Being up five times at night certainly would lead to fatigue, ! Although you've had it several years, it sounds like you are experiencing some difficult or frustrations with your j pouch? (And I understanding that correctly?) Have you had a chance to bring up your concerns and fatigue with your doctor yet? Also, one of our advocates put together this article about some of his experiences with j pouch, https://inflammatoryboweldisease.net/living/j-pouch, which might interest you. And another advocate put together some of her tips, https://inflammatoryboweldisease.net/living/j-pouch-tips. I understand having had it for a few years, you might not find these tips quite as helpful as someone who recently got a j pouch (or is thinking about one), but I wanted to share them just in case something resonates with you. Please don't hesitate to reach out here any time. Sending you gentle hugs. -- Warmly, Christine (Team Member)