What Is Pouchitis?

Medically Reviewed by Minesh Khatri, MD on May 28, 2023
3 min read

Your large intestine’s job is to get rid of solid waste from your body. But if your doctors remove it because of disease, you might have what’s called J-pouch surgery so you can poop as you did before.

In as many as half the cases, the pouch that replaced your rectum eventually gets infected or inflamed. This complication is called pouchitis.

The J-pouch is so named because it resembles the letter J. It also can be shaped like an S or a K. It’s a new storage and passageway for your waste, made out of the lower end of your small intestine and connected directly to your anus.

The most common reason for a J-pouch operation, also called ileal pouch-anal anastomosis surgery, is ulcerative colitis, a form of inflammatory bowel disease. You also might have the surgery because of cancer, growths called polyps in your colon that may turn cancerous, or other reasons.

About 1 in 5 people get pouchitis a year after the surgery, and half of them have it after 10 years. It happens when your immune system goes on defense or turns against itself and inflames the pouch.

Signs of pouchitis can differ from person to person. They might include:

In serious cases, you could become dehydrated, malnourished, or anemic enough that you need emergency medical care.

Researchers aren’t sure what triggers pouchitis. But more and more, they suspect that your gut health may play a key role. One theory is that the mix of “good” and “bad” bacteria in your stomach could pave the way for bacterial, fungal, or viral infections that may lead to pouchitis.

Other possible risk factors include:

  • Extensive ulcerative colitis
  • Inflammatory polyps, or growths, in the pouch
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Weak blood flow to the area
  • Inflamed or hardened bile ducts in the liver
  • Smoking
  • Genetics

Pouchitis doesn’t always look the same way in different people. Or your symptoms may change over time. Your doctor will ask about your medical history and rule out any other conditions, like Crohn’s disease, that may be behind your symptoms.

Diagnostic tools for pouchitis include:

Imaging tests. Your doctor might take a picture of the inside of your belly or pelvis with a CT scan, MRI, or other imaging machines.

Biopsy. An instrument called an endoscope lets your doctor see the inside of the pouch. They may take a small tissue sample to examine under a microscope.

Lab tests. Your doctor may screen your blood for low levels of iron or vitamin D, both of which are common in people who have pouchitis. They may run other tests to check how well your liver is working or if you have any viral infections.

Two weeks of antibiotics is the main treatment. It almost always works. Your doctor may recommend other treatments, including:

  • Probiotic supplements to encourage “good bacteria” to flourish in your gut
  • Medication to control diarrhea
  • Eating less carbs and fiber and more protein
  • Corticosteroids and other medications that tamp down your immune system