Probably low grade or “simmering” pouchitis. You should be scoped. And the symptoms should be getting treated because if not they will get worse over time. If you are not taking anything else right now I would suggest Pepto Bismol for the nighttime issues until you get a handle on what is going on in the pouch.

I agree, it sounds like it is back or coming back. You may just have a better tolerance for pouchitis now which is why it's not bothering you the same as when your pouch was much newer.

I agree with the other responses. This is probably pouchitis, and in all likelihood you can clear it up pretty easily with 10-14 days of Cipro or Flagyl.

Another thing to consider is not getting fully empty with each “round,” which could be indicative of partial stricture at the ileoanal anastomosis line.
Quite a few folks who don’t self dilate, have to have it performed under sedation 1-2 times per year for several years until the scaring process concludes.  Not getting fully empty leads to bacterial overgrowth, likely a top cause of developing chronic pouchitis. 

Here’s another possibility. I’ve had pouchitis or cuffitis symptoms ever since takedown 2 years ago. Two weeks ago, I had a pouchoscopy and was told I have chronic cuff inflammation plus a new one: my pouch was said to be “angulated” and “flapping in the breeze.” My GI said he even had trouble scoping the top part of the pouch because it had folded over. He concluded that my frequency symptoms and nighttime leakage might be happening because of this angulation. I am now scheduled for a barium enema so the pouch position can be visualized. If a folded pouch is the reason for my symptoms, the doc said it could mean another surgery to tack the pouch in place. 

JFill,

I had pouch revision surgeries in 1998 and 2000 due to similar issues although the sensation I had was of incomplete evacuation due to the stool hitting a wall and feeling like it was blocked. Supposedly a “septum” developed in the pouch. In the surgery, a flap of pouch was stapled and I have not had a problem like that since the 2000 surgery, my last of 4 bowel surgeries related to the pouch.

Pouches enlarge after surgery and yours may have over enlarged and revision could (possibly) resolve these issues. They did with me as far as the incomplete evacuation.

CT, that feeling of "stool hitting a wall" is the reason I was told I needed pelvic floor PT, which I did for four months a year ago. It helped, but didn't completely resolve my issues. I've now had three pouchoscopys but this was the first where I was told of a structural issue. Any idea if "tacking the pouch" is another significant surgery or if it's a simple laparoscopic procedure? 

The surgery I had in 2000 to “tack the pouch” was done in Mount Sinai Hospital In NYC. It was done on an outpatient basis under General Anesthesia and no cutting. They went through my rectum with whatever tools were needed to cut, snip and tack. I was discharged the same day as the procedure. I think I took the train to NYC that day and was unaccompanied. Never had any issues after that. The surgery was done by Dr. Steven Gorfine of Manhattan Surgical Associates.

The “tacking” procedure is called “pouchpexy,” and is being used more frequently for several conditions Dr. Bo Shen has referred to as “floppy pouch complex.” 
Here’s a link to a paper introducing the concept and associated problems:

https://watermark.silverchair....85r7UAGNOsqA1nzfhY8Q

CTBarrister posted:

The surgery I had in 2000 to “tack the pouch” was done in Mount Sinai Hospital In NYC. It was done on an outpatient basis under General Anesthesia and no cutting. They went through my rectum with whatever tools were needed to cut, snip and tack. I was discharged the same day as the procedure. I think I took the train to NYC that day and was unaccompanied. Never had any issues after that. The surgery was done by Dr. Steven Gorfine of Manhattan Surgical Associates.

How would they go through rectum to tack it? wouldn't that cause a leak or a fistula by puncturing the pouch to tack it?

Steven Silz-Carson posted:

The “tacking” procedure is called “pouchpexy,” and is being used more frequently for several conditions Dr. Bo Shen has referred to as “floppy pouch complex.” 
Here’s a link to a paper introducing the concept and associated problems:

https://watermark.silverchair....85r7UAGNOsqA1nzfhY8Q

 

link don't work

Pouchomarx2, this site unfortunately does not accept PDF uploads.  However you should be able to download it for yourself here, or simply find it yourself using Google Scholar, Ok?

https://www.researchgate.net/p...floppy_pouch_complex

Pouchomarx posted:

How would they go through rectum to tack it? wouldn't that cause a leak or a fistula by puncturing the pouch to tack it?

There was a septum that developed inside the pouch.  There were 2 procedures to correct it, the first in 1998 which resulted in its re-development, and the second in 2000 which was successful. I do not know exactly what Dr. Gorfine did in the second procedure ( you would have to ask him), but he told me he stapled/pinned back the septum that developed. What I can tell you for sure is that he went through the rectum with whatever he did.  He did not cut through my skin.  It was done as an outpatient procedure.  There was no leaking, no fistula.  I think I was cautioned that I could have a little blood in my stool but I was more or less good to go right after surgery.

He did many J Pouch Revisions, and my understanding was most of them were done that way- through the rectum.  Back in the late 1980s, 1990s and early 2000s this surgical group probably did more J Pouch surgeries than any group in NYC, or perhaps even the USA for that matter. As I mentioned previously, the patriarch of this group who did my original surgery (Irwin Gelernt) did the very first K Pouch in the USA in 1970 and studied under Dr. Nils Kock, for whom the K Pouch is named.  He later pioneered the J Pouch surgery and probably did more of them than anyone before he passed away in 1996.  He was considered the best colorectal surgeon in the USA for J Pouches when I had my 2 step in 1992.