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.
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.
Stage 1 is typically the removal of the temporary ileostomy stoma, creation of the JPouch and a temporary ‘loop’ stoma installed. This is so the JPouch can heal and the waste is managed via a stoma similar to before, however now instead of the stoma being the end of the small bowel, it’s now an opening in the intestine that is pushed through the abdominal wall, but the end is now the JPouch, the loop acts to bypass the JPouch and let it heal.
Stage 2 or the final stage for some who have numerous previous surgeries, is the removal and closure of the loop stoma site and this allows connection of the JPouch to now be fully functioning.
As I mentioned I had my surgery all done in one stage from the temporary ileostomy stoma to functioning JPouch, this meant I was using the pouch whilst it healed and dealing with the closure of the old stoma site. It’s a lot to do and move in one but it offers a more efficient technique, reduced surgeries and reduced risk of complications due to the loop or adhesion's/scar tissue forming etc, however as I said, you are now pooping through the wound site and that requires care not to strain and keeping it clean etc.
The healing process is a long task, I was approx. 14 weeks before I would say I was back to health, however I have been very unlucky so far and suffered cuffitis and now pouchitis, inflammation of the JPouch. I have historically had a very stubborn disease and being Indeterminate Colitis, am always at risk of developing future problems. I am exploring future options to keep my pouch but the alternative, if it doesn’t work, is removal and going back to a stoma! A complicated but possible option.