Pouchitis can usually be diagnosed on examination (or biopsy) during pouchoscopy. This doesn't always match severity of symptoms, though. Pouchitis most commonly causes bathroom urgency and frequency, as well as nighttime accidents. Pouchitis usually doesn't cause bleeding, though it can. For most J-pouchers an episode of Pouchitis can be effectively treated with 10-14 days of Cipro or Flagyl (antibiotics). In some cases, Pouchitis keeps coming back shortly after antibiotics are stopped; this is called antibiotic-dependent Pouchitis, and is generally treated with long-term antibiotics (ideally rotating among several different ones every 2-3 weeks, if possible). Some folks (with antibiotic-resistant Pouchitis) don't get adequate benefit from antibiotics.

Strong probiotics (e.g. VSL #3 DS) can help prevent Pouchitis, or at least reduce its frequency. Pouchitis is sometimes managed with a very low carbohydrate diet.

J-pouchers commonly don't have formed stools, and are better off without them (to avoid the need to strain). I'd suggest reserving the word "diarrhea" for when there is urgency to get to the bathroom. J-pouchers have unformed stools, but they usually don't have diarrhea. 

Angie, we've had some folks here who have suffered with Pouchitis for many years, and feel better after two days of Cipro. A well-functioning J-pouch causes no urgency to get to the bathroom, with 4-6 bathroom trips per day. Working most jobs just isn't an issue, unless something's not right.

I have had periods when my trips to the bathroom are noisy, but there's no way I'll be housebound for a reason like that. If at all possible for you, I'd recommend living your life to the fullest, even with noisy poops in public bathrooms. This isn't a gender thing, it's just a challenge to try to overcome. Most of us choose to make the noise and live with it. If you can't fart in a bathroom then where, exactly, are you supposed to fart?

Not too much to add to Scott's reply. However, one thing I need to point out is that pouchitis is mostly an issue for those with IBD, not FAP. It can, and does occur, but is more likely to be an occasional thing.

But, you can also get bacterial overgrowth (SIBO), which has the same treatment, antibiotics. A diet high in carbs tends to contribute to the symptoms. 

Another consideration is IPS (irritable pouch syndrome), which is essentially the same as IBS. The symptoms can be quite similar to pouchitis or SIBO, but antibiotics are less useful. Diet plays a big role, too. 

If you feel functional the way you are, then there is no issue. If not, talk to you GI about it.

Jan

Thanks Scott and Jan.  The information was so helpful.  For me, I think my situation is "normal" for living with pouch, now that I heard from both of you. I wanted to check.  I do think I lived my life really fully with the pouch for about 23 years - then I had some things go wrong and I have not really been doing so since.  The reasons for that are multi factorial and are problems only I can solve - and some are just working on coping skills, etc.  Rx: major depression and PTSD is part of it, for sure.  I actually think I'm doing pretty well with those two things - but I really do take life a lot more slowly now.  I'm sure there is a middle ground to be found - and at times I find it and at others, I stay home a lot. 

Lucky for me I am an introvert who loves to read, garden (when it's not too hot), paint, knit, refinish furniture - all solitary pleasures that I truly do enjoy - which I think means the depression is a lot better.  I do enjoy my life now - but it's a very different life from the working woman I was. So - trying to find a balance.  Thanks for listening and for your answers.  Obviously, walking and getting out and about help the depression - I know the solutions - digging in and doing them are not easy, but then life never was easy  The depression (I think half of America is depressed!- or think they are) - is on both sides and there were suicides on mother's side of family.  So, I think I come by it honestly.  I have also had a tremendous amount of joy in my life and I don't take a moment of a good day for granted! I hope I can do the part time job I have been asked to do.  It would really build my esteem if I could do it! Frankly, I struggle to now if I just got lazy or if I'm depressed - it's hard to tell as it's a very physical thing for me - maybe that more so than emotional.  Like I'm carrying a 100 pound weight of something all the time.  This happened after my NDE and has sort of never changed.  Luckily, I have a friend who is on the board of IANDS - International Assoc. for Near Death Experiences (she is a former prof. of mine in the counseling field) - and many NDE people go through all kinds of depression struggles - nothing unusual about it. This was long - but it helps me to vent - and I truly do take your suggestions to heart and want to make the best of my time here on this earth.  I know life is a gift - and that joy and pain are part of the journey. Thanks to you both!