Pouchitis | Digestive Health | Loyola Medicine


Overview and Facts about Pouchitis

Pouchitis occurs when the pouch created during an ileal pouch-anal anastomosis (IPAA) surgery becomes inflamed. During an IPAA proctocolectomy, a doctor removes part of the large intestine, colon, and rectum and creates a pouch that can collect, store, and eliminate stool. When inflamed, this pouch becomes irritated and you may have to go to the bathroom more frequently. You may also experience abdominal pain, cramping, or bloating. About half of all patients who have had an IPAA surgery develop pouchitis at some point after the procedure. About 40 percent of people get it every year.

Signs and Symptoms of Pouchitis

Pouchitis often manifests in abdominal pain, cramping, and bloating, along with a more frequent urge to have a bowel movement. You may also experience other signs and symptoms, including:

  • Blood in your stool
  • Inability to control bowel movements
  • Increase in nighttime bowel movements
  • Seepage of stool during sleep
  • Straining during bowel movements
  • Tailbone pain

If your condition is severe, these symptoms may be accompanied by a fever, dehydration, malnutrition, or iron deficiency (anemia). You may also experience severe joint pain and fatigue.

Causes and Risk Factors of Pouchitis

Although the root cause of pouchitis is unknown, it may relate to the changes that occur in bowel movements after IPAA surgery. Since the pouch that now holds your stool is doing a different function than it was originally intended to do (absorb nutrients and water), the inner lining of the structure may cause an immune response due to the bacteria it is now exposed to.

Although anyone who has had an IPAA surgery can develop pouchitis, there are certain risk factors that make it more likely, including:

  • Diabetes
  • Genetic makeup
  • Heart disease
  • Inflamed bile ducts in the liver
  • Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Severe ulcerative colitis
  • Smoking cigarettes

Tests and Diagnosis of Pouchitis

To diagnose pouchitis, your doctor will review your symptoms and may request you have an endoscopy, where the doctor examines the inside of your pouch with a camera. This endoscopy can help the doctor determine the extent of your inflammation, where it’s located, and if there are signs of another condition such as Crohn’s disease. During this procedure, your doctor may take a small tissue sample to check for other concerns. If necessary, additional testing may be needed to confirm pouchitis or rule out other conditions. These tests include:

  • Anorectal manometry
  • Barium defecography
  • Contrast pouchography
  • CT scan
  • Gastrografin enema
  • MRI

Treatment and Care for Pouchitis

In most cases, your doctor will treat pouchitis with antibiotics. To prevent further complications, they may recommend taking a daily probiotic to establish a healthy supply of good bacteria in your gut.

If you have chronic pouchitis, a low-carbohydrate or a low-fiber diet can relieve your symptoms. Over time, your condition may become resistant to antibiotics and can lead to pouch failure. When this occurs, either a combination of antibiotics, corticosteroids, immunosuppressants, or biologic therapy may be tried. If this doesn’t resolve the issue, your pouch may need to be permanently removed.