This isn't a reported side effect from Entyvio. It's possible that your stool got too firm to easily pass, without any structural problem like a stricture, though the problem apparently persisted when things loosened up a bit. Perhaps your attempts to empty have swollen some hemorrhoids, which could add some difficulty in emptying. Things you could consider doing (don't do them all at once):

1. Stop any bowel slowers (Imodium/Lomotil/opiates)
2. Add more fluid, especially if your urine is dark.
3. Try psyllium fiber
4. Try a little Miralax
5. (Probably a last resort): Try a tap water enema

Are you sure your pouch is full when you try to empty it?

Scott, thanks so much for your response. Well, I have 100% aggravated some hemorrhoids. It’s not too bad, but it is definitely noticeable. If that is the culprit, I’m in a very viscous cycle. I try hard not to strain when I empty my pouch, but sometimes I cannot help it.

I am generally waiting until I have a full pouch to empty it, but I have admittedly been fooled by gas lately (which was blissfully nowhere to be heard/smelled while I was on the antibiotics). So, I am still relearning a few things. Of your suggestions, I think I will try a little Miralax. I drink a lot of water, take two servings of Metamucil daily, and have been fortunate not to need bowel slowers lately.

The tap water enema would probably work really well. I’m just not sure I want to go through all that when I’m trying to empty in the middle of the night. As you say though, last resort…

Scott, the Miralax was a great idea. A full dose last night softened things up enough to allow for a pretty comfortable bowel movement. I’ll spend the next couple of days trying to find a dose that I can use for consistent relief without overdoing it. I appreciate the suggestions.