Mark, I can't tell exactly which "lots of things" you've tried, so any advice feels like a potential waste of time. Nevertheless:
Some people have leakage because of liquidy output. Metamucil (or Benefiber or Citrucel) will make your output less liquid, so could potentially help. Others find that the extra bulk from Metamucil has the opposite effect, and some even get gassy from it. It's an inexpensive experiment, in any case.

Many folks with nighttime leakage have pouchitis; some are cleared up in a jiffy with Cipro or Flagyl. Maybe you've tried it, or maybe you haven't.

Sorry I should've said. I am on constant cipro and I take loperamide daily. My doctor dilates my pouch every 6 weeks to try and stop the leakage but it never works. I tried psyllium husk tablets and they have me bad stomach cramps. I have tried not eating before bed and also eating foods that are supposed to thicken it up but nothing ever works

I have been having this same issue for the furst time in three years for a couple of months. My surgeon also suggested Metamucil. Why are you having your pouch dilated for leakage? I also have chronic pouchitis and take augmentin and my pouch had been functioning very well other than this very annoying issue. It is mild but had been occurring almost nightly for the last couple of months. I am also sleeping more heavily and for longer periods of time before emptying and I think this is also contributing to my issues. I hope others have some suggestions also as after suffering forever with anal pain and cuffitis, this has greatly improved only to be replaced with nighttime leakage. To be honest though I would take this over the chronic anal discomfort. My concern is whether it is harming the pouch or not?

Metamucil is psyllium husks, so I don't recommend that you try it, since you already are intolerant of psyllium husk.

Unfortunately, once you've tried all the "tricks" you are left with patience and time. Sometimes, however, there is nerve damage that is permanent.

Jan

Jan,
Would permanent nerve damage show up early after the operation? I am more inclined to think the leakage is from pouchitis. In my case I had no issues like this until my last biopsy that showed true damage to my tissue versus superficial inflammation like I have had pretty much since the takedown three years ago. I keep wondering if I should be more concerned about this than I am as other than the leakage issue my pouch is behaving the best it has in three years the last few months. I also think I sleep through the urge to empty which I never did in my first two tears and that is why we may sometimes experience leakage.

I would think that it would be an early symptom. Nocturnal leakage post op is pretty common. The sphincters normally relax some during sleep to allow for expelling gas. There can be temporary nerve trauma/damage that is subtle, and this is why it is only appparent during sleep. Weak sphincters could even be present before surgery, but not tested with chronic liquid stool. This is why some people are helped by bulking agents.

Mark, since you are intolerant of psyllium, you may want to try methylcellulose (Citrucel) or wheat dextrin (Benefiber).

Also, if you can eliminate excess gas production, there should be less leakage (because of the tendency to release gas during sleep). This is why antibiotics may help.

But, without evidence of pouchitis or bacterial overgrowth, you just have to assume there is persistent sphincter weakness or nerve damage. If antibiotics help, but there is no pouchitis, then there is bacterial overgrowth.

Jan

Some additional ideas: any particular antibiotic can stop working for you. I used Cipro very successfully for a few years, but it ran out of gas (no pun intended) not too long ago (nighttime leakage, etc.). At that time I was able to get things back on track with doxycycline. A probiotic like VSL #3 DS may also help (at least it helps me). Some folks see benefit with a low carbohydrate diet. Some people (like me) do better with Lomotil than loperamide. Good luck!