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4 replies

Struggle to empty pouch

MR Mike ryanMember
Hi I am looking for some advice. It is 9 months now since my reversal, after being on the bag for a year after having my colon and rectum removed due to uc and bowel cancer. My problem is I am still going between 10 to 15 times a day sometimes with urgency and can`t seem to empty fully. I have no problem going but even if I spend half an hour in there trying to force it all out. Often I am back again within minutes doing more and this can happen up to 5 or six times within an hour with something coming out each time but not enough. I could at least half my visits per day or better if only I could just go once and walk away done for a couple of hours. But no matter how hard I push I am still not empty. Is there any techniques to help me empty or anything as I was never shown any. I have had a recent camera examination and the doctor says he can`t find anything wrong, my pouch is okay and a decent size. But its ruining my life as I am constantly running to the toilet which makes working difficult and going out very difficult. I take fybogel 3 times a day and take 8 loperimide, any suggestions please.
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Jan DollarJan DollarModerator, RN, retired
Sometimes, particularly when you had the ostomy a long period, your pelvic floor muscles "forget" what to do for defecation. This is called pelvic floor dysfunction. If you do a search here and in Google, you'll find lots of info about it. It is one of the complications of pelvic surgery. The treatment is physiotherapy/biofeedback.

Basically, you are straining against closed sphincters. The internal sphincter is supposed to relax to pressure from above, but the external sphincter is voluntary.

It is good that your doc ruled out the stuff he can view on a scope, but this problem is not visible on scope. You can go straight to physical therapy, or you can have a diagnostic defecogram to visualize mechanical issues. It is possible there is also a physical issue not seen on scope, like twisting or prolapse that only occurs during emptying.

You are not alone.

Jan Smiler
L liz11Member
yes, sounds like you need a defecogram and a very experienced jpouch doctor scoping you.

in the interim.. have you tried "toilet gymnastics" .. basically moving around into different positions while on the toilet. For me.. what worked best - was "airline crash" position.. leaning over at your waist with your head tucked down by your knees.
BM boy's momMember
My son has same problem and in spite of normal defogram, prolapse was seen in pouchoscopy at Cleveland Clinic. ( 3 other drs had not dagnosed that) Bio feedback with rectal floor reconditioning was prescribed.
Here is question -- local GI pediatrician says bio feedback could help sphincter muscles, but would not help prolapse? Also told not a surgical fix for him. So what is done for prolapse if not bio feedback etc? Has there been anyone on this site who has had success with biofeedback for this issue? Thank you.
Jan DollarJan DollarModerator, RN, retired
It is possible that if biofeedback is successful with the muscular dysfunction, the prolapse might "fix" itself, since it is probably due to straining. It all depends on how serious the prolapse is, I think. Serious ones, like where there is major telescoping of the bowel, they either need to do a resection/redo or possibly tack the pouch in place on the posterior pelvic wall.

What I am saying is that if the prolapse is minor, then it could be overcome and worsening of it prevented by biofeedback training. Not so much that it would be repaired, just more of a non-issue. If he continues to strain, then it will likely worsen.

Jan Smiler

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