J-pouchers generally have "pouchoscopy" rather than proctoscopy. Pouchoscopy is usually performed with a flexible sigmoidoscope rather than a proctoscope, but that may be what he plans to do. It can be very reasonable to "take a look," particularly if he will take a couple of biopsies of the rectal cuff (the tiny remaining part of the colon that can still develop cancer). If your colectomy was done for cancer or dysplasia (or FAP) such screening is very important. To be honest, I delayed pouchoscopy for years until I had symptoms worth addressing. Some folks have them annually, and some are comfortable with three years or longer between.

Loose stools are completely normal for a J-poucher, though ideally they're more like pudding than water. If you want more formed stools then soluble fiber (e.g. Metamucil or Citrucel) is a better idea than antibiotics (IMO).

The prep should be very basic - an enema or two prior to the scope. 

It is routine to check a pouch (pouchoscopy) annually with biopsies if dysplasia were found in your colectomy pathology report or you had surgery due to this.

Four stools a day does not sound like pouchitis to me, especially if you are not experiencing other symptoms (cramps often in waves, urgency, increased frequency, anal burning, night time leakage, sweats, fatigue). You usually know when you have pouchitis, but people can have some inflammation (very common in pouches) and be asymptomatic. My GI says she often has to drag her patients who are feeling well in for an annual scope.

If you feel this should be done as a routine check to also biopsy the remaining cuff (which is a very good idea), then I would agree to it. I have had more pouchoscopies than I can count and I do sometimes have issues for a few days after the biopsies are taken, but I also have a dilation done at the scope time due to a re-curing stricture at my anastomosis, so this could be one reason I have some struggles (if you read my prior posts, I have had many complications with my pouch). You should be fine if you opt to have the procedure done.

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I agree, periodic scoping is routine, so don't worry about that. However, an enema the night before will do absolutely nothing as a prep. Like spitting in the ocean. Even a few hours before is worthless. My doc just has me do tap water enemas until clear before I leave the house. Not sure why your surgeon told you to never have an enema again. Seems rather extreme to me.

Jan

My surgeon and GI basically make me NPO (nothing to eat or drink) at midnight.  However, I, to be "safe" for good, clear photos take a half dose of MOM at night (15mls), and then before the test do one or two tap water enemas (I empty a Fleets and fill with warm water from the tap).  That seems to be plenty, and I've always had no issues with doing things this way.