Pouchitis

An inflammation of the lining of a pouch that is surgically created in the treatment of ulcerative colitis is called pouchitis.

People who have severe ulcerative colitis might have removed their colon and the bowel reconnected with ileoanal anastomosis (IPAA) or J pouch surgery. The pouch is shaped like a letter J and this is done by using the end of the small intestine to create that pouch then it will be attached internally to above the anus to hold waste before it is eliminated.

About 23 to 46 percent or people have pouchitis, which is a complication of IPAA.

Some of the symptoms are:

• abdominal and joint pain,
• diarrhea,
• fever,
• cramps,
• fecal incontinence,
• increased number of bowel movements,
• nighttime fecal seepage.

Signs and symptoms of pouchitis are;

• greater need to pass stools,
• straining during defecation,
• blood in the stool,
• tenesmus,
• incontinence,
• abdominal cramps,
• seepage of waste matter while asleep,
• discomfort in the pelvic area or lower abdomen,
• tail bone pain,
• nighttime bowel movements.

In severe cases, symptoms may include:

• fever,
• dehydration,
• fatigue,
• malnutrition,
• severe joint pain,
• and iron-deficiency anemia.

There is no clear cause of pouchitis but mostly it occurs in people with:

• ulcerative colitis or other forms of colitis,
• familial adenomatous polyposis, which is a genetic condition.

Making a diagnosis of pouchitis is done by performing several tests and procedures.

Your doctor will conduct an endoscopy to check how big is the inflammation, if the ileum is irritated and if you have Crohn’s disease or Crohn’s-like disease of the pouch. This can also show if you have inflammation of the anal transitions zone or cuff (cuffitis).

Your doctor may also get a sample of your tissue (biopsy) to check for other underlying conditions such as infection or polyps or if there is a restricted blood supply.

CT scan and MRI may be recommended to check your abdomen and pelvis.

Pouchitis is usually treated with 2-week antibiotics and your doctor may also recommend probiotics such as Lactobacillus.

Your doctor may also recommend a low carbohydrate or low fiber diet to relieve the symptoms of pouchitis. For frequent or loose bowel movements, antidiarrheal agents may be used.

Since there is no clear cause of pouchitis, there are no ways of preventing it.

You can prevent it by reducing the symptoms such as drinking your antibiotics.

There are no homeopathic or alternative remedies for pouchitis.

Follow some of these tips to cope with pouchitis:

• exercise regularly such as walking or swimming,
• keep yourself busy with activities at day because most people do not have bowel movements during the day,
• drink the antibiotic and probiotics that your doctor recommended.

Extensive colonic disease and NSAIDs are associated with increased risk for developing pouchitis.