A sign of Pouchitis?

Cuffitis or pouchitis, or both. Bleeding is usually cuffitis. If it was just a spot or two on the paper, I might say it was bleeding from anal irritation due to the increased frequency. But, if it is enough to be in the stool, more likely to be cuffitis. Occasionally, there is bleeding with pouchitis, but it is not a routine symptom.

Every once in a while I get a cuffitis flare out of the blue and it quickly advances from scant bleeding to double frequency, increased gas, urgency, and frank bleeding. Canasa suppositories turns it around in a few days for me. But I don't wait around for it to fix itself.

I'd call your doctor if I were you.

Jan

Thank You Jan!

I work at the hospital now, done my first year of med school. The awesome part is that I sometimes work with the surgeon who preformed the surgery on me.

I made an appointment for tomorrow at noon.

Is cuffitis curable?
I am not sick, just stomach is tender and the bleeding wasn't as much when i went for a BM about an hour ago.

You can think of cuffitis as a localized bit of IBD (usually UC) in the rectal cuff. Since it's all reachable via suppository or enema, it may not require oral (or injectable) meds. Your Mileage May Vary.

last night there was bleeding and this morning when i went twice, no bleeding. just very watery bowel movements.

i just feel very tired.

i feel as if there is a blockage in my jpouch,
i push but only little amount of poop comes out. i feel if i push harder, blood will come.

Lavi,

I wonder if you maybe also have a stricture? Strictures can cause bleeding, especially if you are straining. Good thing you are getting checked out today. Keep us posted.

I've never heard of a stricture!!!
ahhh im scared

3 months away from my competition, university being done for the semester.
this **** happens.

A stricture is a pretty common complication. Basically, it is just the anastomosis scar shrinking. That causes obstructive symptoms, with pain, straining, and yes, sometimes bleeding because of the straining. Easily diagnosed with a simple digital exam. If it is not too bad, the digital exam is also therapeutic, by dilating the stricture (usually painful, but brief). If it is very tight, the dilation is done under anesthesia, either by digital manipulation or balloon dilation by endoscopy. It is not something that requires surgery or a hospital stay, if that helps.

Jan

okay i just got back.
i have pouchitits
the doctor prescribed a 10 day coarse of Ciprofloxacin.

Has anyone tried this medication and how did it help your pouchitis?

If you search around a little, you will find that Cipro is one of the most commonly used antibiotics for pouchitis. The other one is Flagyl. They both are pretty equal in how well they work. I take Flagyl when I need it. If it is the right antibiotic, you should see positive results within 24-72 hours. For me, it is within a few hours of the first dose.

Jan

Lavi-
The 10 days of Cipro might be plenty, but don't panic if symptoms return after that course. Some of us need longer courses of antibiotics. I'm on Cipro all the time now, but it's hard to complain: I've scheduled two SCUBA diving trips for this summer!

so i picked up the medication at 6pm last night, took 1 capsule. today i just took 1 already this morning, will take the next 2 spaced out within 4 hours.

i know it is very early for any improvements but i still feel like crap.
cramping, bloating, diarrhea, and blood stools.

but i don't have a fever, no nausea, and i can sleep well.

when you first had pouchitis, how long till the symptoms cleared?

Bloody diarrhea is not a common finding with pouchitis. It is almost exclusive to cuffitis. How did your doctor diagnose the pouchitis? If he did not do a rectal exam, and just prescribed based on symptoms, then that might be the problem. Cuffitis is easily found on rectal exam and antibiotics are not the treatment. No scoping needed.

If it is pouchitis, then Cipro may be the wrong antibiotic. Flagyl is the other one used. You can either give it another day or two, or ask your doc about cuffitis and/or Flagyl (unless you are allergic).

Jan

my mistake. He prescribed me flagyl.

I gave him a list of my symptoms and he told me it was pouchitis. He ruled out cuffitis.

The symptoms i address were:
6-8 bm's
water bm's
4-5bms with blood
bright red blood
stomach pain- mild
urgency- mild
fatigued and tired
no fever/ no chills

How did he rule out cuffitis? Just curious...

Plus, you sure it is Flagyl (metronidazole)? I have never heard of it in capsules. Mine always come in pill form.

Jan

when i described all my symptoms I asked him, is it pouchitis or cuffitis.

he said pouchitis. He said he didn't want too examine me at this time, and that my GI would next week at my appointment.

I thought so. What concerns me is that he would rule out cuffitis, when bleeding is rather specific to cuffitis. Cuffitis otherwise has the same pouchitis symptoms, and bleeding is what sets it apart. It does not mean you cannot have both. I guess if antibiotics are not successful, then you really know.

In my case, Flagyl actually worked well, but I quickly relapsed after discontinuing it. That was when my GI felt that my cuffitis was my real underlying issue. A quick rectal exam revealed a very bumpy rectal cuff mucosa. He then scoped my on the spot, and found that the pouch was fine, but the cuff was severely inflamed. He started me on mesalamine suppositories while I was still taking Flagyl. I then stopped the Flagyl after about a week.

Here is a link to a comprehensive article by Dr. Shen at the Cleveland Clinic. Scroll down to the portion about cuffitis. You will see by the text and the graph, bleeding is rather rare with pouchitis.
http://www.dept-med.pitt.edu/g...eadings/shen2005.pdf

Just trying to help you avoid wasting time, like I did. I messed around with it for years. Back then they did not treat it unless you were very symptomatic. I did not know what to compare with, so I did not complain. That was sort of dumb of me to do.

Jan

okay so my problem is that when i go too the washroom only a little bit comes out. i feel like there is something blocked in there!!!!!!!!!!!!!

i can feel it too.
no pain like an obstruction but when i go too the washroom only a little bit comes out.

Could be an anal stricture. Again, easily determined by a digital exam. If not a stricture, that sort of symptom could be from a partial obstruction close to your pouch. I know I must have a pesky adhesion near my pouch, because I get symptoms of difficulty emptying, almost constipated feeling every once in a while (like a couple of times a year). It lasts a few days, then resolves by itself.

Another possibility is a twisted or "internal prolapse," which is basically a intussusception. Doesn't show up on scoping, because they inflate you with air. Only would show up on a defacogram. But this type of issue doesn't come and go, and is more consistent or progressively worsens with time. Straining makes it worse too. Hopefully, it is not that.

Jan

I think I am over thinking things,

Cramping has reduced, bleeding is a minimal now, and bm’s are from 4-8.
Energy level still a bit low but I hope it goes up

i dont think anything is stuck in my bowel.

Easy for your mind to run amok! The key is if a symptom is persitent. Otherwise, I try to ignore it and hope it goes away. It usually does in a few days...

Jan

I see my GI tomorrow, hopefully he will have some answers!

i spoke with the receptionist at his office, he said he will definitely be examining me tomorrow.

I was a terrible chewer, and a few times, I had things get stuck in there... Portobello mushrooms (haven't eaten them since 2000), a frickin' bay leaf (!), almonds (that came out eventually when I nearly stroked pushing them out... They came out denuded and fully intact), and quinoa (I shudder; that stuff clumped into a tremendous ball of terribleness, after much agony). It was like each thing acted like a bathroom stopper... The liquid stool would come out, then the THING stuck in there would block the outlet, making things feel horribly backed up in there.

I've also had narrowing and required dilations.

Sounds like it could be either/or or a combo. Hope they get it fixed!

Flagyl isn't tolerated by some people at all and it could be making you feel tired too. I think the frequency would be greater with cuffitis. You could have hemorrhoids from straining causing the bleeding.

You are a medical student and could test yourself for cuffitis. Put on a glove, lubricate your middle or index finger and ease it up to your rectal cuff, which shouldn't be more than 2" I'd guess. If it feels swollen, hurts and/or it feels bumpy/knotty it's probably cuffitis.

OR you can wait for your appointment.

From, chronic cuffitis sufferer

TE reading your post made me laugh. The infamous Dr. Shen once told me he scopes himself!!!

LOL Liz, My friend's a GP and she gave herself a pap smear once!