J-Pouch

A J-pouch is formed as a result of a surgical procedure to remove the colon (large intestine) and rectum and create a new reservoir for stool to exit the body. It is commonly performed in people with inflammatory bowel disease (IBD), particularly those with ulcerative colitis (UC), who have not responded to medical treatment.

In a J-pouch surgery, also called an ileal pouch anal anastomosis, the end of the small intestine (ileum) is used to create a “J” shaped reservoir or pouch. The J-pouch is attached to the anal canal and allows the patient the ability to pass bowel movements. This eliminates the need for a permanent stoma (an opening in the abdomen to which an ostomy bag is attached for stool elimination).¹

Who is a good candidate for a J-pouch?

A J-pouch may be an option for people with UC. It is generally not an option for people with Crohn’s disease or those who have difficulty with their anal sphincters. People with indeterminate colitis may be candidates, but the failure rate is higher for indeterminate colitis than UC. The age of the patient is also a factor, as younger patients tend to be better surgical candidates. All surgical options should be discussed with a gastrointestinal surgeon.²

What happens during J-pouch surgery?

Creating a J-pouch can involve multiple operations, and it may take several months for the body to adjust. The number of procedures depends on several factors, including the general health of the patient, medications, the underlying disease, and the judgment of the surgeon.²

Generally, the J-pouch is done in two stages. The first stage is to remove the colon and rectum (proctocolectomy). The surgeon will preserve the anus and the muscles around the anus. The reservoir is constructed using the end of the small intestine, creating a J-shape and attaching the end to the anus. The small intestine will be temporarily diverted to an opening (ileostomy) in the abdominal wall while the newly formed J-pouch heals. An ostomy bag will need to be worn to collect waste as it exits through the ileostomy.

A second surgery will take place a few months later, where the ileostomy is removed, and the small intestine is reconnected to allow the use of the J-pouch. At this point, the individual can pass bowel movements through the anus.^1,2

What happens after a J-pouch?

The J-pouch allows the individual to have bowel movements through the anus. It is normal for people who have had a J-pouch to have more frequent bowel movements. One survey found that about half of the patients had between 5 and 8 bowel movements a day, and 30 percent had 9 to 12 bowel movements a day, including nighttime bowel movements. Patients over 55 years of age tended to have more bowel movements than younger patients.³

The consistency of the stool is generally quite liquid, at first, and it is usually accompanied by a sense of urgency. The stool usually thickens over time, depending on the diet consumed. It may be difficult for patients to differentiate between the feeling of gas or stool after the surgery, and it may be safer to assume that the feeling is stool until the body learns to differentiate between the two.²

As the body adjusts to the J-pouch and the reservoir stretches, the number of bowel movements generally decreases. The reservoir function usually improves 6 to 12 months after surgery. Recommended dietary changes and medications (i.e. loperamide) can also help with the frequency and consistency of the stool. Dietary changes may include adding fiber supplements, increasing fluid and salt consumption, and reducing spicy foods, seeds, and nuts. Each person should talk to their doctor or a registered dietitian about their specific diet.^2,3

What are some of the risks associated with a J-pouch?

As with any surgery, there are some risks with a J-pouch. Potential risks include the possibility of infection, sepsis, leaks, or bleeding from the pouch. Some complications may develop later, such as the possibility of small bowel obstruction (blockages), fistula (an abnormal passageway that occurs between structures), anal strictures (a narrowing of the anus), or pouchitis (inflammation of the pouch). A pouch endoscopy may be performed to confirm a diagnosis.^4-6

Does a J-pouch cure IBD?

There are some who will say that removal of the colon is a cure for ulcerative colitis. However, this is a misleading statement since, even though the inflammation in the colon is gone (since the colon is gone), the underlying inflammatory bowel disease is still present. About half of people who have a J-pouch with UC will experience inflammation in the pouch (pouchitis) at least once in their life. Pouchitis can cause diarrhea, abdominal pain, bloody stool, fever, joint pain, and dehydration and requires treatment with antibiotics or other IBD medications. There are some instances where an individual may require removal of the pouch and will be given a permanent ileostomy.^4-6

Both the J-pouch and an ostomy can be effective symptom-management tools for many people but should not be confused for being a cure.