J-pouch surgery is a treatment for medication-resistant ulcerative colitis (UC) or other conditions like colon cancer that result in bowel removal. If you’re planning to have J-pouch surgery, there are things to know that may help your recovery.
J-pouch surgery is a procedure in which a surgeon converts some of your small intestine into a reservoir that connects to your anal canal to allow for anal stool passage. It’s the most common surgery performed in people with UC whose symptoms don’t respond to medication.
This procedure may require one surgery or up to three surgeries. Usually, however, doctors perform two surgeries.
During the first, the surgeon:
- removes the colon and rectum
- makes the ileum, a portion of the small intestine, into a J-shaped pouch
- creates an opening called a stoma in the abdomen
- creates a temporary ileostomy by pulling a loop of the small intestine through the stoma to attach to an ostomy bag
The temporary ileostomy allows for the passage of stool into an ostomy bag worn outside your body. This is to reduce your chance of infection as your J-pouch heals.
Once your J-pouch has healed enough to be considered “leakproof,” a doctor performs a second surgery to close your stoma and connect your small intestine to your J-pouch. This allows you to pass stool in the usual way through the anus.
These surgeries are typically performed 8–12 weeks apart, and you’ll need time to recover and adjust to your temporary ileostomy and your J-pouch. The following tips can help you recover from J-pouch surgery.
Your J-pouch diet after surgery will start with clear liquids and slowly ease back to regular foods.
Your post-surgical care team can provide specific instructions, but your diet will likely transition in the following order:
clear fluids , such as water broth, sports drinks, and gelatin, for several days- full fluids, which includes clear fluids plus other foods that are liquid or will turn to liquid at room temperature, such as pudding, yogurt, and pureed soup
- full fluids plus low fiber foods such as well-cooked, seedless, and skinless vegetables and soft foods like eggs, pasta, and white rice
You may need to avoid high fiber, spicy, and high fat foods for several months after surgery as your digestive tract heals and adjusts to functioning without a colon.
Your care team will provide you with detailed instructions about wound care before you leave the hospital.
You may receive instructions such as the following:
- Avoid swimming, hot tubs, or baths.
- Keep showers to less than 10 minutes, and avoid excess heat and water exposure.
- Rinse the wound with tap water, and gently pat dry with clean gauze or a towel.
- Do not clean wounds with antiseptics such as iodine, hydrogen peroxide, or rubbing alcohol.
- Wash your hands before cleaning your wound or changing the dressing.
- Remove dried blood by gently dabbing it with gauze moistened with water or sterile saline.
Notify your doctor right away if you have any signs of infection, such as:
- redness
- warmth
- unusual odor
- drainage, discharge, or pus
- fever
- feeling unwell
Before you leave the hospital, your doctor will train you in the care of your ileostomy.
You’ll need to learn how to:
- keep the skin around the stoma dry, clean, and intact
- fit your pouching system and adjust it as the stoma gets smaller
- change your pouch as needed without damaging your skin
To change your ostomy pouching system:
- choose a time when your ileostomy is least likely to pass stool, such as before breakfast
- gather the materials you need before you begin
- remove your soiled pouch
- clean and examine the skin around your stoma
- apply a clean pouch
Most people need to empty their ostomy bag about 6–8 times each day.
You’ll also have to watch for signs of complications, such as:
- non-functioning ileostomy
- bowel inactivity
- mechanical blockage
- infection
- dehydration
- problems with your stoma, such as a hernia or prolapse
After J-pouch surgery, your stool may be looser than it was in the past.
You may also notice other
- reduced ability to hold stool for up to 15 minutes
- more frequent bowel movements
- a feeling that your bowels have not fully emptied after a bowel movement
- fecal incontinence
- gas
- diarrhea
- needing to pass stool at night
Over time, your J-pouch will stretch and be able to hold more stool. You’ll adjust to your new anatomy and learn important things like how quickly you must get to a bathroom, when you can hold stool, and how often you’ll need to go in a day.
J-pouch surgery may have complications that require prompt medical care.
Pouchitis
Up to 50% of people experience J-pouch inflammation called pouchitis, which doctors treat with antibiotics. Pouchitis usually occurs within the first 2 years after surgery.
Symptoms include:
- cramps
- abdominal pain
- diarrhea
- increased frequency of bowel movements
- joint pain
- fever
- dehydration
Pouchitis has a range of causes. One
The probiotic mixture
A 2017 review also found that probiotics may help prevent pouchitis. The review had the following statistics from three different studies:
| Probiotic strain | Control | Pouchitis-free survival |
|---|---|---|
| LGG | no treatment | 93% vs. 71% |
| VSL#3 | placebo | 90% vs. 60% |
| Clostridium butyricum | placebo | 89% vs. 50% |
Eliminating or reducing the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may also help.
Talk with your doctor about steps you can take to help prevent pouchitis.
Sometimes pouchitis may not be preventable, such as when it occurs because of previously undiagnosed Crohn’s disease in your small intestine.
If you can’t prevent pouchitis, seeing your doctor for treatment at the first sign of symptoms may prevent it from worsening.
Obstruction
Small bowel obstruction is another possible complication of J-pouch surgery, often due to post-surgical fibrous bands of tissue called adhesions.
Obstruction symptoms include:
- nausea
- vomiting
- cramps
- abdominal pain
- abdominal distension (swelling)
- inability to pass gas or stool
Treatments include:
- bowel rest, which may include not eating or drinking anything or drinking only certain liquids
- intravenous (IV) fluids
- surgery
Perianal skin irritation
When stool comes directly from the small intestine, digestive enzymes that are typically absorbed by the large intestine remain in the stool. These digestive enzymes can irritate and damage your perianal skin. This combined with the increased frequency of your bowel movements means you may experience discomfort in your perianal area.
Preventive and treatment measures include:
- managing your diet to reduce bowel movement frequency
- perianal skin care
- use of protective skin barriers like ointments
You can also ask your doctor for prevention and treatment suggestions.
J-pouch failure
Though an estimated 90% of pouchitis instances are temporary and respond to treatment like antibiotics, sometimes medical therapy doesn’t work, and symptoms become intolerable.
If this kind of pouch failure does occur, doctors can remove your pouch and divert your bowel back to an ileostomy for stool clearance via an ostomy bag.
Your doctor will recommend a time frame for reduced activity after your surgery.
While a certain amount of movement can help the healing process, your doctor may advise you to refrain from activities like heavy lifting, driving, or contact sports.
You should be able to resume most or all your prior activities once your surgical site has fully healed.
J-pouch surgery is a treatment option for medication-resistant ulcerative colitis or other conditions that require removal of the colon. It’s a lengthy process, usually requiring two procedures and a temporary ileostomy in between.
Recovery can be slow, and you may experience numerous changes to the functioning of your digestive tract. Complications such as pouchitis are common, although they’re treatable, and j-pouch surgery has a high long-term success rate.