Formed stools are not the goal if they are making you strain. I was told not to strain with a j-pouch. Please cut back on your lomitol one a day until you are no longer straining. It is easier for me to pass looser stools and empty my pouch than to strain as it doesn't feel like I empty my pouch entirely when I strain. I think you will feel a lot better without straining.

Yikes! Yes, this is not good.

Is the straining voluntary or involuntary?

If it's involuntary, it might be a sign of another problem like cuffitis or even an anal fissure.

I would definitely start reducing the Lomotil gradually either way to make evacuation easier.

Mom2panda: what do you mean by "formed?"

For me, formed is about the consistency of oatmeal. I think your stools are too formed to be good.

Straining with a J-Pouch can cause it to prolapse.

I'd stop taking anything that slows down your system and add in things that will pass through.

If you need to "form up" your stool, consider adding more fiber instead of an anti-diarrhea medication.

If Jan's right about a fissure, maybe you caused that with the straining?

Anyway, I think your root cause is that your stool is too well formed. For me, the best formed stool looks about the consistency oatmeal. . .almost liquid, almost solid.

Good luck!

I have a K-pouch. My surgeon always is yelling at me not to strain when my output is too think.
He sees it can cause damage to the valve. In our case, we are advised to irrigate.

Thanks everyone!

I have stopped taking lomotil today at your suggestions. I am going quite often - and it is still formed, but a bit less so than before.

To answer some of your questions:

1. When I say my stool is formed, I mean formed solid like a normal person - although in smaller pieces.

2. The straining is both voluntary and involuntary. It feels like there is inflammation there for sure. The area is irritated from the BM and then comes the involuntary straining.

Perhaps if the stools move easier, the inflammation will calm down?

I have had pretty formed stools - and frequent - since pretty early after my take down so I never really realized it was a bad thing until recently after reading some posts.

I guess I'll see how it goes off the Lomotil. I am getting other symptoms of inflammation like fatigue and joint point. If it doesn't clear up, I'll go to my Dr. Not sure what she will do though since the antibiotics are not good for me...

Thanks of listening!

The other suggestion I'd offer is to increase water intake. It might not help, but it's sure worth a try.

FWIW, soft, formed stools are probably fine when everything's working right, so stool consistency may not have anything to do with the problem. You definitely don't want to cross the line to brick production, though.

Oh, and so far today - at 5:00 pm, I've gone to the washroom at least 12-15 times.....Sigh. My bottom hurts.

Alright, so I went to the Dr today and she did a flex sig right then and there. I have a raging case of pouchitis. That would explain my symptoms I guess.

Sorry to hear you have pouchitis, but very glad you have a diagnosis!

Thanks! 3 days on antibiotics and I am feeling much better.

Based on my history so far, I might be one of those that is abx indefinitely. We'll see.