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Do you get partial obstructions with j-pouches?

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Posted 2/13/2015 1:29 AM (GMT 0)
They're not something I seem to hear about. Also, j-pouchers don't receive the same diet advice that ileostomates do: namely, chew, chew, chew.

Reason I ask is because I saw my GI at the end of January and he was unexpectedly positive about me having an ileorectal anastomosis - it helped that my recent MRI scan and flex sig was clear for Crohn's (I do have diversion proctitis tho'). He said he would refer me to the surgeon. Hopefully I will see her in April.

Despite not having Crohn's or a stricture, my stomach has been bugging the hell out of me lately. It gets so sore and uncomfortable, especially very near or behind the stoma. Calling it a 'partial obstruction' is a bit strong, but I dunno what else to call it - IBS? It does feel like things get backed up behind the stoma, but not to the point of causing an actual blockage.

At this rate, I'd almost have the operation just to make my stomach better. I'm not as optimistic as I should be for various reasons. But, nevertheless, if the surgeon agrees I can't see myself turning it down. I think an IRA can be treated like a j-pouch; they're similar enough. Anyway, I'm just wondering: do you - in the absence of a stricture - ever have to worry about obstructions with a j-pouch?
Posted 2/13/2015 6:30 PM (GMT 0)
Most people who have an ostomy reversed have narrowing at the part of the intestine where the ostomy used to be. Some people have a lot of problems with obstructions there, some people have no problems whatsoever. As with most of these things it tends to be related to your propensity to form scar tissue. On j-pouch.org there are several veteran pouchers who struggle with adhesions and SBOs.

Since having my reversal I have had a few instances of feeling bloated/overly full that made me concerned that I might be working on an obstruction, but I don't believe any of them truly were -- none ever escalated to nausea/vomiting, severe pain, or an ER trip. I do still chew very well and limit fibrous foods, not because of fear of blockage, but because they tend to cause anal irritation for me during bowel movements.
Posted 2/13/2015 6:40 PM (GMT 0)
I wasn't going to post here anymore, as a lot don't seem to like "the truth" or "my reality", call it what you will. I know I'm not answering your question NCOT, but please, tread carefully. It's now a full 3 months since my takedown, I'm a 43 year old man that hasn't cried so much since birth, have suicidal ideation and DO NOT recommend a j-pouch. Others do, it worked for them, I'm happy for them. Me, not so ******g much!
Posted 2/13/2015 6:43 PM (GMT 0)
I will also add; if you do "go for it", get used to living on Complan, if I stopped using it that suicidal ideation would be "my reality"!
Posted 2/13/2015 8:36 PM (GMT 0)
Knock wood, in the 4 years with my j pouch I've never had an obstruction.....partial or otherwise. I'm not particularly careful either. Good luck NCOT....hope this is something that works out for you.
Posted 2/13/2015 9:28 PM (GMT 0)
Without wishing to sound condescending, please also bear in mind that you have Crohn's. It's current status, active or not, has no bearing on it's future (potential) impact. A J-Pouch will not "cure" Chrohn's, but as I say, I don't wish to sound condescending, you already know this.
Posted 2/13/2015 10:41 PM (GMT 0)
whoa, that's some crazy good news for you, NCOT! I think...??? I'm absolutely horrified to hear of your mental status, SL- if there were anything I could do, believe me, I would! Are you nervous, NCOT? Excited? You'll do it? And the doctors seem to think this would help with your current problems because...why exactly? They haven't found any mechanical cause of your stomach problems, right?
Posted 2/14/2015 1:25 AM (GMT 0)
One reason why I haven't talked about this earlier is because I've had other things on my mind. I've got a new flat >_>. An empty new flat, which will require painting, carpeting, etc. Even choosing the paint colours is triggering waves of major anxiety :-/ Doesn't help that I caught a cold a few days ago and am still feeling rundown from it. I can't help wondering if anxiety over the flat is making my stomach worse. Which, in turn, triggers more anxiety.

SL - Sh!t, that's crap news, man. What's your main problem? If it's diarrhoea, there's still hope left that it might get better over the next few months. However, practically speaking, if it doesn't get any better, can you not revert back to an end ileostomy? Some people with j-pouches do end going back to an ileostomy, 'cos of Crohn's (usually). I see no reason why you couldn't do the same.

As for me, I feel caught between the devil and the deep blue sea. If I could eat without fear and had my old cast-iron digestive system back again, I wouldn't even contemplate rocking the boat with a reversal. As it stands, I'm more inclined to do it because if I'm going to be miserable, I might as well be miserable without a stoma. I know from past experience I can live with 6-8 BMs a day, particularly if they're mostly evening ones. If the diarrhoea is worse than that, it could pose a problem. And, yeah, the risk of Crohn's returning is a perennial worry. I do have to say that it can return with an ileostomy; I've heard a few nightmare stories of ileostomates having to deal with fistulas under the wafer. But the risk is probably higher if I get reconnected...

Pluot - Oh crap, my one remaining hope is dashed :-/

Eva Lou - My GI didn't suggest surgery to me; I was the one who asked him. I hadn't seen him for well over a year and was determined to ask about surgery one last time. The question made him stop in his tracks, and he thought deeply for about 30 seconds. To my utter surprise, he sounded in favour of it. He'd obviously forgotten, but I had asked him about the same surgery in 2013 and he was down on the idea then. Didn't seem to think it was a good idea; along with a couple of surgical registrars as well.

But this time his tone was quite different. He didn't try to deter me at all; even said he would refer me for a second opinion at St Mark's if need be. He talked about FAP patients and said that they were happy with the results.

As far as I know, there's no mechanical cause. Though I would like to make absolutely sure of this with the surgeon when I see her. I'm satisfied there's no Crohn's; I'm not satisfied there aren't any kinks or narrowings (due to adhesions) anywhere.
Posted 2/14/2015 5:33 AM (GMT 0)
I'm curious to know what a J pouch is. I have a stoma & a colostomy bag, following 2 perforations in the colon & a Hartmanns procedure June 2013. I am not going to try having a reconnection, as I was told by the colorectal surgeon that I would be one of the more difficult to reconnect. This was I can control the firmness of my faeces. No more living in fear of severe constipation & possible perforations for me.
Posted 2/14/2015 11:23 PM (GMT 0)
Hey NCOT, I really didn't mean to dash your hopes... in fact I think most people think I'm pretty optimistic about the j-pouch. The fact is that there are no guarantees in life. Partial obstructions are possible with j-pouches, with ileostomies, and with anatomy that is 100% normal and untouched. Some people do have partial obstructions with j-pouches but I think the incidence is no higher than it is for ostomates. There are plenty of reasons to move forward with reversal or to not move forward but I don't think the perceived risk of SBO should decide anything for you.
Posted 2/14/2015 11:50 PM (GMT 0)

Spook54 said...
I'm curious to know what a J pouch is. I have a stoma & a colostomy bag, following 2 perforations in the colon & a Hartmanns procedure June 2013. I am not going to try having a reconnection, as I was told by the colorectal surgeon that I would be one of the more difficult to reconnect. This was I can control the firmness of my faeces. No more living in fear of severe constipation & possible perforations for me.

a j pouch or its medical name, ileoanal anastomosis, is a procedure they do for UC patients, colon cancer patients or FAP patients. The entire colon and rectum is removed and a portion of the small intestine is brought down a formed into a "J" which essentially becomes the new rectum.
Posted 2/15/2015 3:38 AM (GMT 0)
I've had my pouch for a little over 5 months and I personally haven't had any issues with structures or obstructions. I do get pain and stuff down by the connection and things do bother my pouch which lead to gas or more BM's but 5 months post op and things are pretty good.
Posted 2/16/2015 10:33 PM (GMT 0)
I went 23 years with my j pouch, then out of the blue, started having partial, and full blockages due to adhesions. So when the surgeon went in to work on the adhesions, he disconnected the pouch, but didnt remove it due to being so scarred in, and so difficult to remove. With my ostomy, so far I have been able to eat anything I want to, just like when I had my j pouch.
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