The pelvic pouch has now become the "gold standard" in surgical treatment. Although the operation avoids a permanent stoma and usually improves the patient's quality-of-life, it does not restore the bowel function to normal.
Patients can expect to have many stools per day - as few as two or three for the fortunate few and as many as 40 for the less fortunate, with the average being around eight - and these stools are pasty to watery in consistency. As with any bowel operation, patients experience many changes, both short - and long-term. This article will discuss some of the potential long-term problems that patients with a pelvic pouch may experience.
Diarrhea: The function of the pelvic pouch will change over the first year - improve as the pouch stretches and becomes larger after the ileostomy closure. However, there are still some people who have 20 bowel movements or more, daily. Dietary changes may help these people to decrease the number of bowel movements. Foods, which have been found to help decrease the water content of the stool, may help to reduce the number of trips to the toilet.
These foods include applesauce, bananas, rice, creamy peanut butter, potatoes, cheese, marshmallows, pretzels, toast, yogurt and tapioca pudding. Bulking agents such as Metamucil, Citrucel, Fibercon or Konsyl also help thicken the stool.
These products are ingested with little fluid to allow extra fluid in the gastrointestinal tract to be absorbed. A doctor to slow down stools sometimes prescribes medications such as Lomotil or Imodium. They should not be used without your doctor's approval. Limiting the intake of fried and fatty foods and milk products may decrease diarrhea. Reaction to foods varies with each individual, and other foods may be found to increase the amount of stool produced or change the consistency.
Bowel obstruction and emptying concerns: To construct the pelvic pouch, the small bowel is stretched, along with the blood vessels that provide blood to the pouch, in order to reach the anus. This stretching may predispose a patient to bowel obstructions from scar tissue, twisting or kinking; surgical intervention may be required to relieve the obstruction. Another concern, which may lead to problems with pouch emptying, is a narrowing or stricture at the pouch-anal joint (anastomosis). This is diagnosed by an exam of the anal area. Strictures may cause symptoms that result in a progressive need to strain more and more to move one's bowels. Usually, dilation solves the problem and rarely is an operation needed to correct the problem. Pouchitis: Pouchitis is a non-specific inflammatory condition of the pouch. The cause is unknown, but it occurs much more frequently in patients who have a J-pouch for IBD versus those who have one for familial polyposis. Patients are at risk to develop pouchitis over their entire lifetime, as long as they have a functioning pelvic pouch. For some patients, pouchitis is an isolated event, but others can experience multiple episodes or even continuous "chronic pouchitis."
The symptoms are similar to a mini-attack of UC. Patients report increased bowel movements, pelvic pain, abdominal cramps, malaise, fevers or blood in their stools. However, it is common for patients with a pelvic pouch to notice blood on the toilet paper with normal function of the pouch and yet not have pouchitis. The most common treatment is Flagyl (metronidazole) 750 to 1500 mg daily for 7 to 14 days. This is effective about 85% of the time. Improvement is usually seen within 48 hours.
