This isn’t a sign of pouch failure. It sounds like a spasmodic pouch. The symptoms are sometimes treated with Levsin or Bentyl. Folks here generally seem to report that it clears up over time. @CTBarrister has written about this here - you could do a search of the archive and read all about it.

It could very well be spasmodic pouch and it did plague me for a while after takedown. It is characterized by rapid fire BMs especially after eating. Your butt feels like a machine gun spraying never ending bursts of stools. Bentyl and Levsin taken 45 minutes before meals completely resolves the issues although those drugs can make you feel loopy. As you get further out from takedown peristalsis naturally will slow and you will not need the drugs. I did have to use them periodically for a while after takedown but they do calm down the excessive motility in the bowel.

Thank you guys for the responses! I will read up on this. Although I don’t usually have to go quickly after eating. After breakfast and lunch I often don’t go for 3-6 hours. And it isn’t really rapid fire releasing stool when I do go, it’s the opposite. I have to push and strain to get it out for up to 30 minutes and then still don’t feel empty and then throb and feel sore for quite a while after going. But I will definitely read up on this and bring it up to my surgeon next week!

It’s also possible that the stricture has narrowed - sometimes these things take repeated dilations to stay open. That would result in a feeling of fullness (behind the stricture) that can’t be emptied until stuff works its way through.

I would tend to go with Scott's post above if you aren't having rapid fire machine gun stools one after the other. I also had to deal with a stricture recently and see my thread on "questions on endoscopic balloon dilation."

A stricture at the anastomosis would explain your difficulties emptying the pouch. Have you tried inserting a finger to check how much diameter there is left? You could also try to (carefully!) dilate yourself.

Anyway you shouldn't push so hard that it hurts, that only harms your hemorrhoids. Perhaps you can try to make your stool softer by taking psyllium husk with plenty of water.

Thank you for all the replies. I would be a little afraid to try and dilate myself I think! How would I be able to tell if it is too tight? How far do you go in? And I started the psyllium husk yesterday to see if it would help so fingers crossed there!

Also, how do you get them to check you for a stricture? I messaged my surgeons nurse ahead of my appt next week just to give them a heads up on what’s going on, and they messaged me back that I just need to relax and not push and do sitz baths and the throbbing/pain will stop. I responded that I have been doing sitz baths and that the problem is if I don’t push, I can’t empty and even then it takes so long and I don’t feel empty, then of course the issues that follow come on. I said how can I not push if I can’t empty otherwise? And they literally responded stop pushing and relax. So I’m skeptical they are taking me seriously.

They will know you are strictured if they have trouble getting the flexible sigmoidoscope in. If they struggle to get it through, you need to get dilated. That's my GI's very simple test and it makes a lot of sense to me. This is true if it's at the outlet or the inlet.

Thank you. Sorry for all the questions. I am so new to this all! Will they do a scope? I’m only scheduled for a surgery follow up visit with the nurse practitioner. If they will do a DRE would that show it? I just obviously really want to get my pouch working as well as possible before I have to go back to work which is very soon! I can’t go back if I’m spending 30 minutes in the bathroom several times a day  😔

A digital exam would show if your anal canal is tighter than a finger. If so, it needs to be dilated.

For comparison, some time ago I had a device for pelvic floor training where a probe head had to be inserted with a diameter of about 20 mm. That was still possible for me, sometimes it hurt a little.

You need to be careful that your stool does not get too bulky. Either drink a lot together with the psyllium husk or if that's not enough try to take a little portion of a laxative (too much would make you dehydrated!).