I held it in as much as possible and it really helped.  Yes, it can definitely be uncomfortable.  I was lucky and within about 6 months or so down to about 5-6 times, sometimes less a day.  The only thing I had issues with was leakage during the day and at night.  Seems like once I passed the one year mark, this pretty much went away.  I also don't feel as much pressure and discomfort when the pouch is full.  I am down to 4-5 times now, never at night.  I only take Benefiber once a day and Immodium before bed.  I should say that not everyone has the same results.  Oh the other thing I did religiously were Kegels!

I got very good results from (gently) “stretching the pouch” from the very beginning. I didn’t overdo it, I didn’t do it so aggressively that I had accidents, and sometimes I just took a break, but in the beginning I treated it like exercise repeated just about every time I could have simply gone to the bathroom. I think this substantially shortened my adaptation period.

I feel like I'm doing this, but did anyone else get pain behind/ up inside the bum (guess where the pouch is).  The pain is tolerable but it sure can shoot from 0-60 pretty quick and then dissappears

I guess I get that sometimes, it feels like a cramp. I don’t take it too seriously as long as I can delay the bathroom without an accident. It was probably more frequent when my pouch was new.