J-pouch surgery may be right for you if medication doesn’t work to treat your UC symptoms. The procedure involves removing your colon and rectum and adding a J-shaped pouch to your small intestine.

Ileal pouch-anal anastomosis (IPAA) is commonly known as J-pouch surgery. During this procedure, a surgeon removes your large intestine (colon) and rectum and creates a new rectum using the end portion of your small intestine.

J-pouch surgery can be an option to treat ulcerative colitis (UC) if medication is not working to manage your symptoms.

J-pouch surgery typically involves two or three separate procedures.

The first step is to remove your colon and rectum. During this procedure, a surgeon also creates a J-pouch from the bottom of the ileum section of your small intestine and connects it to your anus.

The J-pouch will need time to heal and cannot be used right away.

Your surgeon will create a temporary ileostomy for use while the J-pouch heals. The ileostomy directs waste into a bag attached to your abdomen through a stoma, which is created from another section of your ileum.

The second surgery is usually performed 8 to 12 weeks after the first surgery. In this procedure, a surgeon closes the stoma and reverses the ileostomy. They also reconnect the parts of your ileum that were used to create the ileostomy to the new J-pouch.

After this procedure, your small intestine will end in the J-pouch, which will be attached to your anal sphincter and anus.

If you have J-pouch surgery in three stages, the final procedure is performed 8 to 12 weeks after the second one.

Surgery to remove your colon and rectum is called a proctocolectomy. After this procedure, your anus and the anal sphincter are still in place, so you have some control over your bowel movements. Waste still leaves your body through your anus.

Your small intestine has three parts: the duodenum, the jejunum, and the ileum. To create a J-pouch, a surgeon loops the end section of the ileum into a “J” shape.

After removing your colon and rectum, the surgeon attaches this new J-shaped pouch to your anus. Food waste will now pass through your small intestine before collecting in the J-pouch and leaving your body through your anus.

UC is a type of inflammatory bowel disease that affects your large intestine and rectum. Any surgery that removes these parts of your digestive system is considered a cure for UC. J-pouch surgery, in particular, is considered highly successful.

Even if J-pouch surgery cures your UC, it may not resolve all your symptoms. Many people experience chronic diarrhea after J-pouch surgery because the colon is meant to absorb excess water.

J-pouches are also prone to pouchitis (inflammation of the pouch), which can cause discomfort, diarrhea, and pain.

Yes. For many people with UC, removing their colon and rectum can improve their quality of life. It’s considered a cure for the condition.

Your small intestine absorbs most nutrients from food, and your large intestine removes salts and fluid.

If you don’t have a colon, it’s important to drink enough fluids. You may also need to add more salt to your diet until your body adjusts to the new balance.

The hope is that you’ll be able to eat a variety of foods once your J-pouch is fully healed. But recovery can take up to a year.

You may find that your bowel movements are very frequent and soft or watery at first. As your J-pouch stretches, they tend to solidify and occur less frequently.

A gradual progression of diets is recommended as your digestive tract heals.

To thicken and reduce frequency of your stools

The following foods can help if you’re trying to reduce stool frequency or thicken your stool:

Immediately after J-pouch surgery

After your surgery, once you can consume liquids by mouth, you’ll be on a clear fluid diet. This can include:

  • water
  • broth
  • clear juices
  • sports drinks
  • ice pops
  • gelatin

A few days after J-pouch surgery

After a few days, you’ll progress to a full fluid diet, which can include:

As you further adjust to solid foods

Gradually, you’ll move to a low residue diet, also known as a low fiber diet. It gives your digestive system a chance to adjust to solid foods.

High fiber foods create more work and bulk for your digestive system. Typically, a low residue diet is necessary for 4 to 6 weeks after surgery.

A low residue diet can include:

  • soft cooked vegetables without skin
  • soft fruit without seeds or tough skin
  • dairy products such as milk, yogurt, and cheese
  • starchy foods made from refined white flour that don’t contain bran, whole grains, or seeds
  • well-cooked, soft meats, fish, and chicken
  • eggs, smooth nut butters, and tofu

As you add more fiber to your diet, pay attention to how foods affect your bowel movements. Expect frequent bowel movements while your digestive system adapts to having a J-pouch.

Some people with a J-pouch experience anal irritation. The following foods are more likely to cause this:

Consume fluids between meals. Having too much fluid with a meal can speed up digestion and increase stool frequency.

Chew your food well to support the rest of your digestive system. You may find that eating smaller meals throughout the day feels better than eating larger meals.

If you’re having trouble eating enough or are not tolerating foods well, you may find it helpful to consult a registered dietitian.

J-pouch surgery is performed to essentially cure UC. It removes your colon and creates a new rectum, or J-pouch.

You’ll need to adjust your diet as your body adapts to the changes in your digestive system.

The goal is for you to feel well and be able to eat a variety of foods. Your healthcare team can address your questions or concerns you have about the process.