Here are a few things to consider, Giselle. Are you drinking enough water, every single day? Are you avoiding bowel slowers, like Imodium? Have you tried soluble fiber, like Metamucil? Have you considered a bit of exercise, even just taking a walk? All of these are gentle long term approaches, not aggressive ways to clear out your current brick. Maybe add some grape or prune juice for your current issue?

Thanks Scott, since 5 years I take 3 pills of psyllium every day. I have eaten a ton of prunes.  I went on liquid diet for a week. I try walking every day. I m being very careful what I eat. I don't take any pan killers, just my blood pressure med and some supplements. Short term I need to clear up before my intestines start rotting ! Did I say that I am 66 yrs old.

Hello, Giselle. My aunt, 85, had this problem. She tried prunes, prune juice, fresh fruit such as oranges with most of the pith left on for fibre, but it didn't work. She started to add extra virgin olive oil to her diet, and it worked like a charm. I think the EVOO must have been like a lubricant for the internal plumbing. She added it to her vegetables, a bit extra in the skillet, as a finish on top of pasta, etc. It makes sense. It's not chemical or drug, and it's natural, just olives. If you try this make sure it's 100% extra virgin olive oil. I hope you will overcome this very soon so you feel better.

Giselle, it sounds like you have a colonic j-pouch, not an ileal j-pouch that most of us here have. Most of us had a total proctocolectomy, so we do not have any colon and constipation is less of an issue. If you retain your colon, things just tend to slow as you age.

Whether you have a colonic or ileal j-pouch you lack the musculature of the rectum that contracts to evacuate. J-pouches empty by gravity and internal pressure. When you have a colonic j-pouch, the stool will tend to be dryer and firmer than with an ileal j-pouch. So, products like fiber supplements should help keep moisture in the bowel so you can move things through better. Try the loose powder rather than the pills, as it seems like you are not taking enough. If that is not enough, Miralax and stool softeners are safe for daily use. Other laxatives are not. Talk more with your GI, as you may not be taking enough Miralax.

I suppose it is possible that there may have been some sympathetic nerve damage with your surgery, leading to a motility disorder. I am not convinced that a colostomy would solve your problem.

Jan

Dr. Bo Shen

Cleveland Clinic

Thanks Bonalou for the Dr. Shen reference.

Thank you Jan for all the info. Indeed I have a colonic pouch. Excuse my ignorance, but I did not know difference.  I finally saw my surgeon yesterday and he ordered a Gastrografin Enema in spite that he believes that I have no blockage, as well  as XR small bowell series. He strongly believes that the pouch is not functioning, i.e. not emptying. I do take Miralax twice daily, take 3 psyllium pills and try to drink 8 glasses of water. i also eat stuff that are supposed to help, like kiwi. 

During the visit it was mentioned, that we will be doing all that, but at the end of the day a colostomy is unavoidable. I am devastated.  I don't want to sound ungrateful. 

could you elaborate your opinion as tfar as the colostomy not solving the problem?

Thank you 

Giselle

Well, if your remaining colon is not functioning properly, then it still will not function with a colostomy. You will likely need to irrigate the colon (like enemas) at least daily, in order to empty it. Plus, you will still need the laxatives and supplements.

Maybe it is just your colonic j-pouch that has a structural defect, such as twisting or collapsing when you try to empty. This can happen with an ileal j-pouch too. A functional x-ray exam, called defacogram, can show these defects. If this is the case for you, you may need a pouch redo or repair. 

If there is no structural defect, then they really need to figure out if you have a motility disorder, and if so, whether it is confined to the colon or throughout the GI tract. If it is just the colon, perhaps you can have a completion colectomy and have an ileal j-pouch, avoiding an ostomy.

If your surgeon does not have any other options for you than colostomy, you definitely need a second, more expert opinion.

Jan

Thank you Jan. 

I have done a Defectating proctogram. the impressions were that there are no fixed or dynamic obstruction, no significant abnormalities, minor barium leakage during baring down.  i am having XR small bowel series next week. the idea is to confirm that it's the j-pouch is not contracting in spite that there are no visible reasons. Do I understand correctly that is what is called "motility". Is that the same as pseudo paralytic ?

A re-do of the j-pouch would mean 2 major surgeries and that is if the colon can be extended enough to do it. That's what I am told. I definitely want a second, even a third opinion and don't mind traveling to get it.

The point is to find the right person (doctor) !

I am not sure whether a defacogram would show pelvic floor dysfunction, but I would think it would. I believe you are understanding motility correctly. 

The right surgeon would be one who has experience with your complications. That can be a tall order in some places!

Jan