A Brief Overview of J-Pouch Surgery for Ulcerative Colitis

An overview of the most commonly used surgical treatment for ulcerative colitis.

Woman recovering from surgery, holding a tablet.

Medically reviewed in September 2021

While ulcerative colitis (UC) is a different experience for everyone, the main goal of treatment is remission. Remission refers to a state where the disease is no longer active, and symptoms get better. Attaining and maintaining remission helps prevent complications and improve your quality of life while living with UC.

Different people require different treatments to achieve remission. Some are able to manage symptoms through diet, avoiding triggers, and taking medications that help control inflammation. Some people require strong medications that act on the immune system. And some people find that UC does not respond to these therapeutic approaches.

If symptoms persist or are no longer responding to medications, your healthcare providers may recommend surgery. The most commonly used surgery for the treatment of UC is called a proctocolectomy with ileal pouch-anal anastomosis (IPAA). It is more commonly referred to as a J-pouch surgery.

Here are some answers to common questions about this procedure.

What exactly is J-pouch surgery?
UC is one of the two major types of inflammatory bowel disease, also called IBD (the other major type is Crohn’s disease). The defining feature of UC is inflammation in the colon (the large intestine). This inflammation can affect only the rectum and lower part of the colon, or it can affect the entire colon.

In some cases, the inflammation is so severe, or these organs have become so damaged, that the colon and rectum are surgically removed (a procedure called a proctocolectomy). Because the function of the colon is to store stool so it can be eliminated from the body, the body will now need a new way to do this—which is where a J-pouch comes in.

A J-pouch is the most common type of ileal pouch (there are also S-pouches and W-pouches). One of the main advantages of ileal pouch surgery is that a person will not need a permanent external ostomy pouch.

J-pouch surgery involves using parts of the small intestine to give the body a new route to store and remove solid waste. Surgeons will use the ileum—the part of the small intestine that attaches to the large intestine—to create a new rectum, which will be attached to the anus. Surgeons will create a J-shaped pouch using the bottom section of the small intestine. This pouch will essentially function as a new large intestine—a place where the body can store stool before it passes from the body.

What is the healing and recovery process?
It typically takes two or three surgical procedures to create a J-pouch. It takes between 3 and 9 months to complete all procedures and allow the body time to heal. To give the body time to heal, a person will need a temporary ileostomy, where waste is diverted through an opening in the abdominal wall and collected in an external pouch. Once the body has healed, a person will have another surgery to reverse the temporary ileostomy and reconnect the bowel. Once a person recovers from this second surgery, the J-pouch will be functional, and they will be able to pass bowel movements normally.

Living with a J-pouch involves numerous considerations, including changes to the foods you eat, the medications you take, and adjusting to having frequent bowel movements. It is important to discuss the changes to expect after surgery with your healthcare team.

Article sources open article sources

UpToDate. "Patient education: Ulcerative colitis (Beyond the Basics)."
Medical News Today. "Ulcerative colitis remission: What to know."
Elsevier Point of Care. "Clinical Overview: Ulcerative Colitis."
Crohn's & Colitis Foundation. "Surgery for Ulcerative Colitis."
Cleveland Clinic. "J-Pouch Surgery."
NCI Dictionary. "Colon."
Cleveland Clinic. "Ileal Pouches."
Medical News Today. "How does it work? J-pouch for ulcerative colitis."
Penn Medicine. "Total Proctocolectomy with J-pouch Reconstruction for Ulcerative Colitis."
UCSF Health. "Special Concerns for People with J-Pouches."

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