Some folks report success with careful use of Milk of Magnesia. In the meantime, are you *certain* that you’re drinking enough fluid? You should be peeing light-colored urine at least 3-4 times per day. What’s your stool consistency? Also: have you tried psyllium or other fiber supplements?

thank you Scott.   I haven't tried psyllium or any other fiber supplements since the first few months after my take-down.  I was afraid because I have always had the problem of feeling throbbing and pain in the pouch area and I still don't really understand the affects of fiber supplements when you don't have a colon. My understanding was that fiber has the opposite affect without a large intestine.  I also have sarcoidosis so maybe that could be causing inflammation in the pouch/small intestine - another question for my doc.  I appreciate your reply and will try Psyllium with my morning millet.  I happen to have some!

This is me too.I would rather have a big clearout than going back and forth some nights.

@Nela posted:

thank you Scott.   I haven't tried psyllium or any other fiber supplements since the first few months after my take-down.  I was afraid because I have always had the problem of feeling throbbing and pain in the pouch area and I still don't really understand the affects of fiber supplements when you don't have a colon. My understanding was that fiber has the opposite affect without a large intestine.  I also have sarcoidosis so maybe that could be causing inflammation in the pouch/small intestine - another question for my doc.  I appreciate your reply and will try Psyllium with my morning millet.  I happen to have some!

I was told that soluble fibre combines with water and forms a soft gel with the other food/waste in your bowel. I found that only the smooth version of psyllium worked for me – the granular version didn’t seem to combine as well with the liquid to get the desired effect.

I do not know why it slows things down for us and speeds thing up for colon owners. Maybe someone else can explain :-)

I use an enema nearly every AM and take a laxative approx 2x per day. Prune juice or Miralax, once in the AM and once in the evening. Without it I cannot empty my pouch. Output needs to be close to liquid to clear out so that’s my strategy to accomplish that consistency. I need to drink a lot of water to counter the laxative or else I feel dehydrated and crappy but that’s probably the case for most people with a pouch with the more typical loose output. I wish I could have a different routine but I don’t think the pouch function will improver over time, more likely it will worsen. I would recommend prune juice and/or Miralax, starting with a small amount and increasing as needed.

I've heard constipation is caused by the fear of letting go.

I've been taking a teaspoon of psyllium twice a day this past week and have had the healthiest bms of a smooth consistency plus fewer.I think watery output can cause bad bacteria  and causes the inner sphincter muscle to become too tight trying to hold in the liquid.The hospital has sent me over ten containers of psyllium husk and the surgeon said keep taking it and increase it even.I take konsyl.

Hi Chook,
Do you take the psyllium to thicken or loosen your stool?

I can relax my sphincter (I’ve done a defecogram) but apparently have a floppy pouch complex and a persistent sinus tract which per Shen affects pouch function. I also have pelvic organ prolaspe that blocks the outlet. To make matters worse my small intestine is very efficient at absorbing fluid so things thicken up quickly. It was the same as when I had the bag. The combination of all these things means too much straining so I opt for keeping things loose.

I’ve tried psyllium and it bound me up even more which is why I ask you what you take it for. It doesn’t seem to loosen things up for me which is what I need.  And yes I drink enough water. The more I drink, the more I pee. It had little effect on stool consistency after a certain point. I agree that pelvic floor dysfunction plays a role in a lot of cases and I’m sure I still sometimes don’t relax fully but it’s more complex than that. Constipation is a real thing with the pouch. Not that common and not a lot of discussion on it.

I just take it to try and have less BMS by thickening it up and the stool seems easier to empty .

Have you read about the inner sphincter? It's what stops you pooing while asleep,it can become too tight if it's holding in liquid alot.instead of straining try relaxing and breathing to relax your inner sphincter and muscles.alot of people are in a rush when using the toilet but you need to relax and let go.But it sounds like you have other things as well.

I have a doctor who just doesn't really care quite honestly, and to try and see another specialist in my area is impossible. There really are not that many doctors familiar with the entire picture. My family doc has continued to refer me to different specialists and now it's been three weeks of constant pain, no sleep, and the bleeding has begun. Thanks, Chook, for the info about the prolapse and pelvic floor. I am certain there is more going on - on top of the flap over surgery I had in 2021 that I am convinced did not work, yet they haven't bothered to do another MRI. BTW, that was the most painful of any surgery I have ever had in my lifetime with the pain and residual affects lasting months. Again, another doc who I don't think really understood/understands what he's doing, nor does he care about this suffering. I am trying to arrange out of province care.