An ileo-anal pouch is an alternative to having a colostomy. It is created from the end of the small intestine, which is known as the ileum. The procedure involves removing the colon and the rectum but not the anus.
The pouch is joined to the anus so that your bowel actions can be controlled in the usual way. The pouch stores waste material until you go the toilet.
The procedure
The operation is usually carried out in two stages. Firstly, your colon and rectum are removed before the pouch is created and joined to your anus. It is usually necessary to let the area around the pouch heal before it is used, so the end of the small intestine is connected to a stoma (opening) in your abdomen. This procedure is known as an ileostomy.
After a couple of months, a second, smaller operation is carried out to close the ileostomy. It can be possible for the operation to be performed without creating a temporary ileostomy.
Advantages and disadvantages
The advantage of having an ileo-anal pouch is that you will not have a permanent stoma in your abdomen or need to use a pouch or regular irrigation. A disadvantage of having an ileo-anal pouch is that you will pass stools very frequently, often up to 20 times a day, until your pouch has fully expanded.
This usually settles down after six months to a year. However, the number of bowel movements varies: some people will only need to empty their pouch twice a day whereas others may have to empty it six to eight times a day.
Accidental leakages from the pouch are also common during the first few weeks after the operation and the pouch can become infected, which is known as pouchitis.
Symptoms of pouchitis include:
- diarrhoea, which is often bloody
- abdominal pains
- stomach cramps
- dehydration
- high temperature (fever) of 38C (100.4F) or above
Pouchitis can usually be successfully treated with antibiotics.
An ileo-anal pouch may not be suitable for everyone. For example, it isn't usually recommended for people with Crohn’s disease because there's a risk that the inflammation associated with the condition may spread into the pouch.
An ileo-anal pouch may also not be suitable for older people who are over 70 years old because they usually don't have sufficient muscle tone to make effective use of the pouch.
