How long does the J-pouch last?

    When we think about food, we often think of how delicious food can be but it is rare for people to think of the nutritional contents. This makes many people eat without consciousness or paying attention to their health. Food can definitely affect bowel movement after it is processed in the body. While we may not be worried of bowel movement, this may not be the case with those having digestive issues. In this DoctorOnCalls’s article, we will learn about J-pouch, a procedure done in patients with digestive issues.

    Since J-pouch will be associated with the intestine or bowel, you may want to know a bit more about the intestine itself. The intestine is a muscular tube which starts from the lower end of the stomach to the anus. Food and digested products pass through the intestine. Intestines are divided into two main sections which are small intestines and large intestines. The small intestines have three segments which are duodenum, jejunum and ileum. The large intestine is wider than the small intestine and the purpose is to absorb water and salts that are not digested. It also gets rid of waste products. The large intestine has four parts which are cecum, colon, rectum and anal canal.  

     For ulcerative colitis, J-pouch is a treatment option on top of medicine. In ulcerative colitis, the colon and rectum become inflamed for a long period of time. J-pouch is generally known as proctocolectomy with ileal pouch-anal anastomosis (IPAA). This surgery removes the diseased large bowel. The operation itself removes the large bowel and creates a “new rectum”. Pouch is made out of the ileum and attached to the anal sphincter muscle. From this pouch, a reservoir is made to store stool and allow controllable bowel movement. The name J-pouch itself refers to the J-shaped internal reservoir that has been made from the individual’s own small intestine.

  J-pouch surgery itself is often a multi-step surgery which requires a temporary ileostomy (stoma) on the abdomen with the use of an external pouch to remove waste. The stoma will be reversed when the surgery is complete and the patient will be able to perform bowel movement as usual through the anus. The temporary ileostomy is removed when the J-pouch heals after 2 or 3 months after the first stage surgery. Removal of the temporary ileostomy is known as stage 2 or the second surgery. Some surgeons may choose to perform the surgery in one go without making a temporary ileostomy but it is less often done because of the risk for infection. Some patients may need a three-stage process in case of additional health issues, those on high doses of steroids or as emergency surgery in case of bleeding or toxic megacolon.

   It is common for the body of those who have just got J-pouch surgery to need time for recovery. It will take time for the body to adapt with the pouch. Increased number of bowel movements can be expected but it will decrease over time. Some male patients may experience some form of sexual dysfunction resulting from nerve damage. Female patients may develop scar tissue around the ovaries and fallopian tube that may contribute to infertility. Menstrual cycle may be irregular for up to a year following the surgery.

    Beside pain experienced by those undergone J-pouch surgery as it is a major operation, those who have had this surgery may wonder how long does the J-pouch last. J-pouch is said to be successful in treating more than 95% cases. This means that the J-pouch can last for a very long time. J-pouch can last for up to 20 years. However, it is worth noting that despite it seeming like J-pouch does not seem to fail, there are still around 10% cases of failing J-pouch.

     Similar to many other surgical procedures, J-pouch does pose risk and possible complications. Complications such as inflammation to the J-pouch or known as pouchitis can occur up to 50% of people. Symptoms include diarrhoea, increased bowel movement, abdominal cramping, faecal urgency (sudden need to empty the bowel), tenesmus (feeling of constantly the need to pass stool) and incontinence (unintentional passing of urine). Some may feel unwell and have fever. Patients may have symptoms of iron-deficiency anaemia This can occur in the 2 years after the surgery. Pouchitis can be treated with antibiotics. Other complications include anastomotic leak or stricture and small bowel obstruction.

  It can be concluded that J-pouch is a procedure commonly done to treat ulcerative colitis. The procedure may take one to three operations. J-pouch involves removal of the colon and rectum and creating the J-shaped pouch. The J-pouch takes the place of the removed colon and rectum. This allows the patient to be able to perform bowel movement normally. It is important for those planning for J-pouch surgery to have a thorough discussion with their surgeon and understand what to be expected or done before, during and after the surgery. J-pouch can be considered as a procedure with high successive rate and last for a long period of time.