I had a pouch redo going from an S pouch to a J pouch after 40 years due to evacuation problems, etc. Since my Takedown in August, 8 months ago, I have been having problems with anal stenosis. Had a dilation several months ago and was put on twice a day self dilation follow up, lots of fun! Apparently I wasn't quite getting it all the way in there and now I'm having the same problem along with lots of anal pain Particularly after BM's. My stenosis got so bad with the first episode several months after my takedown that I had a complete blockage and was hospitalized in extreme pain. I'm scheduled for another dilation under anesthesia this week. Hoping that will solve some of my problems and get back on the self dilation program. I'm interested if anyone has any experience similar to mine and how they've done with this self dilation over time. It is difficult and time consuming and I can't imagine doing it twice a day for ever. Thank you so much for any input you have.
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The anastomosis is where the bottom of the pouch is connected to the rectal cuff, roughly an inch or so inside the anus, at least in my case, and that's what constricts. I self-dilated this for about 10 years, mostly once every couple of weeks or so, to stop it shrinking. I'm told the reason they shrink is that scar tissue from the previous surgery has a tendency to want to shrink.
Like you, I've also recently had a pouch revision after my pouch was diverted with an ileostomy for 2 years, and the surgeon did a "big" dilation due to the anastomosis having shrunk from lack of use. I'm told the anastomosis needs dilating every couple of days.
I understand it's necessary to dilate frequently to begin with, to encourage the opening to stay at the newly dilated size, but over time, as the opening settles into it's size, the frequency can be reduced, hopefully back to every couple of weeks or so, as before. I assume this would be the same for you.
The self-dilating isn't fun, and can be a bit painful (though doing it in my own time is usually better than someone else shoving their finger up there). Sometimes the anastomosis bleeds a bit, esp if I've left it too long. Mine's also currently not helped by having a hemorrhoid. But, overall, I'd expect it to become much easier and more routine as you become familar with it, and ultimately it's worth persevering as the alternative is worse, as you now know!
Thank you very much for your input Trojan. That helps greatly.