Following a colectomy (removal of all or part of the colon), an artificial rectum called an ileal pouch, referred to as a “J pouch,” is created when part of the small intestine is connected to the anus (ileoanal anastomosis or IPAA). If this pouch becomes inflamed or irritated, it’s a condition known as Pouchitis. Usually treated with antibiotics, the swelling of this pouch can result in increased bowel frequency and abdominal pain.
There is no clear cause of pouchitis. It tends to occur with greater frequency in patients with some form of colitis or those with a genetic condition where polyps develop in the colon (familial adenomatous polyposis). It may also be caused by the change in bowel pattern resulting from the IPAA procedure itself.
Symptoms may include:
When pouchitis is suspected, an endoscopy is often performed to check inside the pouch to determine the extent of the inflammation or if Crohn’s disease or a similar condition may have developed. A biopsy may be taken to look for polyps or other unusual growths. Treatment usually involves use of antibiotics for two weeks.
Treatment may also include:
Pouchitis affects approximately 40 percent of patients who have had an IPAA procedure. Risk factors for developing the irritation include being a smoker, genetics, and prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs). Patients with preexisting conditions such as diabetes and heart disease may also be susceptible to developing pouchitis. Even with successful treatment, some patients may experience occasional relapses.