Are Probiotics Helpful For Pouchitis?

Pouchitis is a condition that can affect people who have had j-pouch (ileal pouch-anal anastomosis [IPAA]) surgery for ulcerative colitis. The mechanism of pouchitis is not well understood, and it is thought that it might include several different types of disease. It is the most common complication in people with j-pouches.

Illustration of Lactobacillus crispatus bacteria
KATERYNA KON / SCIENCE PHOTO LIBRARY / Getty Images

Symptoms of pouchitis can include:

  • more frequent and urgent bowel movements
  • abdominal cramping
  • rectal bleeding
  • fever

Pouchitis typically responds to treatment with antibiotics but can recur in about two-thirds of patients. About 10% of patients experience recurring pouchitis that does not respond to antibiotic therapy. These recurring bouts of pouchitis can cause a decrease in the quality of life for people with a j-pouch.

Getting treatment for pouchitis, especially in the period right after surgery, is very important. Anyone who has had pelvic pouch surgery should contact their doctor right away when the pouch seems "off" and there are symptoms of pain, fever, and blood in the stool.

Why Would Probiotics Help?

Researchers discovered that people who experience pouchitis have fewer beneficial bacteria, namely lactobacilli and bifidobacteria, in their digestive tract. The next logical step was to conduct trials to see whether increasing the beneficial bacteria in the digestive tract would help improve the symptoms of pouchitis. Supplements of these beneficial bacteria are called "probiotics" and may include a wide variety of live bacterial strains.

The Evidence For the Use of Probiotics

The American Gastroenterology Association (AGA) released clinical practice guidelines in 2020 regarding the use of probiotics for managaing digestive health conditions, including pouchitis. For adults and children, the group conditionally recommends a combination of eight strains of probiotics as opposed to other probiotics or none at all. The eight strains are L paracasei subsp paracaseiL plantarumL acidophilusL delbrueckii subsp bulgaricusB longum subsp longumB breveB longum subsp infantis, and S salivarius subsp thermophilus over no or other probiotics.

The AGA guidelines further note that patients for whom the feasibility and cost of using this combination of bacterial strain is problematic may reasonably select no probiotics.

As far as specific research goes, there have been several meta-analyses investigating the safety and effectivness of probiotics for managing symptoms associated with pouchitis. Certain probiotics, different for each process, have proven to be effective and beneficial in cases of pouchitis and other digestive health complications.

The Bottom Line

While the medical evidence is sparse on the topic of probiotics, it is fair to say that while probiotics may help for maintaining remission, they are not necessarily helpful in treating acute pouchitis. Your physician will be able to help you determine when probiotics are useful for pouchitis, as well as which product to use, and how much to take.

Important points to remember:

  • Probiotics may be helpful for maintaining remission after pouchitis has been treated with antibiotics or in delaying the initial onset of pouchitis
  • Probiotics have not yet proven helpful in treating acute, severe pouchitis
  • It is important to discuss the use of probiotics with a physician to ensure that the proper type and amounts are taken
  • The evidence for use of probiotics is not yet complete, and results of future studies may change use of probiotics for pouchitis
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Article Sources
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  1. Su G, Ko C, Bercik, P, ET al. AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology. June 9 2020. doi:10.1053/j.gastro.2020.05.059

  2. Sebastián Domingo JJ. Review of the role of probiotics in gastrointestinal diseases in adultsGastroenterol Hepatol. 2017;40(6):417-429. doi:10.1016/j.gastrohep.2016.12.003

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