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So I managed to get in to see a new GI here in my new home area.  First, I had an appointment with the GI's assistant who gathered as much information as possible (the GI was away that week).  A week later, due to a cancellation, I was able to get in again and had a Pouchoscopy done at the hospital.  It was my second one in about 6 months.  I have moved a lot, and each time I relocate it seems my new GI wants to do his or her own scope to see what's going on in there. 

The procedure went as usual.  The GI's findings were that there is some Crohn's apparent in the small intestine as well as some inflammation in the pouch.  Not really bad inflammation, but it is visible. 

However, there was one thing that the GI said that I had never heard before from any of the GI's I have seen over the years (and there have been several).  He said that my pouch is much smaller than the standard ones he has seen.  He says that my high frequency over the years is quite likely attributed to the smaller pouch and smaller resevoir.  He gave me some centemeter figures - which I don't recall at the moment.  He said that my pouch was roughly half the size of the norm.  So even when there is no inflammation and my intestinal health is optimal, I can still expect high frequency - (6-9 bowel movements in a 24-hour period is what seems about as good as its been for me).  When there is inflammation, things become a lot worse. 

I asked him why my pouch is a lot smaller than the standard and his response was "you'll have to ask your surgeon that question."  I also asked him why none of my other GIs ever mentioned this to me.  His response was "they probably didn't measure it."  Hmmm, that answer makes sense - but just how did he know how much smaller it really is? 

This information is interesting but also upsetting.  He wants to make efforts to get the inflammation down with medication because he said that at some point it could result in a stricture or closure that could cause a major problem.

Thoughts?

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That's useful to know, I think, even though there's not much you can reasonably do about J-pouch size, short of surgery. It's possible that your surgeon chose to make the pouch smaller in order to enable the blood supply to reach properly (I'm not certain that the anatomy works that way, but I think it might). It's also possible that your surgeon simply didn't do an ideal job.

I think your GI's advice about managing the inflammation is exactly right.

Hi,

IMHO 6-9 is not high frequency. I was quoted by several surgeons prior to choosing one, that I could expect 6-8 BMs per day. And that’s exactly where I am at 3.5 years later.

like you, on bad days; IPS, cuffitis, or SIBO flareups the number goes higher.

on days where I only have 4-5, i  know the following days I will have more as the small intestine needs to clear itself out.

please don’t stress, your outcome is your outcome (same with me). We just have to make the best of it, as I am never going thru this process again.

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