Ileal pouch-anal anastomosis (IPAA) is commonly known as J-pouch surgery. This surgery creates a rectum using the end portion of the small intestine. It’s done after the large intestine (colon) and rectum are removed.
J-pouch surgery can be an option for people with ulcerative colitis (UC) if medication isn’t working to control their symptoms.
As with any surgery, there are many things to consider. Keep reading to learn the answers to some of the most commonly asked questions about J-pouch surgery for ulcerative colitis (UC)
J-pouch surgery is typically done with two or three separate procedures. The first step is the procedure to remove the colon and rectum. During this surgery, the J-pouch is created from the bottom of the ileum section of the small intestine and gets connected to the anus. The J-pouch needs time to heal and can’t be used right away.
To allow for healing, a temporary ileostomy is created. The ileostomy directs waste into a bag attached to the abdomen through a stoma. The stoma is created from another section of the ileum.
The second surgery is usually done 8 to 12 weeks after the first surgery.
In the second surgery, the stoma is closed up and the ileostomy is reversed. The parts of the ileum that were used to create the ileostomy and the new J-pouch are reconnected. The small intestine now ends in the J-pouch which is attached to the anal sphincter and anus.
In a three-stage procedure, the final procedure is performed 8 to 12 weeks after the second surgery to reverse the ileostomy and reattach the small intestine to the pouch.
Surgery to remove the colon (large intestine) and rectum is called a proctocolectomy. The anus and the anal sphincter are still in place. This allows a person to have some control over bowel movements. Waste is eliminated through the anus as before.
The small intestine has three parts: the duodenum, the jejunum, and the ileum. To create a J-pouch, the end section of the ileum is looped into a J-shape to create a pouch.
After the colon and rectum are removed, this new J-shaped pouch is attached to the anus. Food waste will now pass through the small intestine before gathering in the J-pouch. It’s eliminated through the anus.
UC is a type of inflammatory bowel disease (IBD). It affects the large intestine (colon) and rectum. Any surgery that removes these parts is considered a cure for UC.
After the colon and rectum are removed, J-pouch surgery creates a new rectum.
Yes. For many people with UC, removing the colon and rectum can improve their quality of life. It’s considered a cure for the condition.
Most of the nutrients from our food are absorbed in sites throughout the small intestine. The main job of the large intestine is to remove salts and fluid. Without a colon, it’s important to drink enough fluids. You may also need to add more salt to your diet until your body gets used to the new balance.
Once your J-pouch is fully healed, the hope is that you will be able to eat a variety of foods. The healing process can take up to a year.
A gradual progression of diets is recommended as your digestive tract heals.
You may find that initially, your bowel movements are very frequent and soft or watery. Over time, they tend to get more solid and less frequent.
Once you are able to take things by mouth, you’ll be on a clear fluid diet. This will include water, broth, clear juices, sports drinks, popsicles, and gelatin.
After a few days, you will progress to a full fluid diet. This includes pureed soups, milk, yogurt, puddings, ice cream, and nutritional supplement drinks.
Gradually you will move to a low residue diet. This is also known as a low fiber diet, and it gives the 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 needed for the first 4 to 6 weeks after surgery.
A low residue diet includes:
- soft, cooked vegetables without skin
- soft fruit without seeds or tough skin
- dairy products including 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 start to add more fiber to your diet, pay attention to how foods affect your bowel movements. It’s normal to have more bowel movements while your digestive system adapts to having a J-pouch.
Over time, your J-pouch will stretch and be able to hold more waste. This means your bowel movements typically become less frequent. Bowel movements also tend to thicken over time.
The following foods can help if you’re trying to reduce stool frequency or thicken up the texture of your stool:
- white bread
- white rice
- peanut butter
Some people with a J-pouch experience anal irritation. The following are more likely to cause problems:
- tough textures such as nuts, seeds, thick skin on fruits and vegetables, and whole grains
- foods that are hard to digest such as popcorn, corn, pineapple, and coconut
- spicy foods, pickles, tomatoes, and olives
- coffee and tea
You may be advised to drink more fluids and get more salt in your diet. The colon plays a major role in regulating fluids and salt in your body. Without a colon, it can take some time for your body to get the right balance.
Fluids are best between meals. Having too much fluid with a meal can speed up digestion and increase stool frequency.
It’s recommended to 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 very well, speak with a registered dietitian.
It’s normal to have lots of questions about life with a J-pouch. This surgery is done to essentially cure UC.
Initially, you’ll need to adjust your diet as your body adapts to the changes in your digestive system. Over time, the goal is to feel well and be able to eat a variety of foods. Your healthcare team can help with any questions or concerns you have throughout the process.