The Differences Between an Ileostomy and a J-Pouch

"What type of surgery have you had on your left side?" "If you don't have a colon anymore, how do you poop?" People who have inflammatory bowel disease (IBD) and who have had surgery may hear this question, or similar, from healthcare professionals or others. For those who don't specialize in gastrointestinal conditions, the differences between some of the types of surgery done for IBD may be murky. It's important to be able to describe the differences in these surgeries to those who are unfamiliar, because not everyone understands what an ostomy is, or what a j-pouch is, and the differences are significant.

Put extremely simply: an ileostomy (or any ostomy) means that there is a pouch worn on the outside of the body to collect waste. With a j-pouch, the stool is held in a pouch that was made on the inside (created from the small intestine), and eliminated "normally," through the anus.

Got it? No? Let's get down to some more specifics on the differences between these two types of surgeries.

Colostomy bag
Анатолий Тушенцов / Getty Images

Ostomy Surgery

Ostomy surgery may be done for a variety of reasons, including as a treatment for ulcerative colitis or Crohn's disease (two of the major forms of IBD).

Colostomy Surgery: In colostomy surgery, part of the colon is removed, and a stoma is created. A stoma is when part of the intestine is pulled through the abdominal wall to create an opening through which stool leaves the body. Only a small part of the intestine is actually outside the body. The stoma doesn't have any nerve endings, so it doesn't feel painful. An ostomy appliance is worn over the stoma to catch the stool, and the appliance is emptied into the toilet from time to time when needed. The output (what the stool that comes out of the stoma is called) might be less solid than a bowel movement through an intact colon.

Ileostomy Surgery: In ileostomy surgery, part or all of the large intestine (colon) is removed, and the stoma is created from the small intestine. Just as with a colostomy, an external appliance is worn over the stoma to collect the stool as it leaves the body. The stool is emptied into the toilet when it's necessary. The output is typically a little more watery than the output from a colostomy.

People who have undergone ostomy surgery live full lives. This is especially true because the ostomy surgery was often done to treat a severe, potentially debilitating condition (such as IBD).

Ostomy appliances are now very sophisticated, and a variety of accessories are available to help with the challenges of living with a stoma.

J-Pouch Surgery

Surgery for a j-pouch (more technically called ileal pouch-anal anastomosis, or IPAA) starts similar to that done for an ileostomy: the large intestine is removed. However, there is also an additional part of this surgery, where the last part of the small intestine (called the terminal ileum) is used to create a little "pouch." The pouch is often shaped like a "J," but other shapes have been used, including "S" and "W." This pouch is on the inside of the body, so upon the completion of the surgery, there is no stoma necessary.

The entire surgery is usually done in steps, and most people do have a temporary ileostomy for a while in between surgeries. This delay between the surgeries gives the internal pouch made from the small intestine time to heal. When the surgeon and the patient are ready, the ileostomy is reversed, the stoma is removed, and the new pouch is attached to the 2 cms of the rectum that are left.. This surgery is usually only done for IBD patients with ulcerative colitis, but there are some exceptions.

Why the Distinction Is Important

While these are some broad strokes about ostomy surgery and IPAA, it's important to remember that not every type of bowel surgery for IBD will fit squarely into one of these neat categories. However, knowing the major differences can help when making decisions about surgeries, and can also be informative when explaining to friends, family, or healthcare professionals who are unfamiliar with colorectal surgeries.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Cancer Society. What Is an Ileostomy? Revised October 16, 2019.

  2. United Ostomy Associations of America. What is an Ostomy?

  3. United Ostomy Associations of America. Ostomy Surgery Is a Life-Saving Procedure.


Additional Reading
  • Cleveland Clinic. "Ileal Pouches." Cleveland Clinic. 2015.

  • National Digestive Diseases Information Clearinghouse. "Ostomy Surgery of the Bowel." National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Jul 2014.

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.