Epona's thread does an excellent job of explaining the role of dietary fiber and probiotic bacteria in managing digestion. Both are healthy ways of normalizing a dysfunctional bowel. Epona's question about the amount of bowel removed probably wasn't rhetorical and the short story you told begs a greater detail of what exactly happened.
A blockage caused by massive amounts of enzymes could be a single large dose. A pattern of too much enzymes kills the sensory nerves in the large bowel, paralyzing it, or a portion thereof. Chronic over dosing of enzymes occurs when more enzymes are taken than can be used up by the food eaten, over a period of time. It could be that your remaining bowel is compromised by fibrosing colonopathy, or other damage causing IBS. The transit time for anyone with IBS could be twenty minutes or less in severe cases. IBS is common in CF and is worth having it checked out.
The healthy bowel responds automatically, being part of the autonomic nervous system. When sensing nerves detect food/fecal material they initiate a form of parastalsis or waves of constricting ring shaped muscles moving fecal material from top to bottom, so to speak. How much large bowel remains after your surgery is an important bit of information. The amount you can improve bowel transit is a direct function of how much large bowel you have left. It is common to see DIOS or Distal Intestinal Obstruction Syndrome, a soft sticky blockage that is as deadly as any hard blockage. DIOS implies that the blockage could occur in the large and small bowel, often at the distal or far end of either bowel. Your considerable amount of colon that was removed could be the small intestine, large intestine or a bit of both. My point is your blockage and subsequent surgery should be reexamined in detail. Just guessing, but your blockage may have occurred on both sides of the junction of the small and large bowels. It's a popular spot for DIOS.
The fast transit you describe may be too fast for most enzyme medicines. Creon and all prescription enzymes are time released at about 2 hours except Viocase, the only immediate release form of enzymes. Viocase is not easy to obtain with a CF diagnosis, your doctor may need to explain the reasons why you might benefit from immediate release enzymes in order for insurance to pay. Ideally a combination of Viocase and Zenpep or Creon, depending on the benefits of having sodium bicarbonate in your enzyme cocktail, can be titrated to improve your transit time and the digestion optimized.
There's a bicarbonate cycle in normal digestion. Bicarbonate buffers or stabilizes the acidity and therefore maximizes the effects of all digestive chemistry. It keeps stomach acid reactive and concentrated through the entire digestive process.
Viocase like PancreaCarb gets jerked off the market and returned on a sporadic basis. Just as an excess of time release or enteric coated enzymes can cause damage once released in the bowel, an excess of Viocase can damage the stomach.
Non CF PI is often treated with Viocase or a combination of it and Pertze or such. This is also insurance's new flag. Viocase is not helpful in most CF patients. CFers that have GI dominant issues stemming from pancreatic cystic fibrosis respond best to the combination of immediate effect and enteric coated enzymes. With a portion of large bowel missing, the sooner food and enzymes are mixed together, the sooner nutrients get absorbed.
The high fiber diet that started all of this is important to understand in depth because it is a great tool in managing your brand of misery. Epona again, has given the straight facts most important to managing transit time of food.
There's many classes of fiber available for our ingestion. Roughage ranges from celery to granolas with whole grains including stuff like the fibrous husks on oats and flaxseed. Think of it as an abrasive grit ranging from large to small and soft to hard. Roughage usually is not digested by any enzyme we make and only probiotics can break the cellulose and chitin down. Even a perfect colon is not going to digest more than a fraction of the cellulose. Roughage is essential for cleaning and scrubbing the intestinal tract. Certain conditions prevent or limit the use of roughage. Crone's disease and IBS are two common conditions where roughage may do more harm than good.
Beyond roughage you get into soluble fiber which acts as a bulking agent, making feces dense and heavy so our nerves can sense and start moving it forward. Natural soluble fiber like psyllium is preferred except where excessive gas results. It is common for it to work great for some and be intolerable for others. Inert synthetic PEG or Mirilax is a totally soluble fiber. Of all the sources of soluble fiber, synthetics like Mirilax or lactulose may be the best bet. I'd love to see roughage and natural soluble fiber work for you, it is near ideal. Roughage may tear up your insides, it tears me up and I still use roughage at times.
This is thinking out loud but I wonder what effect you might get from mixing a small amount of PEG into your morning smoothie. By using the water already in the smoothie to bind with the PEG, water that wouldn't be absorbed anyway could be converted to a gel that will perform as a semisolid. Any food with a lot of water could be similarly treated.
You probably don't eat and drink at the same time but if you do, I'd ask my doctor about eating and drinking an hour or more apart from each other. Too much PEG, Mirilax or natural soluble fiber will dehydrate you and possibly constipate you.
I'd strongly suggest you revisit this entire issue. Learning more about probiotics including probiotic bacteria, yeasts and other beasts could allow you to improve your quality of life significantly. Learn about enzyme activity and how CF screws up the timing. I recently changed GI doctors. Before I saw him, I had been slowly increasing my Creon dose hoping for a stool that resembles something formed. My stools weren't far from what you describe except it was a 24 hour process. He doubled my enzymes. WOW! What a difference. I'm even gaining weight. I've been taking enzymes for fifteen years and for the first time ever, the doctor is determined to optimize my digestion.
You've got a lousy issue to deal with, I wish you an improvement in your quality of life, keep advocating for yourself,
LL
