Bleeding with j-pouch

I wouldn't worry unless you are running a high-fever, as that would be go to an ER asap event (you;d want to get checked for sepsis and infections from perforations).

There's a few reasons you might see blood with a j-pouch. Two of the most common are rectal cuffitis or pouchitis. You can still have hemmeroids, fistulas, abscesses, and fissures as well.

Inflammatory Complications

Pouchitis is the most common long-term complication of patients with a J-pouch. Clinical manifestations include abdominal cramping, increased stool frequency, urgency, incontinence, nocturnal seepage, pelvic discomfort, and arthralgia. 5 Similar symptoms can be seen in patients with CD of the pouch, cuffitis, pouch sinus, or irritable pouch syndrome. The severity of symptoms is not directly related to the degree of endoscopic or histologic inflammation of the pouch.16 Endoscopy is the most reliable diagnostic tool. A combined assessment of symptoms and endoscopic and histologic features should be taken into account to diagnose pouchitis. The complication is primarily treated with antibiotics; pouchitis that is refractory to antibiotics should be treated with anti-inflammatory agents, immunomodulators, and biologic therapy.

Cuffitis is common in patients with J-pouch, particularly in patients with stapled anastomosis without mucosectomy. Cuffitis can result from residual ulcerative colitis in the rectum, CD of the pouch, prolapse, or malignancy, and can cause symptoms mimicking pouchitis. Frequently reported symptoms include large-quantity bloody bowel movements, increased stool frequency, urgency, incontinence, pelvic discomfort, nocturnal seepage, and abdominal cramping.10 Cuffitis is diagnosed with a combination of clinical, endoscopic, and histologic examinations. Treatment modalities include mesalamine suppositories, topical lidocaine or corticosteroid agents, and occasional endoscopic injection of long-acting corticosteroids.1

It is usually the rectal cuff that bleeds. Is it painful like razors? Or is it just the skin around your anus/bad butt burn?

If it is cuffitis then you could ask for some Canasa suppositories.

If it is just little bits of blood then I wouldn't worry too much. I'd be more concerned about other symptoms like increases in frequency, difficulty emptying, very gassy, etc. Your post wasn't more specific than just bleeding.

I would chew your food better and just watch it like your doctor said. Have you had a scope recently?

Was the doctor a GI? I would find a surgeon/GI, I am aware that you will need to see someone new, but you should get a quick scope. It only takes a moment and you might have pouchitis of cuffitis.

Yes it's not a hemorrhoid. I never had these

The doctor I called was my surgeon. I took a risk by calling him. Maybe that's why he was not interested in helping me and just told me to observe it.

I'll meet with my GI tomorrow

I'm glad he responded to you, but I agree, you should seek out a new surgeon after how he treated you. Sorry you're still having to deal with so much crap even after surgery. That really sucks.

That's great Andrina. That's right around the corner and it will be a relief to know what's going on. Good for you for taking this step.

The scope is on the 16th. I just noticed I mistyped it in my post above. That was my fault

Could you get bag again???

3timechamp said...
Could you get bag again???

Omg I don't want that. This triggers me hard. I don't think I will be able to sleep tonight edit thanks I'm in a full blown mental breakdown and I still have to go to the pharmacy. I can't go scream crying like I'm doing right now

What's the difference? You can still get inflammation in your intestine whether it's up through your belly or down at your anus? It doesn't matter. My autoimmune disease is active no matter what

I'm on azathioprine why isn't this already enough? I'm getting ready to pick up cipro too. I'm afraid it comes back after two weeks on it

What's funny though is when I was without aza I soiled myself a couple times at night. Started aza again and I'm now able to sleep without diapers. I can even fart. Why is it still pouchitis? The inflammation is clearly visible in the pictures. If I ever get this under control will I get even better?

Surgeries are not a cure and the whole procedure with my surgeon and everything was such a bad experience in my life. Never in my life did I realize what a bad person I am and I've been aware of this 24/7 now. It's so exhausting. I still have people tell me I'm rude even though I don't mean it and I think I'm normal and everything is fine. It catches it me off guard each time I get told I look angry and I'm rude. I'm such a waste of life.

Post Edited (Andrina) : 12/16/2019 7:17:17 PM (GMT-7)

I'm sorry to read you're going through this. It sounds horrible. Hopefully the cipro helps and it doesn't come back. And you aren't a bad person. You are going through a lot, try to cut yourself some slack. Who is telling you you are rude and look angry? First of all, I'd be angry too dealing with all of that. I hope no one close to you is telling you negative things about yourself. I've been frustrated and down lately about my heath and I found an in-person CCFA support group that is a little over an hour away from me. I haven't made it to a meeting yet, but I want to. Not sure if there is anything similar near you or if it would help. I just want to meet some people to talk to in person who understand.

Yes thankfully the arthritis is controlled at the moment with 100 mg of azathioprine since the end of October. I haven't been on it for full 2 months yet so hopefully there is still room for improvement and it will help my j-pouch too.

Why do we get pouchitis? Shouldn't the small intestine not be affected by inflammation or do we have crohn's? And how would a bag make everything better? Because it's no longer attached to the cuff that could still spread inflammation?