Extrusions vs Nuggets

[Big Jay]

Evening all, got an odd question for y'all. I'm about 6 months out of reversal surgery and, I have to say, it has not been that bad. Mild LARS but tolerable.

After a few chaotic months post reversal I thought I'd settled down to a pattern. Warning signs are a build up of pressure and, if I make it to the toilet w/in 3-5 minutes, all is well. However, the pooping itself isn't the same as it was pre-surgery. It's kind of like I'm extruding part of a larger mass... similar to the old Play Doh Fun Factory.



Lots of pushing and straining, but not a lot of product, and quite a bit of cleanup... all the while I'm well aware that I'm not done and there's lot more where that came from.

Anyway, something strange and wonderful happened about a month ago. Suddenly when I had to visit the toilet I produced honest to goodness turds. Small nuggets yes, but turds none the less. The urgency remained but the process was quick, complete, and (most importantly) very clean.

Unfortunately this only lasted for about a week.. maybe ten days... then it was back to the Fun Factory. Not sure what happened... my diet's been pretty consistent throughout that time... so, has anyone had a similar experience? Any thoughts on diet and whatnot?

[NHMike]

I'm familiar with both.

[Gravelyguy]

Hi Big Jay,

That is so funny! I can totally relate. I am about a month behind you and have a pretty good routine going but is definitely not “normal” pooping. I haven’t had 10 days in a row but have experienced the times when I think that was pretty normal and also the extrusions.

The most normal has been the couple of days after my 1 year colonoscopy so I suspect it has something to do with space inside. I think the scope opened things up and that helped. Of course it didn’t last for long.

I wonder if over times things stretch out and become more normal?

Anybody farther out want to weigh in on the subject?

Dave

[margiej]

This is an ongoing problem for me too, and I am nearly three years out from my resection. I feel like it's diet related, but I can't pinpoint it.

[susie0915]

I understand this so well. You think you have turned a corner and nope, not to be. I tried different things for a year and a half. Not having a rectum to store stool until it is filled and ready to evacuate I think is the issue. Yes, diet can make things difficult but I think the lack of a storage facility is the main issue. Every little piece of stool that would've been stored for some time is ready to be evacuated immediately. It is why we go many times a day with very little output. It was suggested to me to use a daily laxative or daily tap water enemas to empty the lower bowel. I chose to do daily enemas as I felt I had more control of when to have a bowel movement. It takes approximately 30-45 minutes and I am bathroom free for the day until I do again the next morning. It has given me quality of life. No, I wish I did not have to do enemas, but it is what it is and I can now eat without fear, have given up medications except a couple lomotil/day for peace of mind, my bottom feels better, and I can participate in life with anxiety of bathroom issues. Some people only use enemas when going to event and want no issues, or when they begin to cluster. I choose to do everyday because it makes the process much easier as stool doesn't build up and the water flows easier. It can be awkward at first and takes a little practice to become proficient, but I had now been doing for almost 2 years and probably could do with my eyes closed. I have also been able to take my equipment and use when traveling with no issues whatsoever. It is something to think about. Many people can do pretty well with taking fiber, meds and diet. For me just too inconsistent. Just and FYI, not all doctors support enemas, others recommend them, and others like my surgeon just said "okay" when he found out and was glad I was doing better. It is becoming more accepted in the medical community though. Good Luck.

[Tupelo honey]

I struggled with this for a year or more, constantly using Colace / Senna / Immodium and never found an answer till I added 1-2 tablespoons of Nopalina (fiber that contains senna) every morning.

With fiber for bulk, I'm able to control consistency (Extrusion vs. nugget) with a daily Miralax dose - for me, the magic amount is half a dose daily. If I skip it for a day or two, I'm struggling with multiple protracted toilet trips to squeeze out hard, milkdud-sized poops. If I take a full dose of Miralax, I have soft, sticky extrusions for a day or two.

I still use immodium once daily in the am to control urges as well, but I believe adding fiber was the answer to a lot of my bowel issues. And it probably helps that the Nopalina fiber I use has prebiotics and senna as well as insoluble fiber. I'm sure the effective amounts of each (fiber, Miralax, Immodium) vary from person to person but I can say, I rarely have to think about my bowel habits at all. I usually go in the morning and then again around 6 pm, and have normal size/shape/consistency.

I'm also a believer in probiotics, mainly for immune system function, and take one daily. I don't think that affect the bowel function but I'm throwing it in there in case it does.

[NHMike]

This is actually a fantastic discussion. I have saved a link to it on my homepage.

[Gravelyguy]

I have a bowl or two of oatmeal for breakfast and take a good probiotic and that has seemed to really help. I teach middle schoolers so can't be running back and forth to the bathroom all day. I am pretty consistently going in the morning when I wake up. This is usually a 10-20 min time. Then again in the pm. The pm time is more variable and I expect it is because of diet.

The biggest issue for me is clustering. This can be problematic when I have early morning meetings. I am thankful to have control back and to be doing as well as I am. Actually thankful to be here period. There are times though when the clustering gets in the way of something (getting some place on time, meals, etc) when I get a little frustrated.

Dave

[Tupelo honey]

It's an easy morning routine. I mix the Nopalina and Miralax together with water or juice, and take an Imodium with it. Over time, I've dialed back the quantities as much as I can for personal effectiveness. I used to use the 2 tablespoons of Nopalina as suggested on the package, but for us rectum-less folks, more fiber result in more bathroom trips. There's a little bit of planning available. I can skip or delay the day's fiber and Miralax till evening if, for instance, I have a flight the next day and I may take an extra Imodium the day of the flight.

[Big Jay]

Hmm... maybe a bit of daily fiber would be a good thing. My diet varies quite a bit from day to day but there isn't a lot of fiber in it.

I'm liking Bob's recommendation, in another post, for dark chocolate. Even if it doesn't help in my case I won't turn down an excuse for some chocolate.. the darker the better...

[Tupelo honey]

....

I'm liking Bob's recommendation, in another post, for dark chocolate. Even if it doesn't help in my case I won't turn down an excuse for some chocolate.. the darker the better...

My mother in law swears by coconut macaroons for ibs and diarrhea. Another delicious natural remedy to try. Like the chocolate, there's certainly some anecdotal support for it if you google.

[NHMike]

I have a bowl or two of oatmeal for breakfast and take a good probiotic and that has seemed to really help. I teach middle schoolers so can't be running back and forth to the bathroom all day. I am pretty consistently going in the morning when I wake up. This is usually a 10-20 min time. Then again in the pm. The pm time is more variable and I expect it is because of diet.

The biggest issue for me is clustering. This can be problematic when I have early morning meetings. I am thankful to have control back and to be doing as well as I am. Actually thankful to be here period. There are times though when the clustering gets in the way of something (getting some place on time, meals, etc) when I get a little frustrated.

Dave

Oatmeal worked for me today. Though it's hard to tell in one day as things working well one day may have consequences for another day.

[Gravelyguy]

Good to hear, Mike! Hopefully it will be a fairly permanent help!

Dave

[Tupelo honey]

That's great. Oatmeal has both soluble and insoluble fiber. I think fiber is the key. While I believe the senna leaves in nopalina are helpful for ME, I have a tendency towards constipation(nuggets). If that's not an issue, fiber alone is prob helpful no matter what the source is. I was amazed at the difference the first time I used fiber, and have rarely skipped a day since.

[NHMike]

That's great. Oatmeal has both soluble and insoluble fiber. I think fiber is the key. While I believe the senna leaves in nopalina are helpful for ME, I have a tendency towards constipation(nuggets). If that's not an issue, fiber alone is prob helpful no matter what the source is. I was amazed at the difference the first time I used fiber, and have rarely skipped a day since.

I have Nopalina in my Amazon cart and will try it. I have CVS Fiber and will keep taking that but I'm willing to try other products to see if they are an improvement.