Ileo-Anal Pouch (J pouch)

The ileoanal pouch is a surgical procedure option for ulcerative colitis, colon cancer and familial polyposis patients who need to have their large intestine (colon) removed.

An ileoanal pouch or (J Pouch) is an internal pouch formed of small intestine. This pouch provides a storage place for stool in the absence of the large intestine.

The anal sphincter muscles assist in holding in the stool. Then several times a day, stool is passed through the anus in the normal way.

Ileoanal pouch surgery is a widely accepted surgical treatment for ulcerative colitis or familial polyposis because it eliminates the disease and gives the patient control of bowel movements and does not require a permanent ileostomy.

This procedure is normally performed in two or three stages, but is most often done in two, usually 2-3 months apart.

Stage 1
The first operation is to remove the entire large bowel and the lining of the rectum, but leaves the rectal muscle intact. A reservoir or “pouch” is made out of small intestine and then is connected to the anus. Then, a temporary ileostomy is made. This temporary ileostomy diverts the stool; protecting the reservoir (pouch) while it heals.

Stage 2
The second operation (normally 2-3 months after the first) removes the ileostomy and reconnects the bowel. The pouch now becomes functional so that waste passes into the pouch, where it is stored. When an “urge” is felt, the stool can be passed through the anus, out of the body.

In most cases, the second operation can be done at the ileostomy site without re-opening the main incision. The skin at the ileostomy site is usually closed with stitches.

After surgery (what to expect)
Once you start passing stool through the anus, stools are frequent and liquid. There may be accompanying urgency and leakage of stool.

All of these aspects will improve over time as the anal sphincter muscles strengthen and the pouch adapts to its new function. Stools become thicker as the small intestine starts to absorbs more water.

Medications to decrease bowel activity and bulk-forming agents to thicken the stool may be prescribed if needed.

You can help during this adaptation process by avoiding foods that may cause gas, diarrhea and anal irritation. Careful skin care around the anus will protect the skin from the irritation of frequent stools.

After six months, most people can expect about five to six semi-formed bowel movements during the day and one at night. The pouch takes up to one year to fully adapt. Functioning of the pouch will continue to improve over time.