Written by Sarah
Depending on your reason for needing an ostomy, your ostomy may not have to be permanent. Some ostomies are temporary and your surgeon may speak to you about possible reversal options once you are healed. Today we will be talking about the reversal option for those who have had their entire large intestine removed: the ileal pouch-anal anastomosis (IPAA) or more commonly known as the J-Pouch.
What is a J-pouch?
A J-Pouch is a replacement for the colon and rectum created from the end of the of the small intestine called the ileum. It is called the J-Pouch because the ileum is folded back on itself and stapled to create a shape that resembles a “J”.
What does the J-pouch procedure look like?
he procedure to create a functioning J-Pouch will take either two or three surgeries depending on your situation.
A surgeon will take the following steps to create the J-Pouch:
- Removal of your colon and rectum in a procedure called a total proctocolectomy.
- Creation of the J-Pouch and temporary loop ileostomy.
- Assessment of the health of the J-Pouch and closure of the ileostomy.
Patients who are having a planned total proctocolectomy and J-Pouch reversal often have steps one and two combined into one surgery. Patients who had an emergency colectomy or proctocolectomy will require three surgeries during this process as you need to regain your health before having the J-Pouch created.
Post-Surgical Recovery
Each surgery will have a recovery period of six to eight weeks of rest as recommended by your surgeon. These are all very large procedures, and your body needs an adequate amount of rest to adjust post-surgery.
Possible Complications
Most patients undergo this process with few complications but as with any surgical procedure, there is a risk of complications. Some of the complications are short-term and can be resolved with medication or time. Other complications may require further surgical intervention and possible removal of the J-Pouch.
Here are a few J-pouch complications that you may encounter:
- An Anastomotic leak is where the pouch does not completely seal at the connection points and waste from your intestines leaks into your abdominal cavity. This can cause infections or abscesses which can become sepsis in severe cases.
- Abdominal adhesions are areas of excessive scar tissue in the abdominal cavity post surgery. These adhesions can cause bowel obstructions or affect the female reproductive organs causing female infertility.
- Sexual dysfunction can be caused by damaged nerves in the anal and pelvic regions.
- Pouchitis is inflammation in the J-Pouch causing abdominal pain, urgency to go, or bleeding. Around 50% of J-Pouch patients will develop a case of pouchitis in their lifetime. For most, it can be cleared up with a round of antibiotics. In a small number of patients, it becomes chronic and requires regular intervention.
- Stricture/Stenosis can occur when excess scar tissue in the ileal pouch causes the pathway to narrow making it hard to pass gas or stool.
- Twisted pouch syndrome is a rare condition where the pouch was twisted in the pelvis when being constructed.
Post-Recovery Outlook
After you have recovered from the final surgery, you will return to pooping the normal way. Your body will not be able to reabsorb fluid the same as before so it will be very important to stay hydrated and possible incorporate electrolytes into your diet.
In addition to needing to monitor your water intake, your waste will not be as solid as it used to be and will be more frequent. You can bulk up your stool by eating starchy foods like potatoes, rice, and bananas. You should also avoid diarrhea-causing foods with high sugar, caffeine, alcohol, and high fat until you know how they affect your system.
For your diet, you will be able to eat most of the same foods as before your surgery. During recovery, it is important to eat a relatively low residue diet to allow your digestive system to heal but after about the eight-week mark, you can start to slowly reintroduce more types of food. Everyone’s body will react differently to various foods, so it is important to reintroduce foods gradually.
For more post-surgery recovery tips, check out our dedicated post-surgery wellness blog,
Wellness Tips for Post-Ostomy Surgery Recovery.
Conclusion
Whether you choose to undergo the J-Pouch procedure or not, it is important to know that you have the option and are informed. The J-Pouch may not be the solution for everyone, so it is important to speak with your medical team and personal support group to make a well-informed decision about stoma reversal after a total proctocolectomy.
More about Sarah
Hello, my name is Sarah. I was born and raised in Pittsburgh, Pennsylvania but now live in Vancouver, BC. I attended the University of British Columbia for Biology and graduated in 2019. In fall of 2021, I was diagnosed with Ulcerative Colitis and very soon after underwent a total colectomy. I lived with an Ileostomy for two years before undergoing the procedures for a J-Pouch. I now spend my time with a fulfilling career helping Ostomates with their post-surgical care at Nightingale Medical Supplies. In my free time, I enjoy reading, volunteering with Girl Guides, and crafting.
Learn more about Sarah's story in her piece: "Finding a New Normal with Ulcerative Colitis".