It has been over a year since I last wrote an article in the Pelvic Pouch Newsletter. Many of you who know me from Mount Sinai will perhaps remember that I have been a recipient of funding from the Crohn's and Colitis Foundation of Canada to study antioxidant vitamins in Crohn's disease, as my thesis project at the University of Toronto. My research has been going well; when my data is all analyzed and my thesis written, I will update you on that information.
Now it is time to think about pelvic pouches and how diet/ food intake might affect stool output. Anybody who has had a pelvic pouch created will probably recall having a rectal tube in place after the surgical procedure. That is because the stool coming through a newly created pouch is liquid, so the rectal tube allows you to control stool output. The loops of small bowel that are stapled together to form the pouch were accustomed to passing liquid stool into the colon, via the ileo-cecal valve. When the colon is removed the loops of small bowel need time to adapt to life without a colon. Eventually the pouch realizes that it needs to adapt to its new role, and the stool gradually begins to thicken. The time it takes for this to occur varies with each individual. Some people have diarrhea stools that persist longer than expected. I'd like to share some information with those of you who might be feeling that control of liquid stool is a problem. Pelvic pouches "love" potatoes, pastas, and short grain sticky-type rice, as well as products such a oat bran, oatmeal, barley, and legumes and lentils. These products are called soluble fibre foods, and are favoured by the small bowel. Soluble fibre foods are fermentable in the lower part of the GI tract, forming short chain fatty acids which are favoured sources of fuel to the colon or newly connected pelvic pouch. In contrast, insoluble fibre foods such as skins, seeds, and raw vegetables and fruits are not as readily fermentable in the bowel, so they do not provide a ready source of fuel from short chain fatty acids, and in fact, the new pouch tends to expel these foods rather quickly to just get them out of the way!! (How many of you have experienced the quick trip that salad takes through a newly created pouch?)
If you take my advice, and increase your intake of soluble fibre foods at each meal, you will probably find that your stool will thicken, and control of stool output will improve. Alas, sometimes too much of a good thing can cause problems for some people!! In a small group of individuals, the increased intake of soluble fibre foods might cause problems.
If you follow my suggestions and then find that gas and bloating become a problem, stool out-put increases and that your bottom-end is constantly raw and unresponsive to a variety of creams, it is probably time to think of another approach. Metamucil, a powder available in pharmacies, might be the answer. Interestingly, Metamucil is called a laxative, but is in fact a soluble fibre product, which will effectively thicken and control liquid stools. It is produced from the psyllium plant, a source of soluble fibre that is less fermentable than the food sources that I mentioned above. As a result, gas and bloating and increased stool out-put might be less of a problem. A dose of 1 tsp. three times a day might be a good beginning. If that does not help the dose could be increased to 3 tsp. three times a day. If severe pain and irritation of the bottom end persist, it is possible that bile acids are playing a role in your problem, see your doctor for evaluation and advice on treatment. As a dietician/nutritionist I naturally always start with advice on food choices before considering pharmaceutical products! I do look forward to your questions, as it gives me a focus for future columns.