ARE POUCH ISSUES COMMON?
In a word: Yes. Pouches are supposed to fix colitis and address colon-based-Crohn's. But complications are common.
A "pouch" (typically a "J" pouch, but sometimes a W, S, or Kock pouch) is an internal "replacement" for a colon (that's gone bad). It's typically fashioned out of the bottom of the small intestine, the ileum.
A "pouch" (typically a "J" pouch, but sometimes a W, S, or Kock pouch) is an internal "replacement" for a colon (that's gone bad). It's typically fashioned out of the bottom of the small intestine, the ileum.
A meta-analysis in 2005 of 43 studies of results and complications, evaluating 9,317 patients after an ileal pouch anal anastamosis (j-pouches and also some less common pouch types). Complications included:
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FECAL STASIS
There's a lot we don't know about pouchitis.
And there seem to be many different types of pouchitis.
But a common pouch complication, strictures (narrowing), can lead to "fecal stasis" (stool staying unemptied in the pouch). This is common at the "ileoanal anastamosis" just above an inch above the anus -- where the ileum was sewn onto the rectum during surgery.
Ever sit on the toilet for a long time? Pushing, sometimes to no result?
Ever feel like you can't properly empty yourself out?
That's likely due to a stricture.
Alas, from my own personal experience, this has led to incontinence.
Yuck.
And, when the stool couldn't leave properly through the primary exit, I've periodically developed a fistula.
This is clearly not the only cause of pouchitis.
But many of the symptoms are self-reinforcing.
Stricture.
Inflammation.
Incontinence
Tighter stricture.
Worse inflammation.
More regular incontinence.
Fistula.
Strictures can be mitigated or removed by dilation.
Sometimes a doctor will try to do this lightly with a finger.
Or using a balloon during a scope (under sedation) to expand the anal canal.
Dr. Bo Shen at the Cleveland Clinic (who specializes in pouches) has perfected what he calls the "needle knife procedure" to carve away tissue (yes, like carving a turkey) to expand the width of the anal canal.
These procedures work well for many patients. Dr. Shen says the balloon dilation causes unnecessary trauma (a small percentage of patients tend to get a perforation, that is, a tear that can cause your poop to enter parts of the body it's not supposed to go to.) Dr. Shen performed the needle knife procedure on me in early 2015, and, just like the balloon dilations I'd received before, within 48 hours of the procedure, I found myself struggling to empty my pouch.
But as Dr. Shen explains:
Chronic pouchitis may be associated with concurrent mechanical or structural disorders of the pouch, such as strictures and anastomotic sinus. For example, pouch outlet obstruction (such as anastomotic stricture), can be associated with pouchitis, presumably owing to bacteria overload from prolonged fecal stasis. The release of the obstruction, often along with concurrent antibiotic therapy, may promote the resolution of pouchitis.
Then I learned about self-catheterization.
And there seem to be many different types of pouchitis.
But a common pouch complication, strictures (narrowing), can lead to "fecal stasis" (stool staying unemptied in the pouch). This is common at the "ileoanal anastamosis" just above an inch above the anus -- where the ileum was sewn onto the rectum during surgery.
Ever sit on the toilet for a long time? Pushing, sometimes to no result?
Ever feel like you can't properly empty yourself out?
That's likely due to a stricture.
Alas, from my own personal experience, this has led to incontinence.
Yuck.
And, when the stool couldn't leave properly through the primary exit, I've periodically developed a fistula.
This is clearly not the only cause of pouchitis.
But many of the symptoms are self-reinforcing.
Stricture.
Inflammation.
Incontinence
Tighter stricture.
Worse inflammation.
More regular incontinence.
Fistula.
Strictures can be mitigated or removed by dilation.
Sometimes a doctor will try to do this lightly with a finger.
Or using a balloon during a scope (under sedation) to expand the anal canal.
Dr. Bo Shen at the Cleveland Clinic (who specializes in pouches) has perfected what he calls the "needle knife procedure" to carve away tissue (yes, like carving a turkey) to expand the width of the anal canal.
These procedures work well for many patients. Dr. Shen says the balloon dilation causes unnecessary trauma (a small percentage of patients tend to get a perforation, that is, a tear that can cause your poop to enter parts of the body it's not supposed to go to.) Dr. Shen performed the needle knife procedure on me in early 2015, and, just like the balloon dilations I'd received before, within 48 hours of the procedure, I found myself struggling to empty my pouch.
But as Dr. Shen explains:
Chronic pouchitis may be associated with concurrent mechanical or structural disorders of the pouch, such as strictures and anastomotic sinus. For example, pouch outlet obstruction (such as anastomotic stricture), can be associated with pouchitis, presumably owing to bacteria overload from prolonged fecal stasis. The release of the obstruction, often along with concurrent antibiotic therapy, may promote the resolution of pouchitis.
Then I learned about self-catheterization.