When people find out that I have an ostomy, a common question they as is “Why not get a J-Pouch?”.
What is a J-Pouch?
When someone loses their colon and rectum due to Ulcerative Colitis, FAP (familial adenomatous polyposis), or cancer, there needs to be a way for stool to exit the body.
In many cases, this ends up being an ostomy, but some people have the option of going with an internal pouch, the most common being a J-Pouch.
A J-Pouch is only one kind of internal pouch that falls under the same procedure: an ileal pouch-anal anastomosis (IPAA). Other internal pouches include a K-Pouch (Kock Pouch), S-Pouch, and W-Pouch.
The J-Pouch is the most common style pouch, especially for those with Ulcerative Colitis, because it has a lower failure rate
How is a J-Pouch made?
A J-Pouch is formed using the end of the small intestine (the ileum). A surgeon creates a j-shaped reservoir that acts like your rectum, in the same place where your rectum would have been.
Most people have a temporary ileostomy created while they wait for their J-Pouch to heal. This is often over several months, although some people wait to have a takedown surgery for a year or more.
While the entire surgery can be done in one shot, most people will have it done in two or more stages to allow for more time to heal and to minimize the risk of complications.
Benefits of having a J-Pouch
For most people, the idea of not having an ostomy bag is the primary reason they opt for this surgery. I can’t blame people for feeling that way since an ostomy can dramatically change several aspects of someone’s life. And if you pay for ostomy supplies out-of-pocket, there’s a financial incentive to reverse it.
Others, even those with stomas that have worked well, prefer to go to the bathroom they way they always have, so a J-Pouch is an attractive offer!
People with Ulcerative Colitis are often told that the J-Pouch is their surgical goal, so it’s often planned well before they go in for surgery. Many may not even know they have a choice in the matter, and simply go with the flow. I encourage this if that’s what you and your surgeon have spoken about and planned in advance.
While the choice to have a J-Pouch is entirely up to the individual, there are a few risks that need to be considered alongside the expected benefits.
Risks and complications from J-Pouch surgery
There are risks to every surgery, and J-Pouch surgery is no exception.
Over the years, complications have dropped considerably, but some patients may still experience any of the following (SOURCE):
- Pouch failure (approx. 5%). This may result in a revision or removal of the pouch – leading to a return to an ostomy.
- Sepsis (approx. 7.5%)
- Fistula (approx. 4.5%)
- Pouchitis (approx. 27%)
- Small bowel obstruction (approx. 11%)
- Incontinence (approx. 6-17%)
There are other complications, but the list above illustrates that even J-Pouch surgery isn’t trouble-free.
In addition to medical complications, having a J-Pouch doesn’t mean that you’ll be going to the bathroom exactly as you were before.
Not having a colon usually means that bowel movements will be loose and more frequent than “normal people”. Often times this liquid output can cause burning to the anus and creams, like Calmoseptine (not vegan) or zinc ointments are often needed to calm things down.
Many new “J-Pouchers” also find that they have leakage or incontinence when their J-Pouch is new. This tends to go away over time, but some may still have the occasional leak from time to time.
Why not have J-Pouch surgery?
Some people, like me, simply aren’t a candidate for the surgery.
Crohn’s patients are often told that they cannot have the surgery as the risk of their disease affecting the J-Pouch is quite high (SOURCE). I would also guess that patients with indeterminate colitis (where no formal diagnosis of UC or Crohn’s Disease has been made), there may be some hesitation to get a J-Pouch out of fear that if it is Crohn’s that it would be problematic in the future.
Because my illness included severe perianal disease, the likelihood that an internal pouch would fail was too high for me to even consider it an option. Plus, I kind of like my ostomy :)
Many patients who’ve had success with their temporary ostomy don’t feel the need to change their lifestyle or risk potential complications. These people may simply opt to keep their ostomy permanently, although, some choose to have their rectum removed down the road.
There are also many people who are undecided and will keep their stoma for quite a while before making the decision. There’s no harm in waiting!
What should I do?
The decision to go ahead with a J-Pouch is a very personal one. I can’t tell you either way which path to go down, but I do suggest that you speak with your surgeon to find out what your risk factors are for complications.
I would also suggest speaking with other people in your situation who’ve either gone through with the surgery or have decided to keep their ostomy. One place to ask is the Community Forum.
If you already have your temporary ostomy, then you may want to consider how well it’s been working for you, or whether you are OK living with it forever.
- De Zeeuw S, Ali UA, Donders RART, Hueting WE, Keus F, van Laarhoven CJHM. Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. International Journal of Colorectal Disease. 2012;27(7):843-853. doi:10.1007/s00384-011-1402-6.
Crohn’s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Brown CJ, Maclean AR, Cohen Z, Macrae HM, O’Connor BI, McLeod RS. Dis Colon Rectum. 2005 Aug;48(8):1542-9. PMID: 15937625