Rectal Cuff Inflammation (Cuffitis) Symptoms and Treatment

Rectal cuff inflammation (sometimes called cuffitis) is inflammation in the part of the rectum that is left after ileal pouch-anal anastomosis (IPAA) surgery, which is more commonly known as j-pouch surgery. IPAA surgery is typically done to treat ulcerative colitis, though it may also be done for other conditions, such as familial adenomatous polyposis (FAP).

Inflammation in the rectal cuff can occur in up to 50% of cases after IPAA surgery. If there is rectal discomfort or bleeding after j-pouch surgery, it should be discussed with a gastroenterologist. There are treatments available to treat any inflammation if it does occur.

Suppository in a foil package on a metal tabletop
 Hans Georg Merkel / Getty Images

What Is IPAA Surgery?

In j-pouch surgery, the large intestine (colon) is removed and the last section of the small intestine (the ileum) is used to create a "pouch." The pouch is many times fashioned into the shape of the letter "J," but there have also been pouches created in the shape of an "S" or a "W." The pouch is then connected to the rectum, and a patient defecates out the anus.

The surgery is often done in multiple stages to ensure healing and improve the chances of better pouch function.

What Is a Rectal Cuff?

The rectum is the part of the digestive system that is between the large intestine and the anus. In j-pouch surgery, some of the rectum is kept in order to help a patient keep stool retained in the pouch, and prevent leaking. However, the rectum can also be affected by ulcerative colitis.

Therefore, the part of the rectum (sometimes called a rectal stump or a cuff) that is left after the large intestine is removed could be inflamed by ulcerative colitis. In some cases, the rectal cuff may also be inflamed after surgery for other reasons. The inflammation in this section of the rectum is known as rectal cuff inflammation or, less commonly, cuffitis.

Symptoms and Treatment for Cuffitis

The symptoms of an inflamed rectal cuff include a frequent need to pass stool and bloody stools. A gastroenterologist may need to look at the inside of the rectum with an endoscope to make the diagnosis.

The inflammation may cause some of the same symptoms as another common problem with j-pouches known as "pouchitis," making it important to get a proper diagnosis. Pouchitis is when inflammation is found in the actual j-pouch. In some cases, rectal cuff inflammation may be considered a continuation of the ulcerative colitis, which is now occurring in the rectum.

Treatment for an inflamed rectal cuff can include the use of topical drugs that are given through a suppository, such as mesalamine or corticosteroids. Medications are not typically given by mouth. In cases that do not respond to the suppositories, some physicians give a longer-acting form of corticosteroid that is deposited in the rectum through the use of an endoscope. The inflammation often improves with treatment, but when it does not, a physician may look for another reason for the symptoms, such as pouchitis, a fistula, or Crohn's disease of the pouch.

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. Zezos P, Saibil F. Inflammatory pouch disease: The spectrum of pouchitis. World J Gastroenterol. 2015;21(29):8739-52. doi:10.3748/wjg.v21.i29.8739

  2. Crohn's & Colitis Foundation. J-pouch surgery.

  3. Cleveland Clinic. Pouch procedure & recovery: types of surgeries.

  4. Steele SR, Wexner SD. Fundamentals of Anorectal Surgery. New York, NY: Springer International Publishing; 2018.

Additional Reading

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.