To understand pouchitis, you first need to know how an ileal pouch works.
When other treatments can’t keep ulcerative colitis (UC) well controlled, your healthcare provider may recommend a surgery called ileoanal anastomosis. In this procedure, a surgeon removes the rectum and large intestine. They then use some healthy small intestine to create a J-shaped pouch connecting the small intestine to the anus.
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As you go about your day, feces collect in this pouch. As it gets full, you feel the urge to go to the bathroom. Without the J-pouch, you would need to have an ileostomy (when the end of the small intestine is pulled through the skin of your abdomen) and collect liquid stool in an ostomy pouch.
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Pouchitis means that J-shaped area has become inflamed. “Inflammation of the ileal pouch (‘J pouchitis’) in patients with inflammatory bowel disease [who have undergone ileoanal anastomatosis] can either be acute or chronic,” says Sandhya Shukla, MD, a gastroenterologist with Atlantic Coast Gastroenterology Associates in Brick Township, New Jersey.
Acute (short-term) pouchitis can come and go, but over time, most cases of pouchitis evolve into chronic (long-term) pouchitis, which needs ongoing treatment.
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If chronic pouchitis doesn’t get better with antibiotics, or antibiotics once worked but now no longer help, it’s called chronic antibiotic-resistant pouchitis.
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Symptoms of pouchitis can include:
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- Lower abdominal pain
- Intestinal cramping
- Urgent bowel movements
- More frequent bowel movements
- Inability to hold in poop
- Straining to poop from pain or blockage
- Feeling like you need to poop but can’t
- Blood in the stool
- Fever or chills
“Patients often describe [pouchitis] as a ‘return of UC-like symptoms’ despite having had surgery,” says Ekta Gupta, MBBS, the chief of gastroenterology at the University of Maryland Medical Center in Baltimore.
“The American Gastroenterological Association emphasizes that these symptoms typically represent a change from the patient’s baseline pouch function, which is usually four to eight bowel movements per day and one to two per night after postoperative adjustment,” says Dr. Gupta.
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Sometimes, symptoms are subtle and confused with other causes, including potential complications of J-pouch surgery like cuffitis (inflammation of the rectal remnant left after pouchitis surgery), irritable pouch syndrome, or bacterial overgrowth, says Gupta.
That’s why it’s important for doctors to use stool studies and a pouchoscopy (like a colonoscopy just for the pouch) if needed to help make a diagnosis and rule out other issues.
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