Do I have a J-Pouch

Jonah, it sounds like you still have most of your colon. Colonic J-pouches are sometimes constructed, but I'm guessing you have a direct connection from your sigmoid colon to your anus. I'm sorry it's working so poorly for you. You're welcome here, but most of us don't know much about your surgery. Has your surgeon had anything to say about your lousy function? Have you tried soluble fiber, like Metamucil or Citrucel, to thicken up your stool?

If your surgeon calls it a j-pouch, then I suspect that it is. It just is a colonic j-pouch, not an ileal one. Generally, the function with a colonic j-pouch is superior to the ileal. Better water absorption and the ileocecal valve is present to prevent backflow into the ileum and resulting bacterial overgrowth.

I see that you had radiation treatment. Is it possible that you are still having residual effects from it, or perhaps permanent damage? Routine pouchitis is usually associated with IBD. I would suspect you have radiation inducec pouchitis. I don't know how the treatment would be different in this case, but I wouldn't be surprised if antibiotics were not effective. You may want to try Lomotil or opiates if Lomotil is ineffective.

Jan

Jan and Roger, Thank you for the thoughtful and helpful feedback.

As I read my post back to my wife, I found an error.  I had rectal cancer, not have. The cancer was found via a routine colonoscopy in Aug 2014. Very low in the rectum. Stage 1.  I had concurrent radiation and chemo in Fall 2014. The rectum and part of the sigmoid colon (a total of one foot) and 17 lymph nodes were removed in Feb this year. The biopsy showed no residual cancer.  The chemo/rad had worked. The cancer had ever gotten out of the inside of the rectum wall. To bad we didn't know, I could have kept my rectum, but technology is not there to be able to tell. 

I noted Jan's comment about the ileocecal valve. I have to check on that with the surgeon. When he did the ileostomy take down, the end of the ileum was damaged and he cut off 4-5 inches. I understand damage to the ileum and the need to remove a section is fairly common.

The surgeon recommended Psyllium husks, which appears to be the active ingredient in Metamucil.  Do you know of any difference or reason to change.  One thing that always concerns me about the info on Metamucil is that it is referred to as a laxative.  The last thing I would think that I need is a laxative, but I'm an engineer not a doctor. I'm teachable.

The gastroenterologist has me starting Cholestyramine (aka Questran).  It is a suspension that addresses bile malabsorption. This is very interesting since the end of the ileum has a bile uptake function that I understand is supposed to remove bile before the stool passes into the colon.  This seems to be committed to the Ileocecal valve as well from what I just read on Dr Wikipedia. I find this very interesting since my impression for the last 7 months is that my colon is inflamed.  The Cholestyramine may help with that.

I had my first colonoscopy since the surgery yesterday. No polyps, yeah! The GI took a number of samples which should help determine if there is an infection. He also biopsied two small nodules that showed up on the most recent CT scan.  My oncologist, Colo-Rectal Surgeon and GI all felt this was a swollen lymph node, probably due to infection. I'm glad they did the biopsy though to make sure. I get the results in 2-3 weeks.  At that point, I will know if the Cholestyramine helps.  If that has not done the trick, I will follow-up with the question on Lomotil.

Thanks again and Merry Christmas, John

John, Jan noticed what I missed - that your surgeon called it a J-pouch. He knows what he did!

Psyllium husks work mechanically to bulk up the stool. If someone is constipated, the addition of a psyllium slurry will soften the bricks to a consistency that can be passed. If the stool is liquid, though, psyllium will thicken it up. It doesn't matter much if it's Metamcil, Konsyl, or no-name. Othe soluble fibers also can help, and some people do better with them than psyllium. Examples include Benefiber, Citrucel. Don't be afraid to experiment - you should see changes fairly quickly.

I would be extremely surprised if you lost your ileocecal valve in the take-down. It is where the appendix is (right lower quadrant, deep in the pelvis), so not where they'd be mobilizing your ileum for an ostomy. For those of us who had a total proctocolectomy, the ileocecal valve comes out with the colon (as does the appendix).

Not much to add to Scott's description of psyllium/Metamucil. All fiber supplements absorb and hold water. If you are constipated, it draws water from the bowel walls. If your stools are loose, it soaks up the excess fluid like cornstarch in cooking. 

Of note, some people are sensitive to psyllium and it does have amild purgative effect to those people. Also, some people develop excessive gas from it (I am 2 for 2 on those issues). You'll know quickly is you fall into that category. In that case, you can try non-psyllium fibers, like Citrucel or Benefiber.

Also, fiber supplements may not reduce your trips to the toilet, unless they are strictly due to the liquid quality. They do not slow the gut at all and do increase the bulk. They are worth experimenting with though, because you don't know if they will help you unless you try them. Plus they are safe and cheap.

Jan