@lhstephenson I also had a j-pouch/vaginal fistula. Mine occurred within a month of my colectomy in 1987. Despite several attempts to repair it, it always came back. I also had recurring anal abscesses and fissures. Because of these issues, I chose to have the j-pouch removed and a permanent ileostomy in 2002. It's not what I would have wanted, but my quality of life is so much better. I haven't had any vaginal issues since then.

I read that you had a temporary ileostomy that was flush, and very difficult to manage. I had one of those as well. My permanent ileostomy is much better placed, protrudes properly, and is easy to manage. I get 4 to 5 days wear time, and I don't have any skin irritation.

I know you don't want an ileostomy, but my experience with a permanent one is nothing like the temporary one.

Have you talked to a colorectal surgeon to see if a j-pouch reconstruction would help with the issue?