Battling Butt Burn: For All My J-Pouchers Out There

If you are suffering from Ulcerative Colitis, chances are that you are going to opt for surgery at some point in your lifetime. Even those with mild cases elect to embark on this journey, as anyone with the disease can tell you how much it can screw up everyday life. This course of action involves what is usually a three-step surgical process. The first step involves removing your colon, the second involves constructing your Ileal Pouch-Anal Anastomosis, and the final procedure opens the gates to your brand new GI tract.

Contrary to popular belief, life with the ileostomy is the easy part. For roughly six months while you wait to complete this surgical process, you wear a bag that collects any poop secreted through an exposed piece of your small intestine. It’s a beautiful feeling to be rid of those annoying and disruptive urges that plagued you through your UC battle and made you a slave to the bathroom.

The real fun begins when you have your final surgery and open the gates to your newly constructed J-Pouch (the Ileal Pouch-Anal Anastomosis I mentioned before). Over time, the J-Pouch becomes more colon-like and you can get back to living a relatively normal life. But for the first year or so, the adjustment can be tumultuous at times. Basically, you start out going to the bathroom at an extremely high frequency. I’m talking like 25–30 times a day in the first month. It gradually goes down over time, but leaves you exposed to one of the most uncomfortable side-effects of this process: butt burn.

The poop coming out of you is a lot more acidic thanks to the absence of your large intestine. Your colon/large intestine essentially does three things: rehydrates you, neutralizes your poop, and serves as a reservoir for said poop. Now that your without this neutralizing agent, what comes out of you can be pretty uncomfortable, especially at the rate it’s coming out. Now you can protect against this heavily through diet and medication, but the best solution is to have a well versed arsenal of skin protectant creams to help sooth the irritation. As a J-Poucher five months out from my final surgery, below I give you my rankings of creams to protect you from butt burn, from least severe to most severe…

  1. Ceravé — This spot is basically reserved for your base level skin protectant healing lotion. Ceravé is my choice because it’s clear and has a soothing feel to it, but at the same time there’s a reason this is all the way on the least severe spectrum of this list.
  2. A&D Lotion — Right now, this is my personal go-to. A&D is a step up from Ceravé and does a pretty good job of helping your behind heal while dealing with a fair amount of irritation. Like Ceravé, it’s clear, so you don’t have to worry about making too much of a mess.
  3. Maximum Strength Desitin — Desitin is a beautiful thing because it not only does it help you fight the irritation, it treats diaper rash, which is common for J-Pouchers. The knock on Desitin is that the most effective version of it (in my opinion) is white and any cream that isn’t clear is automatically a mess. In the event of use, you may want to put a gauze pad or paper towel in your pants to limit the mess.
  4. LMX 4 (Topical Lidocaine) — LMX 4 comes in fourth on the list, but in some cases it could be the best option to deal with the most severe forms of irritation. Lidocaine is a numbing agent. You put this on and you won’t feel anything back there. I had the pleasure of dealing with a fissure and hemorrhoid at the same time. Every time contact was made, whether by pooping or cleaning up, I was in pain. This did a great job of numbing that pain. You rub a small amount on and after approximately 10 seconds of burning, you don’t feel much anymore. I would be careful how often you use this as there can be some side effects from overuse. I would also couple it with a less severe skin protectant such as A&D or Ceravé.
  5. Calmoseptine — If you’re having persistent burning even after you leave the bathroom, Calmoseptine may be the answer for you. This cream has menthol in it, so upon application you get a cooling, soothing feeling. Like Desitin, it’s not clear. Calmoseptine is pink, and therefore can make quite a bit of a mess. As I mentioned before, if you’re using a non clear cream, you may want to put a gauze pad or paper towel in your pants to limit the mess. In some cases, your insurance may even cover the purchase of this cream.
  6. Illex — I was in a pretty bad place when I learned about Illex and make no mistake, it saved my life. In the first month after your final surgery, you can be in the bathroom almost 30 times a day. At one point, I had a day where I was over 40. The irritation can become intense in these scenarios and Illex can be exactly what you need to survive. Illex is a durable rub that I like to compare to rubber cement once it dries. The positive is that it completely seals off the irritated skin, which in turn helps you heal faster. The down side is that usage of Illex can make things messy. Because of it’s rubber cement like consistency, it alters the direction of what comes out of you and gets everywhere. The other gruesome detail is that when the Illex mixes with the consistent poop coming out of you, you’re left with a nasty product stuck to your butt. Like Calmoseptime, Illex is covered by certain insurance plans. The last thing I want to note about Illex is that if you use this, be sure to pair it with a light skin protectant like A&D or petroleum jelly.

Have a suggestion of something that isn’t on this list and works for you? Comment about it below.