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What Exactly is A J-Pouch?

What is a J-pouch? 

That is the question I get asked most often and you know what? I totally get it! They’re kind of complicated and difficult 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.

Today’s post will teach you all the details you need to know about IPAA surgery with easy-to-understand information and less “jargon.” Here we go! 

How Do You Do the Number Two Without A Rectum from Which to Poo?

Before we get into the J-pouch it’s important to understand how the normal digestive system works and what each organ does. Click on the hot spots on the image below to learn about them.

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Your digestive tract is a hollow tube that runs from your face hole to your butt hole and is made up of various organs that have specific jobs. Removing a portion of it breaks continuity and stool may need to exit the body in a new way.

This post will focus primarily on the small and large intestine. The small intestine is where almost all nutrient absorption takes place. The large intestine is the last digestive organ in the system. It’s job is to absorb water and expel waste from the body through the anus. 

How “the normals” poop

So what happens if you have your large intestine removed? How do you use the bathroom without a colon or rectum? That my friends is what we are here to talk about today.

People who have all of their digestive organs, we shall call them ‘the normals,’ use the bathroom when they feel an urge to have a bowel movement. The rectum, that ol’ son of a gun, is quite smart and can even tell the difference between stool and air; at least when it’s working properly. When it receives stool from the colon it expands and lets you know it’s time to have a bowel movement. The normals then make their way to the toilet where stool leaves the body out of the anus (that’s just a fancy word for the butt hole) and into the porcelain throne below. The sphincter muscles are responsible for keeping the stool inside your body where it belongs until you’re where you want to be (on the toilet I hope) when you are poo-pooing.  

But that is how those lucky jerks who own large intestines use the bathroom. What about people who had that intestine removed? Waste has to exit the body somehow and those colonless folks have a few options. The two most common are that they could expel waste from the body via an ileostomy or they could have J-pouch surgery and still use the anus just like they always have. Hot-diggity-dog! 

Hover over the hot spots on the images below to learn more.

The images above are a little peek into the two most common options available for those who need to have their colon and rectum removed. You can hover over the hot spots on the images to read more. 

The surgery that involves removing both the colon and rectum is called a total proctocolectomy. In the past an ileostomy was the only option for people who needed to have their large intestine removed. The J-pouch surgery was a game changer because it allows a person to still use the bathroom through the anus and maintain the ability to be continent even without a colon or rectum. We will go more in-depth about this in just a bit. 

What do we know so far? Let’s review 

  • A normal digestive tract has two intestines: the small intestine and the large intestine.
  • The large intestine is made up of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.
  • Waste (AKA stool, poop, shit, or whatever you want to call it) goes from a liquid to solid as it travels through the large intestine and water is absorbed. From there it enters the rectum until it exits the body through the anus.
  • The removal of the large intestine (colon and rectum) requires a surgery called a Total Proctocolectomy. With the colon and rectum gone waste will now exit the body differently than it did before.
  • Stool could leave the body through a stoma on the abdomen or it could exit the body through the anus with the help of a J-pouch.

The J-Pouch - What is It?

People who have certain medical conditions or injuries that require the removal of the colon and rectum may be a candidate for a surgery called ileal pouch anal anastomosis or IPAA surgery. The colon and rectum are removed but instead of needing an ostomy bag they can still pass waste out of their anus just like they did before.

Click the image to expand

How does that work you ask? First the colon and rectum are removed which is referred to as a total proctocolectomy. For the IPAA surgery the end of the small intestine, called the ileum, is constructed into a pouch by the surgeon and attached to the anal canal. The sphincter muscles are left intact so the person maintains continence and still has control over their bowel movements. This pouch is now responsible for holding stool until the person feels the urge to have a bowel movement and then they use the bathroom just like they used to through the anus. Basically the new pouch takes on the job of their old rectum. 

With the J-pouch everything is internal. Aside from 

surgery scars no one would see anything on the body that would indicate that you have had IPAA surgery. The J-pouch has been very appealing to patients because they can still use the bathroom “normally” compared to an ostomy which requires part of the intestine sticking out of the abdomen and waste leaving the body through that and into an ostomy bag. Both the ostomy and the J-pouch come with benefits and risks and neither one is the “right” choice for everyone.

Getting Technical: "J-Pouch" is Just a Nickname

“J-pouch” is just a nickname. The real name for this surgery is Ileal Pouch Anal Anastomosis or IPAA surgery. A total proctocolectomy (removal of the colon and rectum) is done beforehand.

The pouch/reservoir is made out of the last part of your small intestine which is called the ileum. The word anastomosis means a connection or to join together two parts that are normally separate. The small intestine is not normally connected to the anal canal, rather the colon is in-between the two. The surgical anastomosis in IPAA is connecting the ileum to the anal canal. 

ILEAL + POUCH + ANAL + ANASTOMOSIS = 

A pouch made out of the ileum (ileal pouch) that is attached to the anal canal (anal anastomosis). Easy peasy!

Other Names for the J-Pouch

  • Ileoanal pouch
  • Ileal pouch
  • Internal reservoir
  • Ileoanal reservoir
  • IPAA
  • Pelvic pouch 
  • Parks pouch
  • S or W pouch – these are versions of the IPAA surgery that involve different shapes and sizes of the reservoir.

When you hear any of these names they all refer to the internal pouch that is made out of your ileum that holds stool until you are ready to have a bowel movement.

Why is it called a J-pouch?

The j-pouch gets it's nickname because of it's shape which looks like the letter J

Who Can Get A J-pouch?

In the world of IBD a J-pouch is usually only an option for those who have ulcerative colitis. This is because UC only affects the mucosa of the colon and rectum and does not affect the small bowel. There is a much higher chance the surgery would fail in a Crohn’s patient because Crohn’s can affect any portion of the digestive system and can penetrate through all layers of the bowel. In some cases (like mine) a person has J-pouch surgery when they have a diagnosis of UC and later finds out they have Crohn’s disease. Other conditions where J-pouch surgery is an option is colon cancer and Familial Adenomatous Polyposis (FAP).

In special circumstances a J-pouch may be an option for patients who have Crohn’s colitis (Crohn’s disease limited to the colon) or who have IBD unclassified.

Here is a good video from the CCF describing IPAA surgery.

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.  

Now that you’ve finished reading take the quiz and test your understanding! 

How Well Do You Understand the J-Pouch?

Test your knowledge of IPAA surgery

Sara

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