Pouchitis

Updated: 2024-10-25

Overview

Pouchitis is swelling and irritation, called inflammation, in the lining of a pouch made during surgery to remove the colon. The pouch is made to treat a bowel disease called ulcerative colitis and some other diseases.

Many people with ulcerative colitis need to have their colons taken out. Surgeons use a procedure called ileoanal anastomosis (J-pouch) surgery to connect the bowel again after taking out the colon.

In J-pouch surgery, surgeons use the end of the small intestine, called the ileum, to make a pouch shaped like the letter J. Surgeons attach the pouch inside the body to the area just above the anus. The pouch holds stool before it leaves the body.

Pouchitis is a complication of J-pouch surgery. It happens in nearly one-half of the people who have the procedure.

Symptoms

Symptoms of pouchitis can include diarrhea, belly pain, joint pain, cramps and fever. Other symptoms include passing stool more often, stool leakage at night, trouble controlling stool passage and a strong urge to pass stool.

Causes

The cause of pouchitis is unknown. The condition appears to be due to an interaction between bacteria in the pouch and an underlying issue with the immune system.

Risk factors

Some factors that can increase the risk of developing pouchitis include:

• Having inflammatory bowel disease, also called IBD. Pouchitis happens more often in people who have underlying IBD, such as ulcerative colitis.
• Using nonsteroidal anti-inflammatory drugs, also called NSAIDs. Taking NSAIDS, such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), can contribute to the development of pouchitis.
• Having radiation therapy. Radiation therapy in the pelvic area increases the risk of getting pouchitis.

Diagnosis

To diagnose pouchitis, a healthcare professional will likely start by taking a medical history and doing a physical exam.

Confirming the diagnosis may include tests, such as:

• Lab tests. Blood tests may be done to look for other medical conditions. Stool tests may be done to look for infection. The results can help determine what type of antibiotics are best for treatment.
• Endoscopy. Endoscopy uses a tiny camera on the end of a flexible tube to visually examine the ileal pouch. During endoscopy, a sample of tissue, called a biopsy, may be collected for testing.
• Imaging. A healthcare professional may recommend an imaging test, such as MRI or CT scanning, to find out what is causing symptoms.

Treatment

Antibiotics

Antibiotics are the most common treatment for pouchitis. Most people improve within 1 to 2 days of starting antibiotics and do not develop pouchitis again. The full course of treatment is usually 10 to 14 days, although longer courses are sometimes needed.

Someone who has regular flare-ups of pouchitis may need ongoing maintenance antibiotic therapy. Using probiotics may help prevent pouchitis from coming back.

Surgery

On rare occasions, pouchitis doesn't respond to daily treatment. Then surgeons may need to remove the pouch and do a permanent ileostomy.