given the relatively small size of the abscess and the fact that I have a j-pouch, the surgeon opted not to incise and drain it from the outside. He said if he did this, it would significantly increase my chances of developing a fistula. Instead, he was able to drain the abscess into the anal canal through the infected gland by expressing the contents. He's prescribed me a course of antibiotics in the hopes that it will heal. He said that this approach may not work and that I may end up having to get it incised from the outside, but he thought it was worth being a bit more conservative right now.

I know this is not the typical way perianal abscesses are dealt with. Has anyone had theirs treated this way, and was it successful?

Jan, have you heard of this sort of approach (pressing the contents out into the canal + antibiotics)? Thank you for your reply. It means a lot to have your support!
John95
Last edited by John95
Jan DollarJan DollarModerator, RN, retired
Yes. If it can be drained via a duct, that is best. It is not the most common location, so you are lucky that a more conservative approach was possible. I would do sitz baths at least 4 times a day to help keep it open and draining. The antibiotics should help keep it contained.

It is quite possible this was starting before the scope and the trauma of it just "sealed the deal" so to speak.

Glad you got some relief and hope this works!

Jan Smiler
Jan Dollar
John95John95Member
A brief update…

It has been five days since the procedure. I still feel the lump, but it's definitely not as big as it was. It does cause a little pain from time to time. At the time, the doctor wanted me to go on Cipro and Flagyl, but I told him how Cipro gives me terrible joint pain and Flagyl gives me nausea and vomiting. As a result, he prescribed Bactrim and Clindamycin instead, which I'm taking twice a day. Over the past couple days, I've been experiencing increasing abdominal pain as well as pain in my lower back. It's like I have really bad cramps, and my stomach gurgles quite frequently. I assume this may be related to the Clindamycin because I've been on Bactrim many times in the past with no problems. Is this cramping/pain something I need to be concerned about? Any insight as to what this might be?

Thanks again for your reply, Jan. I really hope this works too!
John95
John95John95Member
Well, I stopped the antibiotics about four weeks ago and had been feeling pretty good ever since. However, a couple days ago, I started feeling mild-moderate pain in the same area. I haven't detected any lump or swelling, so I'm not sure what to make of it. I've taken a couple sitz baths today.

Hopefully these uncomfortable sensations are transient and not a sign of something brewing…

Happy Thanksgiving to all in the USA.
John95
John95John95Member
Thanks for the input, Jan. I haven't felt anything for the past couple days. I've been taking sitz baths so maybe that helped.

I assume the abscess created some sort of internal tract, but it never reached the surface because it was drained into the anal canal. When do these tracts become epithelialized and therefore nearly impossible to heal without surgical intervention?
John95

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