I once wrote an article about the teenager and the toddler inside of me, which were terms I lovingly used to refer to my uterus and my j-pouch. My j-pouch will be 7 years old this year and while it is no longer a toddler, it still fights with my uterus at times — especially when I’m on my period.
I was always very fortunate to have relatively normal and pain-free periods prior to my surgery to remove my colon and rectum and have a j-pouch inserted in their place. I never expected much of a change after my operation because no one indicated there would be. My doctor was male, and although he did prep me on what I could expect with my digestive tract, he never mentioned how surgery would affect the rest of my body.
A "normal" bowel movement and your uterus: a love story
When you look at a diagram of basic female anatomy, you'll see that the colon and small intestine sit above the uterus while the rectum is located behind the uterus and the vagina to meet the anus. Before someone with intact intestines has a bowel movement, their stool remains in their large intestine. When the body says "Hey, it's time," the stool works its way down to the rectum and then out into the free world.
Why does this matter? Because when women who have normal bowels get their period, their uterus is generally unaffected. Before I get hate mail about that, let me explain: Plenty of women have abnormal bowel movements when on their periods. Plenty. Like a whole lot. But it's not because their intestines are in the way or interacting with their uterus or vagina. It's just because their internal teenager is angry and wants everyone to know it.
A j-pouch and your uterus: a tragedy
When a woman has her colon and rectum removed and has a j-pouch inserted in their place, the j-pouch sits directly behind the vagina and uterus. They are all sharing the same real estate. One touches the other.
Why does this matter? Because when the j-pouch is full of stool (which it is a lot of the time), it expands and pushes on the vagina from behind. They're literally fighting for space. When a woman gets craps during her period, these push on the reservoir that holds stool, or even worse, shrink the passage from the small intestine to the j-pouch, making it harder for stool to even get down there. And this is where real pain sets in, and/or the j-pouch becomes hard to evacuate. There just isn't enough room for the party they're trying to have down there.
This situation is further complicated when trying to insert a tampon. Post-surgery you may have noticed that your uterus was tilted when you tried to insert a tampon, likely from the swelling of your j-pouch. It is almost as if when you insert a tampon you hit a back wall too quickly. It's a very strange sensation but generally subsides when the swelling goes down. However, it doesn't always. I found that due to cramping and internal movements and the uterus pushing on my full j-pouch it is often difficult to get a tampon into the right position ,which can be very frustrating. My best suggestion is trying different angles when inserting.
For almost seven years I took the birth-control shot and didn't have a period at all, which was very convenient and also saved me from a lot of stress and pain. Recently, I started getting periods again and was reminded how fortunate I was when I didn't have one at all. If you find that your periods are particularly painful, that you j-pouch gets very angry, or that inserting a tampon is far too uncomfortable there are a few options.
Opt for birth control that limits or stops your periods
There are quite a few birth-control methods now that stop your period altogether or limit it to just a few times a year. This is a good option if the combination of j-pouch and period is just too much for you.
Try a DivaCup
The DivaCup is a small, silicone cup that you use in place of a tampon. It's more flexible than a tampon and may play nicer when your vaginal wall is in contact with your j-pouch.
Opt for sanitary pads
While using a pad won't alleviate any pain or discomfort, it might be more comfortable than tampons or a DivaCup, which come into contact with your j-pouch. You might find that bowel movements are less painful or require less straining.
Use a heating pad
A tried-and-true heating pad will help with cramps and any abdominal pain you have, but I'm sure you already know that. A heating pad is an IBDers best friend.
I will admit that there doesn't seem to be a great option in this whole situation, but everyone has different goals and different family-planning needs. Hopefully some of these methods will make your period a little more bearable and your j-pouch a little happier.
See more helpful articles:
Five Things They Don’t Tell Women About Colorectal Surgery
Long-Term Complications They Don't Tell You About with Colorectal Surgery
Cervical Cancer Risk Higher in Women with IBD?