You should be able to have a bowel movement with modest pressure, but if you are soon after takedown most surgeons will advise resisting the pressure to evacuate so as to expand your pouch and not have a teeny tiny pouch that has no capacity, resulting in dozens of bowel movements a day. The pouch will grow and expand if it is permitted to do so.

You may find it helpful after the initial discharge of payload to arise from the commode to standing position, bend all the way forward (as far as you can go, nose touching knee if possible), then sit back down. And upon resuming your seat on the commode, on the second discharge effort, try torquing your upper body all the way 180 degrees to the left and then 180 to the right. I found that I can empty the pouch more completely by doing these contortions, especially the 180 twisting to the left. This usually sends a shower of resistant stool to the water below. Think of it as a Harry Houdini imitation, just try not to end up like Harry. Or toilet bowl yoga, if you prefer.

Definitely do not strain, that can cause a lot of problems. If your staining, try to drink more water and exercise more, that helps me not to strain

Ha! Thanks, CTBarrister for that detailed description. I definitely do a modified version with a lot of standing and sitting back down but haven’t incorporated the twist. I’ll give it a shot. Also just ordered a squatty potty as I find elevating my knees while sitting up straight seems to align things. The bending over has been helpful for gas release as someone suggested on this forum. I’ve gotten lots of good tips. I’m 4 weeks post takedown today so my butt still aches so trying to figure out if What I’m doing is causing more issues.

Lauren, I definitely try to minimize straining but seems moderate is required for me unless my stool is complete liquid. I’m on abx right now and my ileum seems to be efficient at absorbing fluid (it was the same for me when I had my end ileo) so my output is more formed, like thick oatmeal. Drinking more than 2L a day has no added benefit in terms of consistency. I just pee a lot and my urine is pretty clear with 2L. I think I would float away if I drank a gallon of water a day! I’m slowly starting to walk again after 6 months in and out of the hospital. Exercise Is always good.

@Pouch2021 posted:

Ha! Thanks, CTBarrister for that detailed description. I definitely do a modified version with a lot of standing and sitting back down but haven’t incorporated the twist. I’ll give it a shot. Also just ordered a squatty potty as I find elevating my knees while sitting up straight seems to align things. The bending over has been helpful for gas release as someone suggested on this forum. I’ve gotten lots of good tips. I’m 4 weeks post takedown today so my butt still aches so trying to figure out if What I’m doing is causing more issues.

Lauren, I definitely try to minimize straining but seems moderate is required for me unless my stool is complete liquid. I’m on abx right now and my ileum seems to be efficient at absorbing fluid (it was the same for me when I had my end ileo) so my output is more formed, like thick oatmeal. Drinking more than 2L a day has no added benefit in terms of consistency. I just pee a lot and my urine is pretty clear with 2L. I think I would float away if I drank a gallon of water a day! I’m slowly starting to walk again after 6 months in and out of the hospital. Exercise Is always good.

Float away? I love your sense of humor!!!! LOL! I personally think you need more water, 2L is not enough for me  but okay, just be careful.

When I first had the pouch and had to go back to work, every time I got in my car to drive home I had tremendous urges that were pretty miserable all the way home. Of course, if I went back in to go to the bathroom, the urges stopped. This led to the realization that sitting with my rear end in a specific position brought the urges on and I could empty fully. After 15 years with the pouch, I still do this occasionally.

Another way to help avoid straining and start pouch emptying is to lean for ward with your arms across your belly and cough hard. Often that will get the sphincters to relax some. Worked for me.

Jan

i'm six months post takedown and i never imagined how difficult it would be to not strain. I definitely feel your pain. I've gone through so many products to help my anal pain. so to answer your question, any amount of straining is too much. I have learned the hard way that things are so much better if I don't strain AT ALL. I have a hard time peeing without minor straining sometimes so still working on that (I drink a minimum of 3 32 oz bottles of water plus electrolytes).

I don't know about y'all but I will get so many urges frequently but if I can wait up to a min or so, I'll hear another sound and it won't feel like I have to go anymore. that can happen a lot and it's much easier to hold it if I'm sitting. I have FAP and I'm the only one in my family so I don't really have many people to talk to or compare with but I haven't heard of this with anyone. Also, if I dump, it's gonna be liquid but if I can wait, it'll often be little solids or mush sometimes. I tend to go mostly at night so my sleep is shitty lately. (I'll wake up eight times some nights.)

@Jan Dollar posted:

Another way to help avoid straining and start pouch emptying is to lean for ward with your arms across your belly and cough hard. Often that will get the sphincters to relax some. Worked for me.

Jan

Thanks, Jan. I find even after I get things flowing by contracting my abs (fairly reliable unless pouch is empty), I need to apply consistent pressure throughout the bowel movement which can take quite a long time. I always make sure I continue to breathe so I'm not straining against a closed epiglottis. But, it's not like I can start the stream and then kick back and relax as I did with a colon. I just wonder if others just empty once things get going without any pressure? The only reason I worry is it makes my stoma site sore (still open wound) and I dread any further complications like a hernia or worse stress on the fascial layer setting me up for more adhesions. Maybe I should take a laxative so it just falls out (sorry so graphic) but I was feeling fortunate to have somewhat thicker stool (like thin, formed ribbons rather than liquid) as no more butt burn. I just can't tell what is "normal" or better yet, an achievable ideal. Not sure how you all have done this for 20, 30 years. I'm exhausted and barely in the land of the living after a year and a half. Cheers to all who have such crazy ass fortitude!

Yeah, it is a bit of a learning curve. When your rectum was removed, along with it came the muscles that automatically contract during evacuation. The small bowel has musculature that propels its contents forward. But, when it comes to the pouch that does not exist. This is because half of it contracts one direction and the other half contracts the opposite way. So, you have gravity, pressure, and time. This is why thick stool is not a good thing. Rather than getting into laxatives, you are better off with fruit juices, coffee, etc. for keeping things moving along. Since we are all so different you pretty much have to figure out what works for you, and even that will change over time.

Try not to stress about it too much. Bearing down some is fine. Seeing stars is not. You want stool thick enough not to leak and burn, but not enough to cause you to strain. Sorry that there is no magic plan to follow.

Jan

This is how my early days felt, so I can relate. Eventually you get to feel your own body's "flow" and, yes, baring down is still a part of toileting for me. When my output is super watery no need to strain. When it's not as watery and I know i have gas bubbles that need to come out, I allow myself to strain a bit more. I know though when I'm having a flare up and it's time to sh*t or get off the pot, lol.  It's a journey. Hang in there!!