How To Care For Your New J-Pouch

Your J-Pouch Will Need Special Care In The First Weeks And Months After Takedown

J-pouch surgery that is done to treat ulcerative colitis can bring a new lease on life. It also brings many questions on how to deal with the ins and outs of living without a colon and with having a small intestine that is reconfigured and connected to the rectum. Here you will find tips on how to make those first weeks after j-pouch takedown surgery easier on yourself, as well as how your diet can affect your pouch.


Fruit In A Bowl Of Yogurt
Keeping food simple and light can help you keep your bowel movements less frequent and less painful. Image © Laurie Patterson / Vetta / Getty Images

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

The second is that while you are learning what foods are helpful (and less than helpful) in managing your pouch, it's best to stick to foods you're comfortable with, and add new foods or potentially problematic foods one at a time. In this way, you can make it easier to identify any foods that do cause discomfort.

The third is that people with 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. If you have questions about your diet, speak to your surgeon, your gastroenterologist, or your dietician.


MacLean AR, Cohen A, MacRae HM, et al. Risk of Small Bowel Obstruction After the Ileal Pouch–Anal AnastomosisAnn Surg. Feb 2002; 235(2): 200–206. 10 Nov 2014.



Bidet Toilet
A bidet can be helpful, but if you don't have access to one, there are other ways to keep clean. Image © Ferran Traite Soler / E+ / Getty Images

At first, your 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. Wiping can just 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 very 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 your bottom.

If you must wipe, using wet wipes, wet toilet paper, or even a wet cloth will be more effective and gentler on the skin than just dry paper.



Whether prescription or over-the-counter, be sure you are taking any anti-diarrheal medications properly. Image © Jamie Grill / Tetra images / Getty Images

At first stool will be loose, although it should thicken up over time as your small intestine starts absorbing more water and as you fine-tune your diet. Many surgeons prescribe or recommend various medications for slowing down diarrhea. You may or may not need them, and may also need to use some trial and error to find out the dosage that works best. Talk to your surgeon about any prescriptions or over-the-counter anti-diarrheal medications to ensure that you are taking them properly. If your prescription anti-diarrheal drug contains an opiate (such as loperamide hydrochloride, you might need to see how it affects you before you drive or go to work. 



Car Door
Find out from your doctor when you can drive and go back to work or school. Photo © sixninepixels

While some people have j-pouch surgery electively, others have surgery when they have already been very 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, it could be a new lease on life, and things not possible before are now achievable, such as travel, social events, school, or work. However, it's best to discuss your lifestyle with your surgeon, who can advise you on when you can undertake certain activities.

Driving, having sex, exercising, and going back to a regular pre-surgery daily routine are all questions to ask your medical team. (Try not to worry about embarrassment — remember your doctors have heard it all before, and they will be able to answer your 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 your surgery and how well you were before surgery. Taking your time with recovery, while perhaps being a little frustrating at times, is really a good way to ensure the continued health of your pouch.



Doctor Explaining Pain
A certain amount of abdominal pain can be normal after surgery, but discuss with your doctor what is typical and what is not. Image © Jeannot Olivet / E+ / Getty Images

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. If you experience new pain or intense pain, however, contact your surgeon to ensure that you are not experiencing any complications.