I think we need to clarify some of your understanding of the normal rectum and the J-pouch.
teachpdx wrote:The rectum normally exits through basically a pipe. When the Jpouch is created where does it sit? Is it suspended or is it resting on a muscle that should not have anything resting on it? Also what about physics? You replace a pipe with a rubberband - how does that works? Seems to me that the muscles that normally would be surrounding the rectum would become stretched or slack. Is it possible that it's NOT possible to overcome the laws of physics? Been asking that question from the get go.
a. The rectum does not "exit through a pipe."
The rectum is, itself, a muscle. The rectum is a very dense and thick muscle.
Factoid: The rectum and the tongue are the two thickest muscles in the body.
The muscle fibers of the rectum differ from the rest of the large intestine that precedes it. The muscle fibers of the rectum contain added collagen and elastin and are laid in both perpendicular and horizontal directions. This allows the rectum, as an organ, to expand in shape and size to an extent not seen in the remainder of the large intestine. This gives the rectum storage capacity for feces/stool.
Note that one of the key symptoms of LAR syndrome is multiple bowel movements a day (10-15 +) and clustering episodes. This is primarily due to nerve damage of the pudendal nerve and sacral nerve roots S3-S5, occasionally the obturator nerve.
It is the rectum that enables an individual to be able to hold and retain feces for defecation at a later time. There is both voluntary and involuntary anal sphincter. The voluntary sphincter control allows an individual to hold/retain feces - to a certain point - where it may be more appropriate to have a bowel movement.
b. A J-pouch is created by a 6-8 inch segment of the terminal end of the small intestine (ileum). The length of small intestine is fashioned in the shape of the letter "J" (sometimes in the shape of the letter "K" or the letter "W").
A J-pouch is also referred to as a neo-rectum. Neo-rectum is a name well-suited. The section of small intestine is of narrow-width (1 inch or 1 1/4 inch in circumference), no where near the normal width of a natural rectum (3-4 inch width). The section of small intestine does not have the inherit ability to stretch and expand as does the natural rectum. In creating a J-pouch, it is expected that the segment of small intestine will learn how to adapt and function in accordance to a natural rectum. This can be a tall order for a non-differentiated segment of intestine.
Problems with J-pouches generally are functional problems. That is, failure of the J-pouch to function like a normal rectum.
Again, you are asking a segment of small intestine to function like a rectum in creating a J-pouch. The normal role of the small intestine is the absorption of food nutrients. The lumen of the small intestine has hundreds of small finger like projections called villa. Each villa has a small blood capillary and a small lymph capillary through which nutrients glucose are transferred into the blood stream for metabolic use by the body at a cellular level. As you can see, the lining of the small intestine is much more delicate and sophisticated than that of the rough-and-tumble rectum.
Your J-pouch is not sitting suspended in your pelvis. The surgeon does anchor the segment of small intestine to the wall of the pelvic floor and to the pelvic sling. The pelvic sling is a suspension of ligaments and tendons that supports the rectum, bladder and vagina.
c. I do not quite see your analogy of replacing a pipe with a rubber band, in describing the J-pouch creation.
The rectum, in its own right, is a muscle . . . not a pipe.
The job of the small intestine is the absorption of nutrients and food energy/glucose as digested food material passes through its length. The length of the average small intestine is 15 feet.
The job of the large intestine is the absorption of water and the storage of residual indigestible/non-soluble material as it passes toward the anus for evacuation. The terminal end of the large intestine, the rectum, has the ability to expand and stretch that allows for contained storage until it is convenient to have a bowel movement.
The large intestine and rectum has enteric muscle cells that help propel the residual food material out the body via the anus. Think of the enteric muscle cells as a sort of back-up generator system.
So where does this leave you with your rectal and anal pain?
You might want to look up information on the topic of pudendal nerve entrapment.
The pudendal nerve is one of the primary nerve bundles that serves/innervates the pelvis. The pudendal nerve is often implicated in chronic pelvic pain.
Sacral roots S3-S5 also serve and innervate the pelvis.
Muscles that can become tight and shortened in the pelvis that can contribute to pain include: 1. the piriformis; 2. the levator ani; 3. the obturator interns; and 4. the coccyges muscles.
I highly recommend pilates as an activity for individuals with chronic pelvic pain. The postures and poses are great for stretching and mobilizing muscles, ligaments, and connective tissue of the pelvis and pelvic floor.
For reading on the subject of pelvic pain, there is no better book (in my opinion) than "Heal Pelvic Pain" by Amy Stein, DPT.
Amy Stein holds a Ph.D in physical therapy. You can read excerpts from her book at the web site:
www.healpelvicpain.com
Well, I've written a truck load here - which I had no intention of doing when I started. Of what I have written, take what works for you and disregard the rest.
I hope that you find a measure of relief from your rectal and anal pain,
- Karen -
