Spasmodic Pouch?

I take a prescription antispasmodic called Dicyclomine for IPS and took it before my surgeries for IBS.

I took bentyl. It seemed to work but it made me extremely loopy and dizzy. So i had to quit taking it

Jeff,

I get this same feeling from mild pouchitis in my distal pouch and cuffitis. I am not indicating you have this issue, but if you also have any anal pain, burning, irritation and discomfort (or some blood) along with the pressure, you may want to get checked.

Jeff,

Within one year after takedown I was experiencing frequent and urgent bowel movements in the one hour after eating meals. I was diagnosed with spasmodic pouch. I was prescribed bentyl, then levsin, then donnatal, all anti-spasmodics and all of which work well. With bentyl and levsin I experienced a large degree of feeling loopy/lightheaded, less so with donnatal. You take a pill 30-45 minutes before eating a meal and the spasmodic pouch issue is solved. Completely solved. The only issue then is the degree of the side effects from the meds as discussed above.

I read posts on this board and I think a lot of people have spasmodic pouch after takedown and don't realize it. They try to throw imodium after the problem and imodium is not really effective as it does not control motility as an anti-spasmodic does.

This issue died down for me as I got farther out from takedown. I only need to take donnatal very occasionally these days. A lot of people on the board expect INSTANT results and especially on an issue like excessive motility it took many months or maybe a year before I noticed a palpable change towards normalcy when I ate meals. Try these anti-spasmodic meds and be patient because the motility issue may change over the course of time.

Thank you everyone for the responses, especially regarding the specific medication.

Jeane - Was this discovered during a scope? My takedown was in December and I'm scheduled for a flexible sigmoidoscopy in July. I do have occassional anal pain and a lot of irritation that I've been attempting to treat with calmoseptine. I haven't had blood in my BMs, only a small amount on the wipes.

CTBarrister - I'm going to call my surgeon and request medication because it appears I am battling the same problem that you once did. I know that everyone reacts to medication differently, but I'll try to request the Donnatal since it works so well for you.

Jeane,

One more question: Is it possible that I have cuffitis since I read that it's the recurrence of the ulcerative colitis? I was diagnosed with colorectal cancer, and not UC. Thanks again.

I think Jan can better answer this question and hopefully she will jump on the post

I am not sure cuffitis applies if you have never had UC or a history of chronic inflammation. Perhaps you are still adjusting to your pouch expanding. I do recall experiencing more of what you are describing earlier on in my recovery. I am two years out now and still have that sensation at times but I also have chronic cuffitis. Truthfully that sensation is what often wakes me at night to empty my pouch and I never have nighttime leakage or accidents so in my case I have just kind of gotten accustomed to it. It is definitely a different feeling when you need to empty your pouch than it was when you had a colon. Not sure if that helps it not. Possibly trying the anti spasmodics will help.

Jeff,
Just saw first post question.

Cuffitis can be diagnosed by scope or simple anal finger exam. There are often bumps in the anal canal when performing the anal exam. I had severe anal irritation and burning for many months (no blood) after takedown that it thought was just normal recovery until I had a full scope under anesthesia. I also experience more of the pressure sensation you describe when the cuffitis is active.

I am at two years and take Canasa daily for chronic cuffitis. It is not the optimal solution but without this I would need pouch advancement surgery for that very tiny anal transitional zone area that gives me so much discomfort.

The scope or simple in office anal exam should give you answers but if the pain is internal and not external, your GI may be able to prescribe something to help. If not, warm baths will help with the pain and irritation until you can be seen. I also found calmol (hope spelled right) suppositories that you can get OTC at pharmacy helpful as long as GI agrees. Good luck.

According all of the research I've read cuffitis only happens if you have UC. I suppose you could have had UC too and didn't know it.

You are still healing and the blood could be from small blood vessel breakage, hemorrhoids, skin breakdown from butt burn are a few other reasons I can think of. I think any time you see blood over and over your doctor should be consulted. I hate to contact my doctors all the time but when I do I usually find out I was right in calling them.

Sorry if TMI for some of you but I would get a mirror and look at what is going on. I've used 1% hydrocortisone cream before when everything is chapped looking and it works wonders for what I think of as super butt burn. If it doesn't work then I fall back on calmoseptine. Also I use a bidet sprayer, which is a plain sprayer connected to the toilet's water supply. If you have the room and power supply I'd suggest a bidet seat, but the sprayer gets it done.

Warm Sitz baths are great too.

Jeff..just an add on to CTBarrister's comments regarding the possibility of your having a spastic pouch. Donnatal is often given for irritable bowel. I was also prescribed it during my UC days as I had irritable bowel coupled with my UC.

I had IBS with UC and was diagnosed with IPS with my j-pouch, along with chronic cuffitis. Have you got IPS now too jeane?

quote:

CTBarrister - I'm going to call my surgeon and request medication because it appears I am battling the same problem that you once did. I know that everyone reacts to medication differently, but I'll try to request the Donnatal since it works so well for you.

Jeff-

Just so you know bentyl and levsin are the "front line" drugs prescribed for spasmodic pouch. They worked, but the side effects were too strong for me. They may not be for you. As Jeanne noted donnatal is also prescribed for irritable bowel syndrome and it is something of a multipurpose drug. I found that it worked just as well for spasmodic pouch issues as bentyl and levsin with less of a side effect.

You may want to try bentyl first because it may not tag you with loopiness like it did me. Some people can use bentyl no problema. And side effect or not it gets the job done, as does levsin and donnatal. If you take any of the three 30-45 minutes before meals, your issue with spasmodic pouch should be resolved. It is just a question of the side effects and you won't know until you try. Everyone is different on side effects.