Need for Dilatation

Reading old posts on here: A lot of people needed dialation for stricture issues. Some symptoms from old posts were: diarrhea, tons of straining, etc. from what I remember from reading the old posts.

Did your doctor recommend dilation for you??? Or have you expressed your concerns???

I have already been hospitalized in 12/2020 for surgical correction of “webbing” at the site where the pouch was surgically connected to the anus. I am experiencing increased straining. Stools are soft but difficult to pass. I will speak with my GI surgeon. thank you for your response.

Proctocolectomy: 2/20/2020

Takedown: 19/3/2020

I have often wondered about this, because as the years go on (I am 10 years out) the anal opening gets smaller and smaller because no firm stools are expanding the hole. When I do the camera pill, I worry that it is not going to come out at the end. How DO you get dilated? Normal vaginal dilaters are too big. All of this certainly inspires me to keep my food well-chewed!

My GI surgeon says that a catheter is used for dilatation. I have not yet experienced dilatation, and not certain I would undergo the procedure without sedation. What have others’ experiences been.

Thanks,

Mary Flood

Mary F,

I find it hard to understand what your issue is from your posts.  The "J Pouch" does not get dilated.  What gets dilated, usually, is a stricture, and strictures usually happen at the J Pouch inlet, the J Pouch outlet, the anus, or perhaps in the neoterminal ileum.  For the most commonly strictured area- which is the J Pouch inlet, due to backsplash stool- a flexible sigmoidoscope can be used to do the dilation.  In fact, I am strictured at the J Pouch inlet and my GI said it's a very simple test, he can either get the scope through, or not.  If the scope can go through the anus, J Pouch outlet, inlet and into the neoterminal ileum, no dilation is needed.  If it is needed,  other dilations are done by means of a balloon dilation, using a balloon.

I am not clear on how this procedure would be accomplished with a catheter.  Catheters are typically used to do cardiac dilations.  However, I am not sure exactly what your issue is.  You mentioned "webbing", and what I think you are referring to is a septum within the pouch.  I had the same issue, and it was surgically resolved in 1998 by a J Pouch revision.  This is different than a dilation.

Renee, firm stools are not needed to prevent a stricture or narrowing of the anus. As long as the scope can go through it, there is no issue.  It does expand regardless of the firmness of your stools. What causes strictures is inflammation and/or scar tissue narrowing the channel. Lack of use or expansion doesn't cause a stricture.

@CTBarrister, thank you for your helpful post. Just to clarify, I was not saying that lack of firm stools causes strictures, but I am quite sure they contribute to the outlet (anus) being less large and flexible. I don't know of your background, but I am a nurse (or was one) and I feel quite certain that the anus will get smaller if nothing large is ever passing through it over time.  This is why GI doctors must use "child" scopes to take a look at our pouches, rather than adult size endoscopes. 

I don’t think I will ever post another thing on this website.  I find the answer from CT Barrett quite arrogant. I thought I was asking a simple question of individuals who may have experience with issues pertaining to a J-pouch. Instead I am initially told my issues were discussed a long time ago, insinuating why should I be bringing this up again. Then, CT Barrett makes me feel stupid, giving me an anatomy lesson on what needs to be dilated.
  You should let people know that if they plan to ask questions on this website they need to be prepared to be mocked and ridiculed.

Mary F,

My intention was simply to provide information (including my own personal experience with a dilation issue), and try to figure out where exactly your issue is so that someone here can help you. I am sorry if you felt otherwise. I never said your issue should have been resolved, I am asking questions so we can find out what the issue is. The webbing issue you referred to is also called a septum by some doctors, and it may not have been resolved by your surgery. However, if that's what your issue is, it's most likely a surgical issue and not a dilation issue. That is all that I meant to say. I actually had 2 J Pouch surgical revisions done to resolve that same issue because the first one did not succeed.  I had a sensation of stool being blocked by something, like it was hitting a wall inside the J Pouch. And that  issue was resolved by a second surgery which involved cutting and stapling tissue to remove the "septum". A dilation is a procedure that expands tissue through application of pressure. Depending on where the dilation procedure is done, there is a risk of tearing of tissues. That's why it's important to know if it's at the anus and will impact on the anal sphincter, because incontinence is a risk with that type of procedure. And it's actually a risk whether it's a surgery or a dilation if it's done in that area.

Are you a GI surgeon? My GI surgeon referred to my issue as webbing. I will ask him to run everything past you the next time before he speaks to me. I know what a septum is. It is an abnormal opening between two areas, such as an atrial septal defect in the heart. I did not post here to have my GI surgeon’s terminology corrected or to receive a diagnosis from you. I asked a simple question about others’ experiences with need for dilatation.

A septum is a wall, not an opening. So the nasal septum is the wall between the two nostrils, and an atrial septal defect is a defect (opening) in the wall between the left and right atria.

Mary,

The terminology used isn't important. I had a flap or as Scott said a "wall" of tissue that was blocking stool in my J pouch. My surgeon called it a septum. Yours called it webbing. I am suggesting it's the same thing. My doctor also called it a "flap". It's an abnormal development of tissue or a channel that is impeding stool. That is the bottom line. There was no intention to belabor the terminology because I think we are referring to doctors using different words to describe the same phenomenon. Nobody is "correcting" anything, as opposed to providing information. Doctors can and do use different words to describe the same thing. I am just sharing my experience with what sounds like a very similar or the same issue.

Hi Mary, I had dilation done under anesthesia. I'm my case I ended up with several blockages needing hospitalization and a gi tube to unblock before they finally tried to do a pouch scope and found the stricture that didn't show up on ct scan. So I guess my symptoms were pains in the abdomen, constantly straining and not being able to empty my pouch. Bloating was terrible also, and I would feel nauseated alot. Hope this helps you. I do self dilate now a couple of times a week. It helps.

Aimee

@Mary F posted:

I have already been hospitalized in 12/2020 for surgical correction of “webbing” at the site where the pouch was surgically connected to the anus. I am experiencing increased straining. Stools are soft but difficult to pass. I will speak with my GI surgeon. thank you for your response.

Proctocolectomy: 2/20/2020

Takedown: 19/3/2020

Your welcome! Hope things get better