What is a J-pouch?

So what is it? That is the question I get asked most often and you know what? I get it, a j-pouch is kind of hard to understand. Most people have never even heard of a j-pouch and when I explain it to them I am often met with puzzled looking faces. I’ve even had doctors and nurses at the hospital confused when I say I have a j-pouch and they start looking for an ostomy bag. 

This is a common conversation in my life. 

Me: So I have Crohn’s disease and because of it I had to have my entire large intestine and rectum removed and I now have a j-pouch. 

Person: Sooo….*eyes look at my body searching for an external pouch*….how do you go to the bathroom?

Me: Just like anyone else. 

Person: So you don’t have a colostomy bag? 

Me: *rolls eyes (it’s ileostomy you fool!)* No I don’t, my pouch is internal and it’s made out of my small intestine. 

Person: *stunned look on their face which quickly changes to confusion* Oh. Well I’m glad you’re okay! 

Not a lot of people understand what a j-pouch is so I’m gonna break it down a little bit for you in some hopefully easy terms to understand and with less “jargon”. 

What does it look like?

imageThis is what the digestive system looks like after j-pouch surgery. You can see that the entire colon/large intestine has been removed and that only the small intestine is left. The surgeon constructs a pouch out of the end of the small bowel and attaches it to the anus so that stool is still passed there instead of needing an ostomy.  The pouch acts as a reservoir for stool so that it is held there until the patient feels the urge to have a bowel movement.  Sphincter muscles are left intact so that control of the bowels remains. 

Why is it called a j-pouch? As you can see in the photo above the pouch resembles the letter J. It’s as simple as that!

Other names for the j-pouch: ”ileo-pouch”, “internal reservoir” “ileoanal-reservoir” “IPAA” When you hear any of these they all refer to the internal pouch that is made out of your small bowel that holds stool until you are ready to have a bowel movement.

Technically speaking: The technical term for j-pouch surgery is ileo-pouch anal anastomosis or IPAA. What the what?! Don’t let that big name confuse you, if you break it down it’s quite simple. Ileo-pouch simply means a pouch made out of your ileum which is the end of your small bowel. Anal anastomosis means that the pouch is attached to the anus since anastomosis means in simple terms where they join two ends of bowel together. So ileo-pouch anal anastomosis means a pouch made out of the end of the small bowel that is attached to the anus. Easy peasy!

Who gets a j-pouch?: In the world of IBD a j-pouch is usually only an option for those who have ulcerative colitis. Since UC only affects the large bowel (colon) it is an option because j-pouch surgery removes the entire colon and generally there is no risk for the disease attacking the pouch since UC does not affect the small bowel. Why is it not an option for Crohn’s patients? Because Crohn’s disease affects the entire digestive tract. This means that the j-pouch that is created out of the small bowel is at risk to fail or have complications since the Crohn’s disease will probably attack the pouch. In Crohn’s patients the disease usually recurs where portions of the bowel have been removed. Since in j-pouch surgery the colon is removed the disease will likely recur in the j-pouch.  There are some surgeons who will do the j-pouch operation on some Crohn’s patients. Typically those who have Crohn’s Colitis (Crohn’s disease of the colon only) or patients who have indeterminate colitis. In other cases (like mine) a person has j-pouch surgery when they have a diagnosis of ulcerative colitis and later find out they have Crohn’s disease. Other conditions where j-pouch surgery is a treatment is colon cancer and familial polyposis.

Did you know?! There are also s-pouches, w-pouches, and t-pouches. They are given these nicknames because of the letters the pouch resembles. The J pouch is the most common and therefore the only one you usually hear of. It seems to be just the right size and shape to work most successfully.

Well there you have it! This is just your basic guide to a j-pouch and there is a lot more to be learned about the surgery process itself and possible complications. We will get to that another day. 


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