What is a JPouch and how does it work? Stages of surgery and what to expect.

This is written from my experience and is not medical advice or technically quoted, just what I have learned, explained in a way others can understand.

I had never heard a JPouch until I had my first surgery for an Ileostomy stoma. I initially thought that was it, I had a stoma for life!

I was a few weeks after surgery that my consultant suggested I may have further options for surgery to ‘reconnect’ me, I was baffled as I had absolutely no colon left (large bowel) and didn’t realise how much if any rectum was left.

I had my colon out due to severe indeterminate colitis and all medications and biological trials had failed, it saved my Life!

As it was decided that I had indeterminate colitis (IC) and not straight forward Crohns disease (CD) I was a candidate for the JPouch!

The stoma sits on the outside of the body and has a stoma bag, so how is the JPouch different?

The JPouch is, very basically, the small intestine that has the ileum currently made into a stoma, disconnected and put back inside the body, moved into the cavity in the pelvis where the old colon finished, it is sewn into a J shape and the bottom of that is opened and sewn to the anus, the remaining rectum is removed and just the cuff and anus left.

The cuff gives the control needed to manage the emptying of the JPouch on the loo as it has muscles and can control the opening.

The small bowel which is now finished with a JPouch, has no muscles or mucosa lining (this is the lining of the colon that suffered disease previously). However, the rectal cuff has the same mucosa and therefore can, although not common, become troublesome with colitis type symptoms, a problem known as Cuffitis.

Stages of JPouch surgery

How the new JPouch is connected to the Anus!

Once the JPouch is connected it can hold stool in the reservoir that is the J and when full, the feeling of needing the toilet helps you manage going to the toilet as you would of before.

The new JPouch is still the same tissue etc of the small bowel and whilst it can absorb nutrients etc, it can not absorb the excess water that the stomach passes on, this would have previously been absorbed back into the body by the colon, also it is not able to compact and form the stool. This means the output is significantly higher and waterier than before. Transition time from eating/drinking to needing to pass stool is also quicker, in my case now approx. 4 hrs.

JPouch output at its best is, ideally, a soft porridge consistency and is needed to be emptied between 6-9 times a day typically and occasionally during the night, although this is different from person to person and effected by many factors, such as diet, exercise, metabolism and other health factors.

I had my JPouch created and connected in one surgery without the need for a loop stoma, via a single incision and laparoscopically. Many JPouch’s are done over a few stages, although they mainly start with the removal of the colon and a temporary ileostomy stoma creation.