J-Pouch Ileo Anal Pouch

The J Pouch is a relatively new procedure. It is a procedure that is offered for people suffering with Ulcerative Colitis.

In the olden days for Ulcerative Colitis, people were offered an operation for Colitis offering a colostomy bag.

Nowadays, although not widely given, people are offered the chance of an internal pouch.

Not only does it help people who suffere from this disease to feel somewhat normal, but it takes away from the uncomfortableness of having a stoma sticking out of your stomach with a colostomy bag attached.

Well here I am back again, talking about my husband John.

John was diagnosed with Ulcerative Colitis in 1997, 6 months after his Nissens Fundoplication operation. John had an operation called Nissen Fundoplication in 1996 for severe acid reflux and heartburn, please see my lense on www.squidoo.com/nissen-fundoplication

He was put on medication and lived for 3.5 years taking medication and keeping the Ulcerative Colitis under control.

In August 2000, while John was starting to set up a Company, he started to bleed quite heavily from the back passage. This continued on and off until November 2000. John had been attending the hospital regularly for steroids, but nothing helped.

He attended the hospital one Friday in November and when he returned for an appointment 3 days later, he had lost 9 lbs in weight. Things were getting very bad.

John was admitted to hospital and given a course of steroid treatment that the hospital hoped would stop the bleeding, but nothing worked.

By mid November, a surgeon came to John while I was in the hospital with him, and told him that they had no option but to remove 6 feet of his bowel and give him a colostomy bag.

To say we were shocked would be an understatement. It took so long to get over the previous operation and the complications of infection, John was terrified, also a colostomy bag had not been mentioned to him before, so this was a shock for a 33 year old man to lose his bowel and have it sticking out of his stomach and attached to a colostomy bag.

In order to have a J Pouch (Internal Pouch), there are three Operations to be followed. This procedure can usually be carried out in two operations, but as John's was an emergency, they had no option but to spread it over three operation.

On November 23rd 2000, John had his first operation. This operation entailed John being opened (where he had the previous Nissens Operation), 6 feet of Johns Intestine was removed and the rest of the intestine was moved to his right side.

This part of the intestine is called the Stoma.

The Stoma is effectively the bowel on the outside of the stomach.

You can eat as normal, food goes down through the intestines and comes out of the Stoma into a Colostomy Bag.

As I said in the previous module, the Stoma is the part of the bowel that is now on the outside of the stomach and attached to a colostomy bag.

The advantages of the Stoma are that you go to the toilet into this colostomy bag and it takes the pressure off the remainder of the intestines allowing them to heal before the next operation.

The Disadvantages of the Stoma, for John the disadvantages were that food would pass through John very quickly and I know they have been improved since, but the bag used to burst quite a lot, leaving John in very embarrassing situations and knocking his confidence a lot as we would have to be careful where we went out to just in case it burst and not all public toilets would be the best to try and change the bag.

The colostomy bag, is made to fit over a stoma.

Most bags last 1 - 2 days, but contents would have to be emptied out several times a day.

Operation 2 came in June 2001, 7 months after John had his bowl removed and a colostomy bag fitted.

This operation was to enable the Doctors to reopen John and make the J Pouch from the remainder of his intestine.

The Pouch is formed by folding loops of the remainder of the intestine back on themselves and stitching or stapling them together.

The internal walls are then removed forming a resevoir, which is then stitched where the rectum was.

Thankfully this operation went well, there were no complications and John was out of hospital after 2 weeks

COUNTDOWN NOW TO OPERATION 3

Operation 3 came at the beginning of September 2001. Our daughter Lauren at age 6, had just started her second year in school.

John was admitted to hospital and the final procedure was performed to attach the intestine to the now newly formed internal pouch and to close the Stoma.

After 5 days in hospital, John was discharged.

9/11 is a day that went down in history, but I remember it so well, because as I was watching the terror unfold on the TV, John was crying in pain on the couch beside me.

After a couple of hours, there was nothing more for it, I had to rush John into Accident and Emergency, as he was going downhill rapidly.

Thankfully he was seen to immediately and it turned out that there was an infection and a blockage in the pouch, but this was treated very quickly

Every year, John must undergo minor surgery to check the pouch.

This entails surgery by colostoscope, where the surgeons check out the pouch and also take a biopsy to ensure everything is ok.

Pouchitis is also a risk, so regular scans and xrays must be performed to keep a check on this. Pouchitis is basically an infection in the pouch that would mean the pouch would not be working to its full potential.

Johns lifestyle is somewhat different to most people with a normal bowel.

Toilet Visits (ie Bowel Motions) would be anything from 10 - 12 movements per day, the reason for this would be that the pouch is a lot smaller than a normal bowel and does not hold as much quantity.

Curries, Vegetables, Fruit, Juices, these all have a knockon effect on John, because they go through the system very quickly and it would mean that if John ate Mushrooms at lunchtime, by teatime they would be gone through him.

John has to take tablets to slow down the process of the pouch, some days would be more than other, depending on his food input.

Doctors have told John that there is not a lot more they can do, only keep checking it every year and if worst comes to worst he could resort back to the Colostomy Bag, which he really does not want to do as his experience with this was not nice.