How to Care for a New J-Pouch

Keep Diet Simple, at First

In the first months after j-pouch surgery, the small intestine is adjusting and learning to do more of the work that the large intestine used to do. While that is going on, stool is likely to be very acidic. Keeping the diet to simple foods is helpful for several reasons. The first is that avoiding fats, spices, and carbonation, can help keep the stool from causing too much pain and burning as it passes.

The second is that while learning what foods are helpful (and less than helpful) in managing a j-pouch, it's best to stick to foods that are already known and add new foods or potentially problematic foods one at a time. In this way, it makes it easier to identify any foods that do cause discomfort.

The third is that people who have had j-pouch surgery are at a greater risk of developing a small bowel obstruction. Avoiding foods such as seeds, nuts, popcorn, and very fibrous foods may be the best course of action for a time. For questions about diet, speak with the team that completed the surgery and aftercare, including the surgeon, the gastroenterologist, and a dietician.

Avoid Wiping

At first, stools will be acidic and frequent. Everyone's experience is different, but in most cases, people with a new j-pouch will have irritated skin around the anus from passing multiple loose stools a day. Wiping can irritate the area further. The best choice is to clean up using water, which can be done in one of a few different ways. Having a bidet toilet or a bidet toilet seat can be helpful to people with a j-pouch, both in the early days when the pouch is new, and even as time goes on. It can be a monetary investment, but it is one that will pay dividends for a long time.

Another way is to use the bathtub or shower — either with a shower attachment or even just sitting in a few inches of water in the tub. A portable option is to use a squeeze bottle with a nozzle: fill it with warm water and use it to squirt off the bottom.

If wiping is absolutely necessary, using wet wipes, wet toilet paper, or even a wet cloth will be more effective and gentler on the skin than dry paper alone.

Slowing Down the Loose Stools

At first, stool will be loose, although it should thicken up over time as the small intestine starts absorbing more water as the diet becomes more fine-tuned. Many surgeons prescribe or recommend various medications for slowing down diarrhea. They may or may not be needed and there could also be some trial and error to find out the dosage that works best. Talk with the surgeon about any prescriptions or over-the-counter anti-diarrheal medications to ensure that they are being taken properly. If the prescription anti-diarrheal drug contains an opiate (such as loperamide hydrochloride), it may be necessary to see if there are any affects that may interfere with driving or going to work.

Get Back to Activities Slowly

While some people have j-pouch surgery electively, others have surgery when they have already been quite ill with ulcerative colitis. Many people start to feel better after the colectomy, and understandably there's a desire to be over and done with all the surgery and to get on with the business of living. For some, things not possible before are now achievable, such as travel, social events, school, or work. However, it's best to discuss any lifestyle change with the surgeon, who can advise on when it is safe to undertake certain activities.

Driving, having sex, exercising, and going back to a regular pre-surgery daily routine are all questions to ask the medical team. (Try not to worry about embarrassment — remember that doctors have heard it all before, and they will be able to answer questions based on their experience). In general, however, it will be a few weeks to a few months before most regular activities are recommended, depending on the specifics of the surgery and health pre-surgery. Taking time with recovery, while perhaps being a little frustrating at times, is really a good way to ensure the continued health of the j-pouch.

Some Pain Is Typical

J-pouch takedown surgery, while typically less invasive than the creation of the j-pouch and the colectomy, it is still surgery. The hospital stay and recovery time tends to be quicker than with the previous surgeries (which could have been done in 1 step or in 2), but it is important to remember that some surgical pain is to be expected. As recovery continues, the pain should lessen. New or intense pain, however, is a reason to contact the surgeon in order to ensure that there are not any complications.