While I would not be overly concerned, especially if you are not seeing actual blood, the fact that it’s now happened twice, would cause me to seek out an opinion from a urologist.

They would be the best qualified to determine if further testing is warranted.

Probably not a bad idea except for the fact that where I live, it would probably take at least 2 years to get in to see a Urologist! 

That brings up another matter I have been meaning to post....  I've had my j-pouch now for almost 24 years.  It has obviously changed my life drastically in a lot of ways.  Hopefully for the better; who knows what life would have been like if I chose to forgo surgery and continue along thr path I was going...

Anyway, for those nearly 24 years, each and every time I have a bowel movement (which has likely been 7-12 times / day on average), I push hard to try and empty everything that will come out.  This may sound disgusting and something trivial.  That said, I feel better and I am also convinced that it serves as more of a preventative thing.  I am a very active person and would prefer to know that I won't have that urgency again - or at least be able to delay it for a later tike than what may have been.  If that portion of my digestive system is emptied completely, then it is likely to take longer to feel the need to go again.

Are most of you doing the same thing or am I doing something that could be detrimental to my health / the health of my pouch?

According to all procedures / exams in recent years, I am told that my pouch is intact and in really good shape.  Thanks for reading....  I always appreciate your responses and input. 

I used to take a shuttle bus into the Bronx; between the bad roads and bad suspension the story was that a number of the people on that route would develop blood in their urine after a couple of weeks.

@capper I also try to empty my pouch pretty well, but I try to avoid pushing hard. Even though it has been okay for you so far it really can cause problems. Be gentle - it’s the only body you get.

In my experience pushing hard is of no use. Pushing normal is enough to empty the pouch (given that your stool is not too hard), which has a normal volume of only about 300 ml. That's not so much, especially if there is also gas, and it's less than the volume of a rectum at the end of the colon that we had before the pouch.

I prefer to wait some time and lean forward, backward and to the sides, so that my small intestine keeps working and pushes some more stool forward into the pouch by peristalsis. This is nothing you can do willingly.

For several years i have had non visual blood in my urine but microscopic. Urologist did a cystoscopy twice over a few years and found nothing suspicious in my urethra or bladder. so no idea