Ileal Pouches

What is an ileal pouch?

An ileal pouch is a reservoir surgeons create inside your body after a total proctocolectomy, surgery to remove your large intestine (colon and rectum). You may need a proctocolectomy due to colorectal disease or other conditions.

The pouch allows you to store waste products of your digestive system (stool or poop) inside your body without an external (outside of your body) pouch. You maintain control of your bowels, passing stool through your anus or an opening in your abdominal wall (stoma) made by your surgeon.

In most cases, treatment is successful, although complications may arise. Your care team supports you through surgery and beyond, so you recover well and maintain good health.

What conditions do ileal pouches treat?

Ileal pouch-anal anastomosis (IPAA), also called an ileoanal pouch, is the most common surgery for ulcerative colitis when medications don’t work to control your symptoms.

Surgeons often use IPAA to treat conditions such as:

• Ulcerative colitis.
• Familial adenomatous polyposis (FAP).
• Colorectal (colon) cancer.
• Rectal cancer.

What are the types of ileal pouches?

Ileal pouches are a type of reconstructive surgery to allow you to poop normally through your anus. Surgeons can make three types of internal (inside your body) pouches from your small intestine. They are:

• J-pouch (most common).
• S-pouch.
• Kock pouch, or K-pouch (rare).

J-pouches and S-pouches are often shaped like the first letters in their names. They reroute how stool travels to your anus, so it can exit your body in the usual way. Your surgeon may recommend a Kock pouch (named after the surgeon who invented it) if you’re not eligible for the other types.

Who might get an ileal pouch?

To have an ileal pouch, your digestive system — including your intestines, pelvic nerves, anus and anal sphincter muscles — must work properly. This allows you to manage bowel movements and avoid accidents once you have the pouch.

Your age is also a factor. People between the ages of 20 and 50 typically have the best outcomes from ileal pouch surgery, but people over 50 often qualify for them, too.

Who might not receive an ileal pouch?

Your surgeon may not recommend ileal pouch surgery based on your overall health.

You may not be eligible if you have:

• Crohn's disease.
• Fecal (bowel) incontinence (poor anal sphincter control).
• Class III obesity.
• Low rectal cancer.

What should I expect during ileoanal pouch surgery (IPAA)?

Surgeons perform ileoanal pouch surgery in two or three operations. Your procedure depends on the type of ileal pouch your surgeon recommends.

Your surgeon may make:

• J-pouch or S-pouch: Your surgeon removes your colon and rectum, then uses the end of your small intestine (ileum) to form a pouch inside your body that collects waste. Your surgeon connects the pouch to your anus.
• K-pouch: Your surgeon makes an internal pouch that attaches to an opening in your abdomen (stoma).

What happens after ileal pouch surgery?

During your recovery, you stay in the hospital for a week. You may receive a temporary pouch placed outside your body while the ileal pouch heals. This is typically closed three to six months later with a small operation.

Your care team monitors you closely for complications and supports you as you adjust to the changes to your digestive system. Talk to your team if you have questions or concerns.

What are the potential benefits of ileal pouches?

J-pouches and S-pouches allow your body to store and remove waste as close to your usual way as possible. With these types of pouches, you don’t need a permanent bag outside of your body. The K-pouch allows you to empty your bowels when you choose, without having leaks.

How successful is ileal pouch treatment?

Ileal pouch surgery is highly effective, with a long-term success rate of about 95%. In most cases, your quality of life improves over time. For instance, people with ulcerative colitis no longer experience an urgent need to run to a bathroom.

How often will I move my bowels?

Most people have seven bowel movements per day, plus or minus one at night. The thing people with pouches like best is that they can hold it and don’t have any urgency and don’t need to rush to the bathroom. Most people won’t have accidents at all, but some do have seepage, especially at night when deeply asleep.

What are the risks or complications of ileal pouch surgery?

Ileal pouch surgery is a high-risk procedure. Pouchitis is the most common complication. It occurs in about 81% of people who have IPAA surgery. There are two main risks to your pouch. First, it may leak while you’re healing, but this can often be corrected. Second, you may develop inflammation or Crohn’s-like disease of the pouch.

Other complications include:

• Blood clot or hemorrhage.
• Cuffitis or stricture (inflammation or narrowing of area where pouch connects to anus).
• Pelvic sepsis (if the pouch leaks internally while healing).
• Perianal abscess.
• Pouch fistula, an abnormal connection between your pouch and another part of your body.
• Skin irritation around the anus due to more frequent bowel movements.
• Small bowel obstruction.

Sometimes, your pouch may need to be repaired (ileal pouch reconstruction, also called a redo pouch) or removed and replaced with a new one. Sometimes, your surgeon recommends a stoma. The rate of pouch failure is between 5% and 10%.

The K-pouch has a higher rate of complications than other types. Talk to your care team if you have new or worsening symptoms.

How long will it take for me to feel better after ileal pouch surgery?

You can usually resume normal work and activities about four to eight weeks after surgery. Your specialist examines the inside of your pouch every year, or every other year, to monitor your condition. Follow your care team's instructions and keep appointments so you stay well. After you recover, your providers may want to check your pouch every several years with a pouchoscopy — like a mini-colonoscopy — to look for inflammation or polyps.

Will I need to take any medicines?

Your provider may recommend medications to help manage pain and reduce inflammation. Talk to your care team about any medications you take for other conditions. Some people need to take medicines to slow down their bowels, or fiber to thicken the stool and make it less watery.

When should I call my healthcare provider?

Seek medical attention right away if you notice any new or unusual symptoms. Contact your care team if you have:

• Abdominal swelling or cramping that continues for more than two or three hours.
• Bleeding.
• Changes or injury to your stoma.
• Difficulty removing waste.
• Excessive leakage.
• Pain.
• Severe nausea and vomiting or diarrhea.

Does an ileal pouch affect pregnancy?

In most cases, having an ileal pouch doesn’t affect your ability to conceive or maintain a healthy pregnancy. Your provider may recommend you deliver your baby by cesarean section to avoid damaging your anal muscles and nerves. Together, you and your provider can discuss your health and options for starting a family.

How does an ileal pouch affect my diet?

At first, you may have to adapt your diet to your new digestive system to easily absorb and pass foods. Your care team can provide recommendations and may refer you to a dietitian to help you develop a healthy eating plan, but most people can eat whatever they want.