15484 Pouchitis

Overview

Pouchitis is inflammation of an internal pouch that a surgeon creates inside the body after the colon is removed. This pouch collects stool so that you can pass it normally without a bag on your belly.

Yes, pouchitis is fairly common. Up to half of people who have had this type of pouch surgery will get at least one episode of pouchitis.

It affects people who have had their colon removed and an ileal pouch created, usually because of ulcerative colitis or a condition called familial adenomatous polyposis (FAP).

Symptoms

Common symptoms

• Loose, watery stools or diarrhea
• Passing stool more often than usual
• A strong, sudden need to go to the toilet
• Belly cramps or pain
• Feeling that you haven't fully emptied your bowels
• Small amounts of blood or mucus in stool
• Discomfort or pain in the pelvic area

Symptoms in children

• Children may have the same changes as adults, like diarrhea and stomach cramps.
• They may have less appetite, feel tired, or lose weight.
• Young children may not tell you what is wrong, so look for more nappy changes, crying, or holding their tummy.

Symptoms in older adults

• Older adults may have less specific symptoms like feeling weak, confused, or dizzy.
• Diarrhea can quickly lead to dehydration, so watch for dry mouth, dark urine, or feeling faint.
• They may be less likely to have severe pain but still need prompt care.

Causes

Main causes

• The exact cause is not fully understood, but it seems to happen when bacteria in the pouch grow out of balance.
• Inflammation can build up in the lining of the pouch, causing symptoms.
• Changes in how the pouch works or its shape can also play a part.

Risk factors

• Having surgery for ulcerative colitis instead of FAP
• Being a woman
• Smoking
• Having other autoimmune conditions
• Using certain medicines that affect the immune system
• A longer history of ulcerative colitis before surgery

When to see a doctor

See a doctor urgently if:

• If you have a high fever, severe pain, or signs of dehydration, see a doctor or go to urgent care the same day.
• If you have heavy bleeding or can't keep fluids down, get medical help right away.

Book a routine appointment if:

• If you have diarrhea, belly cramps, or urgency that lasts more than a few days, make an appointment to see your doctor or IBD nurse.
• If symptoms return after finishing treatment, let your healthcare team know.

Diagnosis

Your doctor will ask about your symptoms, do a physical exam, and may need to take a sample of stool or order a camera test to see inside the pouch.

Tests that may be done

• Stool sample to check for infection
• Blood tests to look for signs of inflammation or dehydration
• A pouchoscopy, where a thin, flexible tube with a camera is gently placed into the pouch
• A small tissue sample (biopsy) taken during the pouchoscopy to look at under a microscope

What to expect at your appointment

Pouchoscopy can feel a little uncomfortable but usually takes only a few minutes. Your doctor may give you a light sedative. They will explain each step and help you stay calm.

Treatment

Treatment for pouchitis aims to reduce inflammation and balance the bacteria in the pouch. Most people need a course of antibiotics, and many feel better within a few days.

Self-care at home

• Drink plenty of fluids to avoid dehydration.
• Eat small, frequent meals instead of big heavy ones.
• Choose bland, easy-to-digest foods during a flare, like plain rice, bananas, or toast.
• Avoid caffeine, alcohol, fizzy drinks, and very spicy or high-fibre foods if they make symptoms worse.
• Keep a diary of what you eat and how you feel to spot triggers.

Medical treatments

Doctors usually prescribe an antibiotic course to fight the bacterial imbalance. For people who need more help, they may recommend anti-inflammatory medicines, medicines that support the immune system, or treatments that help restore healthy bacteria in the pouch. The exact plan depends on your situation and is guided by your specialist.

When is surgery considered?

In rare cases where pouchitis does not respond to any treatment, a doctor may talk with you about surgery to revise or remove the pouch. This is never a first option and is only considered after many other treatments have been tried.

Living with this condition

Pouchitis can come and go. Work with your healthcare team to make a plan for managing flare-ups, and know when to seek help. You can live a full and active life with a pouch.

Lifestyle tips

• Stay well hydrated every day.
• Try to reduce stress with deep breathing, gentle activity, or hobbies you enjoy.
• Get enough rest, especially during a flare-up.
• Keep in touch with your IBD nurse or doctor so you feel supported.
• Talk with others who have a pouch if you find it helpful.

Diet and exercise

A balanced diet and regular gentle exercise are good for your health. During flare-ups, you may feel better with a lower-fibre diet, but make sure you still get enough calories and electrolytes. Talk to a dietitian if you need guidance.

Mental health and emotional wellbeing

Living with pouchitis can be stressful, worrying, and tiring. It is normal to feel anxious or low. Talk openly with your doctor about your feelings. If you ever feel in crisis or unsafe, contact your local emergency number or a crisis support service right away.

Prevention

There is no guaranteed way to prevent pouchitis, but staying on any prescribed treatment, eating a balanced diet, staying hydrated, and managing stress may reduce the number of flare-ups.

Vaccines

There is no vaccine that prevents pouchitis. However, keeping up with routine vaccines helps you stay generally healthy and may reduce other infections that could upset your pouch.

Screening programmes

If you have frequent or persistent pouchitis, your specialist may recommend regular check-ups of the pouch. Follow their advice on how often to be seen.

Complications

If left untreated

• Uncontrolled inflammation can make the pouch narrow or stiff, leading to more pain and difficulty passing stool.
• Fistulas (abnormal tunnels between the pouch and other organs) may form.
• Long-standing pouch inflammation could, in very rare cases, increase the risk of changes in the pouch lining that might lead to cancer.

Long-term outlook

Most cases of pouchitis respond well to treatment and do not cause long-term problems. With the right care and support, the vast majority of people continue to enjoy good health and an active life.

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