Crohn’s disease and ulcerative colitis (UC) are two types of inflammatory bowel diseases (IBDs) that affect the gastrointestinal (GI) tract. While Crohn’s disease impacts any portion of your GI tract, UC tends to affect both the colon (large intestine) and rectum only.
Medications and lifestyle changes are necessary to help reduce inflammation from IBD that can lead to GI tract damage. However, in severe cases, surgery may be necessary if medications are not adequate in stopping your symptoms and prevent damage from chronic inflammation.
Depending on the type of IBD you have, different surgeries aim at removing certain parts of the GI tract to prevent further damage. J-pouch surgery is a type of procedure used specifically for UC.
Read on to learn more about J-pouch surgery for UC, along with benefits, potential risks, and overall success rates.
J-pouch surgery is a surgical procedure that’s used for the treatment of severe UC. It’s also considered the most common surgery for this condition.
Like other types of IBD surgeries, J-pouch surgery is only recommended in cases where medications for UC are no longer working. The procedure may also be done on an emergency basis for toxic megacolon, as well as uncontrolled GI bleeding.
J-pouch surgery, also referred to in the medical community as a proctocolectomy with ileal pouch-anal anastomosis (IPAA), involves the removal of both your rectum and colon. A surgeon then takes a portion of your small intestine and creates a J-shaped pouch to collect and aid in waste removal.
While surgeries are not as common for IBD
After J-pouch surgery and recovery, you may experience fewer UC symptoms, such as:
- stool inconsistencies
- abdominal pain/discomfort
- bloody stools
One advantage of J-pouch surgery compared with other procedures for UC is that the J-pouch itself eliminates the need for an external stool bag (ostomy).
After you’ve fully recovered, you will not need to wear an ostomy or have to empty it, and you will have more natural control over your bowel movements. However, depending on how many stages your surgery is performed in, you may need to use an ostomy on a temporary basis.
You may be considered an ideal candidate for J-pouch surgery if you:
- currently experience UC symptoms despite medications
- notice your symptoms are worsening
- have precancerous colon cells
- are experiencing uncontrollable bleeding from the colon (a rare condition)
- have developed holes in the colon as a result of chronic inflammation
- need surgery to remove your colon and rectum but you’d rather have an internal pouch to collect waste instead of an ostomy
J-pouch surgery for UC is typically done in two or sometimes three stages, each scheduled several weeks apart.
The first stage involves the following steps:
- First, your surgeon will remove both your rectum and colon.
- Next, they’ll take a portion of your small intestine known as the ileum and form it into a j-shape, or “J-pouch.”
- To allow time for the newly formed pouch to heal, your surgeon will create a temporary ileostomy (opening in the abdominal wall). A loop of your small intestine will be pulled through this opening to form a stoma, which allows waste to exit your body into an ostomy bag.
Once the J-pouch has healed, your surgeon will perform the second stage of this procedure, about 2 to 3 months after the first stage. You can expect the following during the second stage of your J-pouch surgery:
- First, your surgeon will disconnect the ileum from the temporary ostomy.
- Next, they will reconnect the ileum of your small intestine to the J-pouch previously created from the first surgery.
- Once connected, your waste will collect in the J-pouch so you pass stools naturally through your anus.
Third stage (only used in certain cases)
Sometimes, a three-stage surgery is recommended. This involves an additional step where the J-pouch is directly connected to your anus. This three-step process may be used in the following cases:
- emergency surgery for bleeding
- toxic megacolon
- you’re currently taking steroids in high doses
- if you’re in overall poor health
Why the procedure is done in stages
Rarely, J-pouch surgery is done completely in one procedure. This is because the newly formed J-pouch needs time to heal so it does not become infected.
Each stage of J-pouch surgery is done 8 to 12 weeks apart. If you have a temporary ostomy, you’ll need to follow your doctor’s care instructions for emptying it and keeping it clean.
After your surgery is done, you may experience an increase in bowel movements. You may eliminate stool 12 times in one day. These bowel movements will gradually decrease in number after several months, as your anal sphincter muscles become stronger.
Your doctor may advise you to wait at least 6 weeks before resuming any physical activity. The exact timeline depends on how well your GI tract heals after surgery, as well as whether any complications arise.
Despite the potential benefits, the J-pouch procedure is still considered major surgery. As with any major surgery, you may be at risk for infections, bleeding, and side effects from general anesthesia.
Sometimes it’s possible for the newly formed J-pouch to become infected. However, such risks are higher in one-stage procedures.
Other potential complications from this procedure include:
- Small bowel obstruction. While considered uncommon with this surgery, it’s possible to experience temporary small bowel obstruction due to adhesions between tissues. This may be treated with bowel rest. Some common symptoms include vomiting, abdominal pain, and an inability to pass stool.
- Pouchitis. This is an inflammation and infection of the J-pouch, and it occurs in an estimated 50 percent of people who undergo this surgery. While it’s treatable with antibiotics, you may experience symptoms such as fever, diarrhea, and abdominal pain.
- Pouch failure. If your body fails to respond to the newly formed J-pouch, your surgeon may recommend a traditional stoma. In such cases, the J-pouch will need to be surgically removed.
- Phantom rectum. Another common occurrence after removal of the rectum, this condition may cause feelings of pain or needing to pass stools despite the absence of a rectum. Pain relievers, guided imagery, and antidepressants may be used for treatment.
- Sexual dysfunction. This is caused by nerve damage, and it may occur in both men and women.
- Infertility in women. This may occur from scar tissue that grows around both the fallopian tubes and ovaries.
If you do develop pouch failure, your doctor may recommend either an ostomy or another type of colorectal procedure called a K-pouch surgery.
Pouchitis is the most common problem following J-pouch surgery and other pouch surgeries. This is a treatable condition and does not necessarily mean you’ll develop pouch failure. However, chronic pouchitis has been linked to possible failure of the J-pouch.
As the most common surgery for UC, your doctor may recommend J-pouch surgery if other treatment methods are no longer adequate for your condition. It’s also sometimes used as an emergency surgery.
With J-pouch surgery, your colon and rectum are removed, while your small intestine is used to create an internal pouch for waste collection. For some people, this method is preferable to wearing an external ostomy.
As with any surgery, it’s important to discuss all the potential benefits and risks of a J-pouch procedure with your doctor. The overall outlook is positive, but complications may still arise.