Ileostomies and J-Pouches: What’s the Difference?
To help relieve ulcerative colitis (UC) symptoms, there are many different strategies and treatment options to explore with your health care team, including surgery. Many people think surgery is the last treatment option, but that isn’t necessarily true – surgery is an effective treatment option for many people living with UC. In fact, research estimates that between 20 and 30 percent of people will undergo surgery at some point during their journey with ulcerative colitis.
However, surgery can still be a huge source of stress and concern. We’re here to help you understand the two most common surgical procedures used to treat UC so that you can make informed decisions with your health care team.
The two most common surgical procedures to treat UC are ileostomy surgery and ileal pouch anal anastomosis (IPAA), which is sometimes referred to as a j-pouch surgery. Both procedures require a proctocolectomy (the removal of the colon and rectum), but how do these surgeries differ?
Proctocolectomy with ileostomy
In an ileostomy, a section of the small intestine is joined to the surface of the stomach. This is called a stoma. Waste leaves the small intestine through the stoma and collects in an external appliance, often called an ostomy bag, which is attached to the skin with adhesive. The ostomy bag is then emptied into the toilet several times a day.
Proctocolectomy with ileal pouch anal anastomosis (IPAA)
In an IPAA, the end of the small intestine, sometimes called the ileum, is used to form an internal pouch that is attached to the top of the anal canal. This surgery is referred to as j-pouch surgery because the internal pouch is commonly shaped like the letter J. The internal pouch collects waste and allows stool to pass through your anus in a bowel movement.
While this procedure can be achieved in a single surgery, your health care provider may recommend performing the procedure in two or three surgeries. If more than one surgery is required, the first surgery is always a colectomy (removing the colon) with creation of a temporary ileostomy. The temporary ileostomy allows a part of your small intestine to be pulled through an opening in your stomach to allow waste to exit your body into an ostomy bag. During this time, you will need to wear an ostomy bag at all times. The subsequent surgery is to reverse the temporary ileostomy and create the internal pouch.
Please note: images of surgery can be graphic and may be triggering to some individuals. Please explore UC surgeries on the internet with caution.
A note from The Mighty: It’s common to feel apprehensive about more intensive treatment options, like surgery. However, it’s important to know that these surgical procedures are well-studied and your health care team will recommend these options to help improve your quality of life and to prevent the damage living with untreated UC may cause. The majority of people who undergo surgery do very well after their surgery, but be sure to discuss any concerns or questions you may have with your surgical team.