what is a jpouch

What is a Jpouch?

Though I have talked a lot about my different surgeries, I know it can be a bit confusing and difficult to understand and so I thought I would dedicate this post to explaining exactly what a jpouch is.

A  j-pouch has a few different names which can cause a little confusion, it is also referred to as an ileal pouch-anal anastomosis (IPAA), an ileo-anal pouch, restorative proctocolectomy, s-pouch, w-pouch or an internal pouch and it is a bag formed from the small intestine that is attached to the anus.  It was was pioneered by Sir Alan Parks at St. Mark’s Hospital in London in the early 1980s.

“It is a surgically constructed internal reservoir; usually situated near where the rectum would normally be. It is formed by folding loops of small intestine (the ileum) back on themselves and stitching or stapling them together. The internal walls are then removed thus forming a reservoir. The reservoir is then stitched or stapled into the perineum where the rectum was. The procedure retains or restores functionality of the anus with stools passed under voluntary control of the patient.” (via Wikipedia)

In simple terms, when the large intestine (colon) has been surgically removed, doctors create a pouch out of the small intestine that is attached back onto the anus.  This pouch acts as a store for waste matter so that patients regain the ability to ‘hold it’ when they need to poo and therefore improves life quality.

what is a jpouch

 

Ileo-anal pouches are constructed for people who have had their large intestine surgically removed due to disease or injury, this could be from;

  • Ulcerative colitis
  • Crohn’s disease
  • Familial adenomatous polyposis
  • Colon cancer
  • Toxic megacolon

It is entirely internal and not the same as an ostomy in any way.  From the outside you can not see anything and people with a jpouch go to the toilet and poo in the same way as anyone else.

 

Immediately after surgery, the patient tends to pass liquid stool with frequent urgency, up to 20 bowel movements per day, but this eventually decreases with time. Because the  jpouch is a considerably smaller space than the colon, patients tend to have more frequent bowel motions; typically 6-8 times a day.

Also because the small intestine does not absorb as much water as the colon, poo is much more fluid than usual and some patients need to take daily medication to slow the process and thicken the stool.  Because of the loose stools, more water is lost and patients can get dehydrated easily and can also suffer salt deficiency. For this reason, some are encouraged to add extra salt to meals or electrolyte mix drinks.

Because the ileum does not absorb as much of the gastric acid produced by the stomach as the colon did, poo also tends to burn the anal region slightly meaning many patients need to use wipes and barrier creams.

One complication of a jpouch is Pouchitis which is an inflammation of the ileo-anal pouch. The symptoms are normally somewhat similar but less acute than those of colitis, and include (sometimes bloody) diarrhea, urgency or difficulty in passing stools, and, in few cases, pain. The standard treatment for pouchitis is a course of antibiotics.  Other complications that can occur are pouch fistula, and pouch stricture.  Early complications can be leaks and the pouch coming apart which will require more surgery.

I can’t find any official success stats but I can say that my surgeon told me this.

40% will be perfect/excellent

40% will be acceptable with some issues

10% will be poor but the patient will put up with the problems as they are stoma averse

10% will need to be defunctioned

So you can see that even though this surgery is called a ‘reversal’ (meaning it is reversing the surgery of having a stoma/ostomy), it is not that simple and people with a jpouch have their lives changed forever.  You read an awful lot of negative stories about jpouches, but I always think that it is because all the people who are having a good experience aren’t on the internet telling you about it, they are off living their lives!

For me it has been 18 months since my surgery and in the early days, I did struggle and wonder if I had done the right thing.  As time goes on, life is getting a lot better.  I go to the toilet around 8 times a day but usually without urgency or pain.  My jpouch is working well and I am happy with it.

It hasn’t rid me of all the extra intestinal manifestations of having IBD, I still struggle with fatigue, bad joints and sore eyes.  I still take medication every single day and I have had to accept that i have a chronic illness that will never go away, an auto immune disease that affects my whole body.

I hope this post has answered some of your questions, the more we all speak out, the better it is for everyone.  I aim to educate, raise awareness and as always to #StopPooBeingTaboo

 

Love Sam xx

8 replies
  1. Michelle
    Michelle says:

    Thank you. Now I have a better understanding of what’s inside me, and how it’s likely to affect me when it’s reattached. Nervous, but I think I can cope. I can also point people here when they say to me ‘so what is a J Pouch’ instead of struggling to explain it myself…

    Reply
    • John Mullins
      John Mullins says:

      Actually it wouldn’t help you, record keeping on j-pouches has historically been quite poor. That is what prompted the creation of this: http://pouch.iasupport.org/ileal-pouch-registry. The figures Sam (‘s surgeon) quoted come from various meta studies conducted over the years. Surgeons typically talk about the 4-4-2 rule, 4/10 good, 4/10 fair to middling, 2/10 poor. Sam’s surgeon just went into more details on the 2/10. It is also fair to say that this surgery is still relatively new, the first ones being done between 1976 and 1978 and much of this data is based on pouches that were done when the surgery was quite new and surgeons were inexperienced. It would be interesting to see how those figures stack up 20 years time when the people who are having their surgeries now are included.

      Reply
  2. Jo Gibson
    Jo Gibson says:

    I had my large intestine removed in early 1985, just after my 17th birthday I had a j-pouch formed, by Mr P Hawley at St Marks, City Rd London. My pouch lasted for 29years when I had to have it removed as it was causing me a lot of pain to the point that I couldn’t walk to the toilet. I had a good 29years with it.

    Reply

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  1. […] you can have a good read of my explanation here, but in short, a jpouch (also called an Ileo-Anal Pouch or Ileo-Anal Anastomosis) is an internal […]

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