What to Expect Directly After a J-Pouch Surgery

As many of you know, I have had many surgeries to bring my Crohn’s under control. I did try just medication, but my case was so severe that it was time for a j-pouch.

What happens during j-pouch surgery?

The full name for this is an Ileal pouch-anal anastomosis or IPPA. For this, the surgeons took out my colon and most of my rectum. They then use small bowel to create a pouch which serves as the new part of the rectum that is taken out. The surgeon connects the pouch with the anus and allows you to eliminate waste somewhat normally.

For most situations, it’s a two-part surgery. Usually, an ileostomy is added to allow the pouch to heal. After about ten weeks, a second surgery is performed to remove the ostomy and reattach the intestine (also known as takedown).

Now that you know at a high level what the surgery is all about, here is what the doctors don’t tell you. Below is what I went through after surgery.

Although it's not pleasant, you need to know that it's temporary, and varies amongst patients who have IPPA surgery. Please note, I am talking about things that might occur after the 2nd surgery when the j-pouch is fully functional.

Many bowels movements after j-pouch surgery

Remember that the pouch is a new system in your body. Your body has to get used to not having any large intestine for the food to pass through. You may use the bathroom many times a day during the first few weeks of having the pouch.

Remember the j-pouch is created as the reservoir for your waste to be stored. Since your pouch will be small, it will fill up very quickly. As a result, you may go to the bathroom many times.

I remember the first few weeks after surgery. I was saying to myself, “This pouch thing isn’t working. I am going to the bathroom just as many times as I did before the surgery."

Folks, it takes time. I would say around twelve weeks after my reconnection of the rectum to the J-pouch is where I saw more stability with the pouch. My bowel frequency decreased by half.

Pouchitis or inflammation of the pouch

There is a possibility that you can get inflammation of the pouch.  I have chronic pouchitis but the percentage of those who get chronic pouchitis isn’t high.  Pouchitis symptoms include, increase stool frequency, fever and urgency.

I remember my first bout of pouchitis. It was like having a flare. I did respond to antibiotics, and the urgency went away. Unfortunately, I get bacteria in the pouch so often, that I am on constant antibiotics.

Cuffitis is another form of inflammation

This is inflammation of the one-inch rectum that the doctor leaves to connect the pouch. I also have cuffitis and this includes lots of the same symptoms that pouchitis presents. I had to take steroid suppositories to help the inflammation. Again, might not happen to you - this is just my experience.

Re-gaining sphincter strength

Yep its almost like potty-training yourself! You might have to do sphincter strengthening exercises called Kegels. This is an unpleasant thing to do, but I am telling you, it will benefit you in the long run.

Painful bowel movements after j-pouch surgery

When you are sent home, it will likely hurt to have a bowel movement for a while. Because your body endured such trauma in surgery, your insides are still sensitive to pain.

Remember your bowel has been manipulated. So when you bear down to have a bowel movement, it is going to be painful. Please don’t be a hero. Take a pain reliever if your doctor recommends it. Trust me, it might help you.

To be clear, the j-pouch surgery can improve your quality of life. It has for me! I have faith it could for you, too. It is going to take some time.

Some of the events listed above might not happen to you at all, as we are all different! And I hope it doesn’t. I just want you to be prepared in case you are having this surgery. Good luck. #BeatCrohn’s!

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