Pouchitis

Pouchitis is a complication of a procedure used to treat ulcerative colitis and other conditions in which the pouch created in the surgery becomes inflamed.

About Pouchitis

Some patients with ulcerative colitis or colorectal cancer may need to have their entire colon removed. This is sometimes accomplished through a surgery called an ileal pouch anal anastomosis (also known as a J-pouch surgery). In this procedure, the colon is taken out and the lower end of the small intestine is used to create a pouch that is then sewn to the anus. This pouch creates a larger reservoir where waste can be stored before it is eliminated through the anus. While this procedure allows patients to avoid a permanent stoma in the abdomen, the newly formed pouch can sometimes become inflamed. The exact cause of pouchitis is unknown, but it is thought to be linked to a disruption to the gut microbiome following surgery.

Symptoms of Pouchitis

Pouchitis symptoms can be either acute (lasting under four weeks) or chronic (lasting four weeks or more)

Symptoms of pouchitis may include:

• Abdominal cramps
• Increased frequency of bowel movements
• Blood and/or mucus in the stool
• Urgency to have bowel movements
• Less commonly, fever

Risk Factors For Pouchitis

Pouchitis is a common complication of ileoanal anastomosis and some patients are at higher risk of developing the condition.

Risk factors for pouchitis may include:

• Genetic predisposition
• Health history: More extensive involvement of ulcerative colitis in the colon and use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are risk factors for pouchitis
• Lifestyle: Smoking tobacco can make pouchitis more likely

Diagnosing Pouchitis

Pouchitis is diagnosed using an imaging technique known as pouchoscopy. This is similar to a colonoscopy but the scope only has to be inserted a short distance, with easier preparation beforehand. A sample (called a biopsy) will also be taken from the bowel to assess for the extent and type of inflammation. Following this procedure, your condition can be treated.

Treating Pouchitis

Most commonly, a short course of antibiotics will be given to treat the inflammation. In some cases you may be recommended to take probiotics (good bacteria) to help prevent recurrence of the inflammation. In more severe or recurring cases, anti-inflammatory medications or even biologic agents may be needed to keep the inflammation under control. Your physician will work with you to determine the best course of treatment.

Care Team Approach

Patients are cared for by a dedicated multidisciplinary care team, meaning you will benefit from the expertise of multiple specialists across a variety of disciplines. Our board-certified and fellowship-trained gastroenterologists have extensive experience treating inflammatory bowel disease and work alongside a team of digestive health experts, including colorectal surgeons, physician assistants, nurses, advanced practice providers, dietitians, social workers, and more, providing unparalleled care for patients every step of the way.

We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to identify new therapies to improve treatment outcomes. We are committed to communicating and coordinating your care with referring physicians and other partners in the community to ensure that we are providing you with comprehensive, whole-person care.

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