What to expect after Ileal Pouch Anal Anastomosis

“Normal” Bowel movements

Every person has a unique pattern of bowel movements. Some people may go once every 4 to 5 days while others may have 4 to 5 bowel movements per day. What you have and what you have always done is probably normal for you (unless there has been a recent unexplained change in your bowel habits)

Defecation is an involuntary process. It is under the autonomic nervous system and you cannot control it. You may facilitate it somewhat by bearing down to initiate the act of defecation just like you can slow down your heart rate by doing yoga. But you cannot stop your heart from beating. It is an autonomous function and it will beat as it wants to. You cannot control your breathing or your heart rate or the secretions or motility in your G.I. tract. You have no control of these bodily functions. So, let go of this idea that you can control your GI track.

Many people want to have one good bowel movement at the start of the day and then be done with it. In real life that is a fairytale story.

Forcing a bowel movement (Straining for defecation)

Bearing down or pushing down for a bowel movement is a very bad idea. It not only damages the rectal wall and causes swelling and prolapse but it will eventually also damage the pelvic floor muscles as well as the pudendal nerves that supply the levator muscles. One must not spend more than 10 minutes on the restroom commode because sitting and bearing down will cause swelling of the rectum. The brain is unable to process that information and thinks that the swelling/fullness in rectum is caused by stools. It asks you to strain even more, causing the swelling to get even worse. This is a vicious cycle which Eventually results in the solitary Rectal ulcer syndrome. If you have been in the restroom for 10 minutes and nothing came out, then just leave the restroom; it will come later.

Function of the rectum

The function of the rectum is to Store the stools and then evacuate it at the appropriate time. This is aided by the capacity of the rectum, it’s numerous inbuilt reflexes and it’s muscles and nerves.

You have an ileal pouch (not a rectum) so you cannot have the same bowel movements that you used to have before. You Cannot! After an Ileal pouch anal anastomosis, you don’t have the rectum, you don’t have to same nerves, and the muscles have been cut. So, there is no way One can have the same defecation process.

Bowel habits after IPAA

The body however has an amazing capability to re-organize things. Leave it alone and your body will take care of the defecation process. You cannot control the bowel movements (see above). They are an involuntary act and they will happen whether you want them or not. The best idea is to go with the flow and leave the things to your body which will rearrange itself within a period of time. You just have to get used to the way your body wants to evacuate, you cannot control it. So stop trying to have your way.

MiraLAX or other laxatives are taken to treat a slow-moving colon. You don’t have a colon! Therefore, taking any laxatives will only cause your bowel movements to become more frequent, more liquidy, and difficult to manage or control. Metamucil is fiber, it causes the stools to become bulky, so that when the stool arrives in the pelvic pouch the surrounding nerves and muscles have a better idea that the pelvis is full and therefore, they can help evacuate the pouch by allowing the brain to better process this information. Imodium also helps.

The definition of constipation is no bowel movements for more than three days or passing less than 30 g of stool per week. You have neither! You do not have constipation! You have disordered defecation, meaning the stools do not evacuate properly and the treatment for that is biofeedback therapy or controlled evacuation early in the morning using a suppository. Bearing down or pushing down Will only make it worse by stretching the nerves and muscles (making the muscles weaker)