Anal Stenosis due to loose stools

Hi MJC,

The only medicine I use to thicken everything up is 6-8 Loperamide a day which I find helps.  I sometimes do use psyllium husk powder but find the loperamide does the trick.  A toothpaste-like consistency is the best I can get.  I also found codeine to work slightly better than loperamide but it has its downsides.

I was always told to stay away from too much fibre, and stick to starchy white bread, potato and pasta for thicker stools and I notice these foods do help. 

Truly formed stool isn’t really ideal for J-pouchers, because we no longer have the muscular rectum needed to readily push that stuff out. We’re better off with a texture like oatmeal or pudding, and most of us don’t develop stenosis anyway. You should be able to do gentle self dilation just to maintain (rather than enlarge) the opening after your dilation under anesthesia. If your surgeon won’t support this you might try to find a thoughtful gastroenterologist who will.

Thank you.

@AnthonyA posted:

Hi MJC,

The only medicine I use to thicken everything up is 6-8 Loperamide a day which I find helps.  I sometimes do use psyllium husk powder but find the loperamide does the trick.  A toothpaste-like consistency is the best I can get.  I also found codeine to work slightly better than loperamide but it has its downsides.

I was always told to stay away from too much fibre, and stick to starchy white bread, potato and pasta for thicker stools and I notice these foods do help.

Interesting since loperamide is for slowing the bowel and not for thickening..

It's for slowing and thickening. Because stool moves through more slowly, there is increased time for absorption of fluids.

@Pouchomarx posted:

Interesting since loperamide is for slowing the bowel and not for thickening..

Yes, I have found it makes a definite difference.

How many times a day do you use the bathroom? I go at least 12?

The procedure went well. My stomach is no longer bloated! Discussed the use of Loperamide with the colo-rectal surgeon and it was not advised. Thinks that using a very small dilator after a couple of weeks might help. Maintaining a high fiber intake is still the plan. I will have to experiment with different foods as well as continue to use the Metamucil wafers. I usually only have about 2-4 movements a day unless I don't keep my fiber intake and water intake up, then it's water only several times a day with a lot of bloating.

I’ve never heard of a J-Poucher have so few movements.  i am in awe!  And honestly a bit jealous!!

@Mary O posted:

I’ve never heard of a J-Poucher have so few movements.  i am in awe!  And honestly a bit jealous!!

It has been that way since about 8 months after my takedown. The only thing that affects it is whenever I have had Pouchitis. Then it's more like 8 times a day.

Figured I'd chime in as I'm in the midst of having a few issues, but have been as fortunate as MJC.  Every since my takedown back in 2004, I've been "blessed" with an ever decreasing amount of daily BMs, down to about 2-4 per day.  I don't know if this is due to the slowing of the bowel, age, or otherwise. 

Unfortunately, I'd prefer to have either a few more BMs daily, or better output, as I'm constantly feeling not fully emptied, and pretty uncomfortable.

Something I've never paid too much attention to has been diet, and how it affects BM frequency, consistency, etc.  I do admit to not drinking enough over the years, which probably doesn't help.

I'm awaiting my next GI appt to get a look at what's going on inside - otherwise, the general recommendations are usually the fiber and liquids - and hopefully stay away from the narrowing...good luck!