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Life After Surgery: Part III

Long-Term Concerns
Most patients do well following ileal J-pouch anal anastomosis surgery. However, you should discuss long-term considerations with your surgeon and nurse.

This article will talk about pouchitis, strictures and blockages, the symptoms of each, and what you and your doctor can do to treat these problems, if they occur.

Be sure to ask your surgeon what the recommended follow-up care is in your case.

Remember: Everyone who has had this procedure should be sure to carefully follow the advice your surgeon and nurse have given you. Don't be shy to ask for help when you need it. Enlist the support of family, friends, and qualified members of your healthcare team.

A Word About Pouchitis
Pouchitis is a common infection of the ileal J-pouch. No one knows why this occurs. Some patients never develop pouchitis, while others may have repeated problems with it.

You should learn to recognize the symptoms of pouchitis, which include any or all of the following:

  • Watery diarrhea
  • A general flu-like feeling
  • Weakness
  • Foul smelling stools.

Antibiotics—i.e., metronidazole (Flagyl) or ciprofloxacin (Cipro)—are usually successful in treating the pouchitis.

Remember: Not everyone develops pouchitis, and for most patients it is treatable.

If your doctor prescribes an antibiotic, be sure to take it exactly as directed. Always finish the entire course of antibiotics—even if you are feeling better.

Taking "good" bacteria such as those found in cultured yogurt is sometimes helpful. Just be sure to get the plain yogurt—not the kind with sugar and fruit or the diet brands. These type of bacteria can also be found in products such as Lactinex and VSL#3.

For some patients, Pepto-Bismol chewable tablets help.

Strictures
It is not uncommon to develop a stricture (narrowing) of the area where the ileal J-pouch is joined to the anal canal. This narrowing can lead to difficulty emptying the pouch of stool, which in turn, can lead to increased bacteria and pouchitis.

Your surgeon can usually easily treat such a narrowing or stricture by digital dilatation (stretching).

Blockages
Anytime you have had any abdominal surgery, you can develop blockages due to scar tissue in the abdomen causing a "kink" in the bowel.

What are the Symptoms of a Blockage?
Usually, people complain of feeling all right and then getting nauseated and having abdominal cramps. They also complain of decreased pouch output or noisy abdominal sounds or an increased volume of clear watery stool. A person may also have abdominal distension, abdominal pain, and vomiting.

What Should You Do?

  • Try a clear liquid diet (i.e., chicken broth, Gatorade, Jell-O) for a day or so.
  • A heating pad placed on your abdomen might help ease the cramping—do not burn yourself! A hot bath is often helpful.
  • Stop taking any antidiarrheal medicines (i.e., Imodium, Lomotil, codeine).

If the symptoms persist beyond 24 hours, call your doctor. Tell your surgeon what your symptoms are and what remedies you tried. You may need to be admitted to the hospital for fasting and intravenous fluids for several days before the symptoms go away. Surgery to fix this problem is seldom required.

Follow-Up Care
Following ileal J-pouch anal anastomosis, a yearly checkup is recommended for examination of the lower one quarter to half an inch of rectum that is remaining.

It is recommended that patients with ulcerative colitis get a blood test once a year to check the levels of a liver enzyme called alkaline phosphatase (ALP). This is done as a screening test for sclerosing cholangitis—an inflammation of the bile ducts that 5 of 100 ulcerative colitis patients can develop.

In patients with familial polyposis, every 2-3 years a scope of the stomach, duodenum and ileal pouch is also performed.

Remember: For any questions about your surgery or your follow-up care, it is always best to contact your physician.

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