J-pouch surgery has high success rates. There are some potential complications, however, and occasionally pouch failure can occur.

J-pouch surgery, also called ileal pouch-anal anastomosis (IPAA), is the main treatment for severe ulcerative colitis (UC) that doesn’t respond to medication. If you live with UC or any condition such as cancer that involves colon removal, your doctor may have suggested this surgery.

J-pouch surgery is typically performed over two to three separate procedures.

In the first procedure, a surgeon removes your colon and rectum. They then create a J-shaped pouch from the end of your small intestine that connects to your anal canal.

To give this new J-pouch time to heal, the surgeon creates a temporary ileostomy by pulling a loop of your small intestine through a stoma, or opening, in your abdomen. Stool will pass from your body into an ostomy bag attached to the stoma.

After 8–12 weeks, a second surgery is performed to close the stoma and reverse the temporary ileostomy. The surgeon reconnects your small intestine to the J-pouch to allow for the usual method of passing stool through the anus.

If you’re considering J-pouch surgery, you might have some questions about the potential outcome of this procedure.

J-pouch surgery has a high long-term success rate. Although complications like pouch failure can occur, most people experience pouch longevity.

Research from 2017 tracked the success of J-pouch surgeries for 1,875 people. At 30 years after surgery, 93.3% of the study participants still had a functioning pouch. Their stool frequency had increased only slightly, from a mean of 5.7 daily bowel movements after 1 year to a mean of 6.2 daily bowel movements at 30 years.

Additional research from 2023 estimated that the long-term stoma-free success rates for J-pouch surgery were about 95% in experienced centers. A thorough preoperative assessment and appropriate postsurgical care were associated with a better chance of pouch survival.

Like any surgical procedure, J-pouch surgery has some risks, including:

  • blood loss
  • clotting
  • tissue damage
  • organ damage
  • adverse reactions to medications
  • infection
  • pain
  • slow recovery of bodily functions

Post-surgical risks specific to j-pouch surgery include:

  • strictures
  • pelvic abscesses
  • pelvic sepsis
  • new Crohn’s disease
  • anastomotic leaks
  • pouchitis
  • pouch fistulas
  • persistent pouch dysfunction
  • small bowel obstruction

Pouch inflammation known as pouchitis is a common complication that occurs in about 50% of people who’ve had J-pouch surgery. It usually happens within the first 2 years after surgery. Doctors treat pouchitis with antibiotics.

A 2020 survey of 159 participants who had J-pouch surgery found that:

  • 43.8% had pouchitis
  • 40% had an ileus or small bowel obstruction
  • 34% were readmitted to the hospital within 30 days of surgery
  • 16.4% had an infection other than pouchitis
  • 13.6% had an anal stricture
  • 12.1% had a fistula, or abscess
  • 10% had an anastomotic leak
  • 7.6% had pouch failure
  • 5% had blood clots
  • 4.6% had an incisional hernia

A total of 64.8% of the study participants experienced complications.

J-pouch surgery can reduce or eliminate UC symptoms for many people.

However, with a J-pouch, you may still have about three to eight bowel movements each day, sometimes with urgency. You may also be among the 10–20% of people with a J-pouch who experience some incontinence.

There’s a chance you may also experience pouchitis, the symptoms of which can mimic those of UC.

There are ways to reduce some of the issues that can result from J-pouch surgery. For example, if you experience nighttime incontinence, having a bowel movement before bedtime may reduce the chance of this happening. You can also ask a dietitian if avoiding certain foods in the evening can help.

Quality of life is an individualized experience. For some people, J-pouch surgery can improve their body image because they don’t have to wear an ostomy bag. Others prefer the ostomy bag because they have more control over when they need access to a bathroom.

Research from 2017 surveyed quality of life measures after IPAA surgery and found that only a small percentage of people experienced severe restrictions.

Quality of life measureSevere restrictionsMinor restrictions
family relationships1.5%11%
sexual activities7%19%

The research also found:

  • 92% of people kept the same job
  • 82% experienced no impact on employment
  • 54% maintained the same diet they had prior to surgery
  • 46% had a diet that was slightly more restricted

Other research examined J-pouch bowel function in 159 participants and found that:

  • 92.4% had loose stool
  • 80.3% had diarrhea
  • 77.1% had increased bowel movement frequency with the consumption of solid foods
  • 68.2% had increased bowel movement frequency with consumption of liquids
  • 66.2% used antimotility agents to reduce their number of bowel movements
  • 62.4% limited the types of food they ate
  • 56.4% had bowel movements less than 15 minutes apart
  • 56.1% limited the types of beverages they drink
  • 47.8% adjusted activities due to bowel function
  • 27.6% soiled their undergarments at night
  • 23.8% used pads during the day in case of stool leakage
  • 18.6% soiled undergarments during the day

Although life after J-pouch surgery is not quite the same as having a disease-free colon, quality of life is often improved compared with living with symptoms of severe UC.

Recovery from J-pouch surgery can take several months. The time can vary between people, depending on factors such as:

  • how many surgeries you have
  • your overall health
  • whether you experience complications
  • whether you have open, robotic, or laparoscopic surgery

Laparoscopic surgery is often referred to as minimally invasive surgery because it requires smaller cuts than traditional, or open, surgery. It differs from open surgery in several ways, including:

  • less postoperative pain
  • reduced need for pain medication
  • shorter hospital stay
  • less chance of female infertility

You can help your recovery by staying hydrated and following the dietary plan provided by your doctor.

While it’s important to get up and walk when you can, rest is also important. Some people find the support of a walker to be useful after abdominal surgery.

Pouch failure means that a J-pouch needs to be partially or completely removed. Doctors may replace a failed pouch with a new one, or in some cases, create a permanent diversion.

Research comparing 26 studies found the failure rate of j-pouch surgery ranged from 2–15%, with an overall prevalence of about 6%.

Common risk factors for pouch failure include fistulas and pelvic sepsis.

A fistula is a narrow tunnel or passageway that connects the intestines and a nearby organ or skin.

Sepsis is a chain reaction that occurs in the body in response to infection. It’s a medical emergency, and if left untreated can result in organ failure and death.

Other risk factors for J-pouch failure include:

  • chronic pouchitis
  • primary sclerosing cholangitis
  • Crohn’s disease
  • surgical complications
  • being male
  • older age
  • higher body mass index (BMI)
  • extraintestinal manifestations of UC

Complications that lead to pouch failure usually happen sooner after surgery rather than later. The longer a pouch functions without failing, the less likely it is to happen.

J-pouch surgery has a high rate of long-term success, but there can be complications and side effects. For some people, these issues are well worth the decrease in UC symptoms.

Post-surgical quality of life is generally good but can vary between people. For some, a few adjustments to their diets and activities are all they require. Others need more medical care to manage complications.

Your doctor can discuss with you in more detail the risks and benefits of J-pouch surgery to help you decide whether to try it, have an ostomy bag, or manage UC symptoms through other therapies.