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:
Pouchitis is often the result of a surgical complication. When people with extensive cancer, ulcerative colitis or inflammatory bowel disease have a large section of the colon removed, surgeons will create a J-shaped pouch where the bowel is reconnected. Pouchitis may occur if this pouch is not created properly.
There are several other causes of pouchitis in this J-pouch. One main cause is that the ulcerative colitis that was present is so extensive that it begins to affect the J-pouch now that much of the rest of the bowl has been removed.
There are some lifestyle causes of pouchitis as well. For instance, those who smoke after the surgery that creates the J-pouch have a high risk of developing pouchitis and other complications. Those with improperly controlled diabetes are also at risk for pouchitis.
The use of non-steroidal anti-inflammatory drugs (NSAIDs) is a known cause of pouchitis. This normally occurs when high doses of these drugs are given or if they are taken over a long period of time.
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.
There is nothing that can be done on the part of the patient to prevent the J-pouch creation surgery from going wrong. There are ways to prevent certain other causes of pouchitis.
In order to keep the pouch from developing irritation and infections, doctors recommend that patients take probiotics such as lactobacillus after surgery. A diet that is low in fiber and low in carbohydrates is also recommended.
Those who are smokers should stop smoking immediately if they have had the J-pouch surgery. This will go a long way in preventing pouchitis and a host of other health related problems.
Patients with the J-pouch should not use NSAIDs if at all possible. Consult with a surgeon or a primary healthcare provider to see what alternatives are available for NSAIDs.