Rectal Pouch

(also known as an IPAA or J- Pouch)

When certain disease conditions require the removal of the rectum as a part of the treatment, a rectal pouch may be created.  The new pouch serves as a reservoir for feces, and allows the patient to maintain control and eliminate feces at a convenient time and place.  The rectal pouch is also referred to as an ileal pouch-anal anastomosis (IPAA), J-pouch or neo-rectum.

The rectal pouch is constructed and used after a rectal cancer has been removed or after the colon and rectum have been removed as a part of the surgical treatment of ulcerative colitis.  A pouch may also be used when the rectum has been removed in the treatment of certain hereditary colon or rectal conditions such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome).  The procedure may be performed in a non-invasive fashion with a laparoscope or during an open, traditional operation.

Ulcerative colitis is an inflammatory bowel disease (IBD) that affects the digestive tract. This disease commonly affects the rectum and/or the colon (large intestine), and may ultimately require a removal of these organs.  This is the most common condition requiring the construction of a restorative pouch.  Symptoms of ulcerative colitis include:

  • Abdominal pain
  • Diarrhea
  • Fever
  • Blood in the stool
  • A rectal discharge or leakage
  • Malaise or weakness

In the past, after removal of the large intestine and rectum when treating ulcerative colitis, an ileostomy was fashioned.  An ileostomy is a permanent opening on the abdominal wall which receives the contents of the small intestine.  With a pouch, an ostomy may not be necessary, or may only be necessary on a short-term basis.

Benefits

Unlike a permanent colostomy or ileostomy, both of which require an external bag to collect stool through an opening in the abdomen, the rectal pouch provides the patient with an internal storage reservoir.  This frees the patient from the need to wear a bag or appliance over the abdominal wall and allows for control over the time and place of fecal elimination.

Not all patients report achieving the desired benefits of a rectal pouch however.  While most patients experience a vast improvement in stool control when compared with their preoperative control, some patients report having many stools, both during the day and during the night.  Additionally, for unknown reasons, some patients experience pouchitis, which is an inflammation of the pouch.  This may result in a pouch failure, necessitating removal of the pouch and resulting in the creation of a permanent ostomy.

The Procedure

During the course of the operation, the large bowel and rectum are removed.  Several inches of the end of the small bowel are then used by the surgeon to construct an internal pouch.  The surgeon will then attach the newly constructed pouch to the anus. This pouch functions similarly to the removed rectum.  Additionally, a temporary ostomy may be constructed at this time.  This ostomy may be closed several weeks or months after the pouch to anus connection (anastomosis) has healed.

It is important to note that after this procedure is completed, the patient will most likely have between two and six bowel movements per day. You should also expect that these frequent bowel movements may be softer than normal or may contain more water than normal.  Usually however, in patients with ulcerative colitis, this is an improvement compared to stool frequency and appearance during active ulcerative colitis.