Can't fully empty

It sounds like symptoms of a pouch prolapse. You should do a pouchoscopy to clarify the exact reason.

Could be a pouch prolapse, could be "other mechanical issue" with pouch, and could be untreated pouchitis. For your sake I hope it's the last of those 3, which is easily fixable. In 1998, 6 years after I got my pouch, I had all the symptoms you are describing. It turned out that a "septum" had developed within the pouch that was blocking the stool and preventing me from emptying the pouch completely. I had the same sensation of the stool being blocked. Like it was hitting a wall. Unfortunately, it took 2 surgeries to fix, but it did get fixed and I have had 23 fairly good years with the J Pouch since the second of those 2 surgeries.

I have also had the sensation of incomplete evacuation during bouts of pouchitis. However when the septum developed, that was the only time I felt like something was flat blocking the stool. The surgeon never gave me a clear explanation on how it developed, but he said a septum had developed within the pouch. I suspect that a flap of tissue that was supposed to be sutured either came loose or otherwise developed into a super adhesion. Whatever the case, the fix was cutting and stitching. After that second surgery in 2000 it was fixed and never had the issue again.

The one piece of good news is that it was done laparoscopically through my anus and as an outpatient procedure. So not super invasive and although you are knocked out, no post operative pain.

Good luck getting to the bottom of it. I would call your surgeon and let him or her take a look at it. An office visit and look up with a scope is warranted.

If pouchoscopy doesn’t answer the question a defecogram might be needed. It’s an embarrassing imaging study but isn’t otherwise difficult.

I had very similar problems right after my takedown. Mine was caused by a mucosal prolapse - sort of drooping/folding of the pouch lining made worse with straining, the resulting which was 80% narrowing and incomplete emptying.  Treated simply with endoscopy. Tends to recur, and it goes hand in hand with bacterial overgrowth, so on maintenance antibiotics.  I also had the defecogram Scott mentioned in order to diagnose.

I was thinking it might be small intestine bacterial overgrowth (SIBO) as AMB mentioned above.  I guess it's time to see your GI doc.

Do something simple first. Stop pushing. Doing so could get your pelvic floor muscles working against each other and you can get anal congestion. I’m experienced unfortunately. Use Metamucil and give your pelvic muscles something easy to move. Oatmeal works for me. I also bleed when I push. That area is already “friable” as I was taught, and easy to pop a hemorrhoid. Plus, I use Ilex cream and push it in deep which also helps me to relieve anal congestion.