Trouble emptying, then urgency

Did you have these symptoms before you started Flagyl? If not, I would suspect that the thickening of the stool from Flagyl was sufficient to reveal a bit of an emptying issue.

A j-pouch does not empty like a rectum. A rectum contracts to empty, while a j-pouch empties mainly by gravity and relaxing the sphincters. So, thickenng of the stool can have a big impact.

So, even though the Flagyl is working, by thickening the stool, you can still have some unresolved pouchitis, and if you are not fully emptying, the residual stool can be irritating, leading to this urgency. I sure get that when I have pouchitis. If your studies rule out structural obstruction, I would assume it is pouchitis + too thick stool.

Jan

Thanks Jan. I was hoping you would reply.

I was on cipro before this happened but it didn't feel like it was working. I went off cipro and then this issue started so I went on flagyl (I had some left over from another time).

So, if the flagyl could be causing this potentially, would it be good to go off the flagyl and see how I do with looser stools?

What would you do?

Well, if you have pouchitis, it should be treated. Rather than "throwing out the baby with the bath water," and going back to square one, I'd stay on the Flagyl, but increase fluids, especially fruit juice, to help keep things a little looser. If you are taking any bowel slowers, I'd stop or reduce them until you are no longer on antibiotics.

I definitely have to adjust my usual regimen when I am on antibiotics.

Jan

I think it is both, pouchitis and some scar tissue in the pouch because in the last few days I'm eating much less and having more liquids like broth and taking the flagyl and the urgency has died down thankfully. But the feeling like I can't empty is still there.

Today I did a small bowel barium test where I drank this awful chalky stuff and they xrayed my small intestines. She said I might be there up to 4 hours as they watch the barium go through and the average time is usually 2-3 hours for it to go to all the way through. However, after I drank the barium, they had me lie down for 15 minutes for my first xray. She said they'd take several as the barium went through me. But, after the first xray, they said it had gone through me already (in 15 mins) and was in my pouch. I'm wondering if the test was even worth it?

What does that mean that it went through me so fast? Is that bad (in terms of absorption or something else? Could this explain my dehydration problems?)

It may or may not mean anything. Barium contrast media can be constipating for some, and purgative for others. The good news is that it did not hang up anywhere, so if there is narrowing anywhere, it is not severe. Sometimes, weirdly enough, that barium contrast seems to clear up obstructions for people. But, if you are still symptomatic, then obviously not an obstruction.

Your emptying problem may very well be functional and not structural at all, unless there is anal stricture (which would not show up on this study), but that has been ruled out.

Jan

I had my flex sigmoid yesterday. I stayed awake for it. The last one was 15 months ago which showed a little inflammation in the pouch. Yesterday's showed inflammation all over the pouch, like wallpaper! It also showed the area where my anus and small intestine are connected to be narrow. She put a balloon in there and tried to make it bigger but it was so painful with all the air that she stopped. Is that called the inlet?

She said she wants me to come again and get sedated and do the balloon. I have such a hard time with clear liquids the day before, I get so weak and I'm already thin that it's hard to go through this. Add on sedation and I'm worried because any kind of sedation or pain meds go right to my head and make me feel horrible, really drugged up.

She said that she'll give me something for the pouch in the next few days once the biopsies come back. In the meantime, and for the last 3 weeks, I am getting up hourly to go to the bathroom, losing weight and super weak. I still have this sense of urgency even though barely anything comes out because I'm not eating much. She mentioned enemas or suppositories. Any suggestions on what has worked for you?

I'm thinking of also starting the FODMAP diet. I wonder if sugar is at least partially causing all of this. I have a sweet tooth and need to reign it in.

The connection between the pouch and anus is the outlet, not the inlet (that is the top of the pouch). Anyway, this is often referred to as an anal stricture. Can't imagine having balloon dilation without sedation. And actually, they generally do this with full general anesthesia, not just sedation.

Even if drugs make you feel lousy, you need this addressed. The stricture is probably causing the pouchitis, because you never really empty well. If you get the stricture addressed, the pouchitis is easier to treat and have it stay away. You will feel better overall and feel like eating a normal diet.

Jan