Hemorrhoids in a J-Pouch?

Yes, J-pouchers can get hemorrhoids (I have). Yes, they can sometimes feel like “a smooth skin-like bubble protruding out.” They can get smaller when the pressure is reduced. It’s best to get a competent doctor to take a look, to ensure that you aren’t feeling a prolapse - I’m glad you’re seeing one on Friday.

Ben,

I have similar experiences. Sometimes after cleaning up, I have to immediately sit down again due to incomplete evacuation.  It’s weird, because it feels like everything is out, but then it does not.

I’m thinking  the issue is trapped gas. When I get up the gas is somehow freed up and wants to be expelled.  Then as you say, kaboom, the gas and the rest of whatever is evacuated and I go on my way.

Yes, I still get hemorrhoids now and then from the straining that I do to accomplish a complete emptying of the pouch. The feeling of swelling  by the anus can be somewhat off putting. I typically use the generic prep h cooling gel (regular prep h formula does nothing for me). This seems to calm things down, and by the time of the next BM, my butt seems to go back to normal.

I have read the other post too. Hopefully it is only hemorrhoids, not a pouch prolapse. I would take care of the following things:

- Do not strain hard, it makes no sense. Sometimes together with bloatings there is still stool in the small intestine that needs to be transported into the pouch. You can ease that by breathing deeply into the stomach and leaning forward / backward / to the side changing position from time to time. But in the end it needs some time.

- Using a bidet attachment for the toilet with cold water helps prevent hemorrhoids as far as I know.

- After a BM there is almost always gas left in my experience. If possible I go to a private place afterwards, roll on my back knees up and try to evacuate the gas. That helps a lot to feel less bloated.

- Taking psyllium husk before or with a meal can help to keep the stool smoother if that is a problem.

- It is a good idea to have a visit to your GI doc tomorrow, perhaps you need to go to a proctologist also if it's hemorrhoids.

I almost always massage my guts using my hands to help with the movement of fecal matter through the pouch.  The large intestine tissue knows how to do this but the small intestine tissue does something different than what is needed for a complete BM.  My internal muscles help too, so it's a combination.  This gets rid of the need to strain, however, when the tissue is inflamed this doesn't work as well because everything gets mushy and it seems like the intestines aren't discerning of waste vs. inflamed tissue.  Psyllium husk powder before meals (1 heaping teaspoon in 8 oz H2O) seems to tone and soothe the intestines and helps a lot with emptying more completely, in my experience.  The massaging also helps with expelling the gas that usually follows. 

I was told after sigmoidoscopy I had hemorrhoids & fissures.  I bleed at times.  Never sure if it's the hemorrhoids, fissures or straining.  I use bidet harder to empty our completely.  My dr said I'm using it like a enema.  She said not so good but it's the only way I feel better.  I have so much gas & lately heartburn.

I wanted to say this compound drug I was given for hemorrhoids & fissures is called diltiazem 2% ointment.  It was helpful in healing around that area.

I hope all goes well with you.

g.

@tf posted:

I was told after sigmoidoscopy I had hemorrhoids & fissures.  I bleed at times.  Never sure if it's the hemorrhoids, fissures or straining.  I use bidet harder to empty our completely.  My dr said I'm using it like a enema.  She said not so good but it's the only way I feel better.  I have so much gas & lately heartburn.

I wanted to say this compound drug I was given for hemorrhoids & fissures is called diltiazem 2% ointment.  It was helpful in healing around that area.

I hope all goes well with you.

g.

I have noticed that magnesium spray or lotion applied near (but not on-that kinda burns) the anus helps relax the muscle and decrease the pressure on hemorrhoids and fissures, which helps with healing.  That might be an OTC version of this ointment. 

@SteveG posted:

I have read the other post too. Hopefully it is only hemorrhoids, not a pouch prolapse. I would take care of the following things:

- Do not strain hard, it makes no sense. Sometimes together with bloatings there is still stool in the small intestine that needs to be transported into the pouch. You can ease that by breathing deeply into the stomach and leaning forward / backward / to the side changing position from time to time. But in the end it needs some time.

- Using a bidet attachment for the toilet with cold water helps prevent hemorrhoids as far as I know.

- After a BM there is almost always gas left in my experience. If possible I go to a private place afterwards, roll on my back knees up and try to evacuate the gas. That helps a lot to feel less bloated.

- Taking psyllium husk before or with a meal can help to keep the stool smoother if that is a problem.

- It is a good idea to have a visit to your GI doc tomorrow, perhaps you need to go to a proctologist also if it's hemorrhoids.

proctologist and GI are same thing

@Ben S. posted:

Can a person with a J-Pouch get hemorrhoids? I recently posted on the Urgent! I Need Help! forum about straining too much while I go to the bathroom. First,  thank you for the people who responded to my question.

Two days ago while I was going to the bathroom I felt I couldn't get all the fecal matter out. But, with a J-Pouch does one get 100% evacuation on any given day? I had to go to the bathroom multiple times before I left the house. Many times I will strain to get the last bit out and then "KABOOM" like an explosion, I feel great and go on my way.

But this particular time I felt something odd. Not like a bit of food that gets stuck near the opening but a smooth skin-like bubble protruding out. I literally felt and thought it was my intestines coming out.

I currently don't feel sick in any way. No fever. I have an appetite.  Just the uncomfortable feeling of not being able to relieve myself like I normally do.

I can't seem to find or actually had the time to find a definitive answer on whether a person with a J-Pouch can get hemorrhoids in a J-Pouch and if you can what is the course of action without compromising our precious pouches?

I did get on the phone asap with my GI and I have an appointment this Friday to have a pouchoscopy. Very lucky and thankful to get in and be seen on short notice.

It's been 20+ years with a J-Pouch with very few complications.

Thank you fellow pouchers for taking the time to read this and possibly send some thoughts about the whole hemorrhoid and J-Pouch thing.

so what did the scope show??

@Pouchomarx posted:

proctologist and GI are same thing

Proctologist is an older name for a colorectal surgeon. “GI” (or “GI doctor,” for “gastro-intestinal”) most typically refers to a gastroenterologist, and they aren’t surgeons at all.

Went and got a pouchoscopy yesterday. Second one in 3 weeks. The first was a bust because I wasn't fully cleared out. The next one they had me do a full-on prep for a regular colonoscopy. I was definitely fully cleaned out for this one. They found a polyp. It was not a pouch prolapse. the doctor took a biopsy of the polyp but unfortunately, I have to wait 2 weeks for the pathology report.  If it is noncancerous they with leave it because the risk of perforation if they try to take it out surgically, but if it comes back positive we'll cross that bridge. Hopefully, I won't have to cross that bridge.

@Pouchomarx posted:

so what did the scope show??

@Ben S. posted:

BSBen S.Member

Went and got a pouchoscopy yesterday. Second one in 3 weeks. The first was a bust because I wasn't fully cleared out. The next one they had me do a full-on prep for a regular colonoscopy. I was definitely fully cleaned out for this one. They found a polyp. It was not a pouch prolapse. the doctor took a biopsy of the polyp but unfortunately, I have to wait 2 weeks for the pathology report.  If it is noncancerous they with leave it because the risk of perforation if they try to take it out surgically, but if it comes back positive we'll cross that bridge. Hopefully, I won't have to cross that bridge.

So you have a polyp on the outside of anus?

No. On the inside.

Omg, I’m so glad I came across this post. I just had surgery to remove internal hemorrhoids and had a pouchoscopy and I’m hurting so bad. I have incontinence, not being able to hold it does anyone know if this is normal? I also had a feeling of a bubble coming out when I would wipe and I thought it might have been the pouch prolapsing. Had anyone had this surgery done ?

@A.J posted:

Omg, I’m so glad I came across this post. I just had surgery to remove internal hemorrhoids and had a pouchoscopy and I’m hurting so bad. I have incontinence, not being able to hold it does anyone know if this is normal? I also had a feeling of a bubble coming out when I would wipe and I thought it might have been the pouch prolapsing. Had anyone had this surgery done ?

I'm getting ready for my first scope in 20 years.  The colo-rectal surgeon will be doing it and looking at the hemorrhoids as well.  She's going to give me a recommendation regarding possible treatment of hemorrhoids that would decrease the discomfort without adding more risk/issues (like incontinence).  From what the internet says, hemorrhoid surgery recovery is very painful, so that sounds normal.  The incontinence might be normal too, but hopefully short term?  I would be curious to hear what others who are further out from the surgery have to say. 

I don’t have a rectal cuff anymore since transanal mucosectomy done 4/17 via minimally invasive surgery so I don’t have the issue of humorous anymore

the pouch is handsewn to the anus now due to fap and a risk of high grade dysplasia /cancer which thankfully came back benign

len

Hemmorroids not humorous lol

@Len78 posted:

Hemmorroids not humorous lol

Agreed!  Hemorrhoids are not funny! 

@Pouchomarx posted:

proctologist and GI are same thing

Nope, proctology and Gastroenterology are totally separate specialties with completely different training after med school.

Hello all. I have been having hemorrhoid issues off and on, but mostly on, since last April.  It's been vexing. 

I have recently found a TCM formula that helps me with the constant downward pressure of the j-pouch on the anal sphincter (since I don't have the rectal cuff either, which provides more structure and support) that leads to hemorrhoids.  It's a treatment for prolapse and it's called Bu Zhang Yi Qi Wan, or "Central Chi" if you purchase the "Plum Flower" brand.  It tones and lifts that area.  It has helped so much with hemorrhoids.  I take a half dose of it 3x/day.  If I take a full dose it lifts too much and I end up with indigestion-but I'm about 110lbs so a larger dose might work for a larger person.  This is a recent experiment and I'm not sure if it will help long term, but it sure pulled things up and did it quickly, which really changed things for the better.  For some it may take months to feel the effects of the formula and they may need the full dose.  It's a great formula for spleen deficiency + hemorrhoids.  I imagine many of us have spleen deficiency because of the watery stool effect from having no colon.  If you have that condition, heat may also help your hemorrhoids instead of cold.  Most of the hemorrhoid ointments are designed for heat conditions (so they are cooling) and sometimes I imagine we do get heat conditions on the surface of the skin, especially when it's hot outside.  Now that it is cold, I sit on a heating pad before bed, and this seems to also help the hemorrhoids a lot.  All summer it was a cold pack, which is what the internet recommended, and that helped in a short term way (like right when I was sitting on it), but the hemorrhoids just kept hanging around. Literally!

Be warned, though, the Central Chi has also made me want to snack more, since weak spleen people with a colon tend to have poor appetites, and of course most formulas are made for intact bodies. I don't have a poor appetite, so I ended up getting a bit fattened up.  I think this will even out, especially now that the food-oriented winter holiday season is over.  If you're underweight, this formula would be perfect!

I started using the heating pad when I started the Central Chi formula.  It's only been a few weeks, so this combination certainly needs more testing.  But it's been so great and it makes so much sense that I thought I'd share it with my fellow j-pouchers. 

Disclaimer: my understanding of TCM is obviously rudimentary.  I have been getting acupuncture and using TCM herbs for about 18 years and my understanding of it has grown but is incomplete, so if I'm explaining things weirdly or incorrectly, it is because I'm sharing the experience of a layperson. More anecdotes. 

Happy New Year!

Here is some more info:

The effects of modified Buzhong Yiqi decoction combined with Gangtai ointment on the wound healing and anal function in circumferential mixed hemorrhoid patients https://pmc.ncbi.nlm.nih.gov/a...0adverse%20reactions.

Traditional Chinese Medicine in the treatment of hemorrhoids—a review of preparations used and their mechanism of action https://pmc.ncbi.nlm.nih.gov/articles/PMC10620711/

Qi Collapsing or Qi Sinking https://www.meandqi.com/tcm-ed...apsing-or-qi-sinking

From Hemorrhoids to Depression… https://www.miridiatech.com/ne...9LaC0SIOcVwgDOOS-w4d

These articles refer to two different sounding formulas, but they are the same.  The last word just describes the pill shape: "Pian" refers to a tablet or flat pill, while "Wan" refers to a pill or capsule.