Ileal J-pouch anal anastomosis surgery is in most cases a two-step process.

The first surgery removes the entire colon and all -- or nearly all -- of the rectum (total proctocolectomy).

What is known as a J-pouch (because it looks like the letter "J") is constructed from 10 to 12 inches of your small intestine (ileum) as a reservoir for waste and replaces the function of the rectum. The pouch is connected to the remaining anal muscle so that elimination remains relatively the same.

During the procedure (in most cases), the surgeon also creates a temporary "loop" ileostomy to allow the bowel to heal and to protect the newly formed J-pouch.

The second surgery, which usually takes place eight weeks later, reverses the "loop" ostomy.

In this article, we will talk about what you can expect to experience following the first surgery -- ileal J-pouch anal anastomosis surgery.

Remember: Everyone's experience is different. Much of what you experience will depend on your disease state, your age, and your overall health.

Be sure to give yourself time to mentally prepare for what you may experience postoperatively. Share your feelings about the operation with your doctor and nurse. Express your concerns before and after surgery. That's what your healthcare team is there to address.

Pain
Unfortunately, everyone will experience a certain amount of pain postoperatively. Yet, your medical team can do a lot to help make you more comfortable.

Most patients choose a PCA (patient controlled analgesia) pump to achieve optimum pain relief.

The pump allows you to administer pain medicine at set intervals -- usually every 10 minutes -- through your intravenous (IV) line. Your doctor can adjust your dosage up or down, according to your individual needs.

Some patients choose an epidural catheter for pain relief, as is commonly done for pregnant women who are in labor. A small tube is inserted into the back, and pain medication is delivered to this area.

Remember: There is no reason for you to suffer needlessly in pain. Let your surgeon or nurse know right away if your pain medication is not working effectively, so he or she can make the necessary adjustments. If you are in pain, you tend not to breathe deeply, which clogs up your lungs and causes fever.

Intravenous Lines & Tubes
Do not be afraid if you wake up with an intravenous (IV) line. It is there to provide fluids, medicines, and, in some cases, nutrients until you are well enough to take them orally.

• You also will have a bladder catheter (tube) in place. The catheter is inserted during surgery to keep the bladder empty throughout the operation. Afterwards, it helps keep you comfortable until you are strong enough to get up and go to the bathroom. Usually, the catheter is removed on the second or third day after surgery.



• Temporary drainage tubes are inserted during the operation to remove fluids or bloody drainage. These will help the area to heal properly. Drainage tubes are usually removed between the first and fourth postoperative day.



• Lastly, you may have a sore throat because of a tube that helped you breathe during surgery. Lozenges can help soothe your throat.

Remember: The tubes are only temporary. However, they are necessary for you to heal and help minimize the potential risk of infection.

Discharge from the Anal Area
Your anal muscles were stretched during surgery. Therefore, it is common to experience some anal leakage. Swelling can also contribute to anal leakage -- much like a swollen hand, your anal muscles cannot grip tightly.

The drainage can be watery to bloody. This is normal. It can also have a strong odor and look like stool. This drainage will often continue until the ileostomy is reversed in the second operation.

Remember: It takes time for the anal area to heal. For added comfort, some patients find that a cotton pad helps -- especially at night. The most absorbent and least expensive pads are pressed cotton "makeup removal" pads that are sold in the cosmetics area of most grocery or drug stores.

Initially, after surgery you will not be allowed to eat or drink until you have no nausea and in some cases until bowel function returns. You will be able to have ice chips and will continue to receive intravenous fluids. In fact, most people are not hungry following surgery.

How soon bowel function returns varies among individuals, which is normal. For some people, bowel function returns in 24 hours, while in others it may take several days.

Most folks wonder how they can have a bowel movement when they have not eaten in days. This is possible because you produce about a quart of digestive juices every day, whether you have eaten or not. The passage of this liquid waste is a sign that your bowel function has returned.

Once bowel function has returned and you are not nauseated, you can expect your diet to be gradually advanced -- beginning with clear liquids (i.e., juices, Jell-O, popsicles). You will graduate to full liquids (i.e., ice cream, milk, cream soups) and then soft, bland foods (i.e., eggs and toast). This is your meal ticket home.

Remember: Most people don't have much of an appetite at first. It is best to begin your intake slowly. Eat and drink what you can, but do not force yourself to eat. And be sure to chew your food thoroughly.

After surgery, you feel full after only a few bites of food. You may not be able to eat large meals. It is often better to have many small snacks throughout the day.

Restrictions
With a temporary ileostomy, it is best to proceed slowly with any bulky fiber in your diet. Non-digestible dietary fiber can cause a food blockage in the small bowel near the abdominal wall or stoma. Foods to avoid include:

Remember: If you had to restrict your diet before your surgery because of diabetes, heart disease, high blood pressure, or other medical reasons, you will have to continue to do so.

Getting Out of Bed
On the first day after surgery, your healthcare team will help you get up to walk. Pain medication may be given beforehand to make it more comfortable for you.

Even if you can only take a few steps in the beginning, walking is important for the recovery process. It also helps decrease the risk of pneumonia as well as other postoperative complications. Additionally, walking helps bowel function to return more quickly.

What You Should Do

• To get out of bed, turn to your side and use your arm to push up, avoiding strain on your abdomen.



• Deep breathing exercises are important to prevent pneumonia after surgery. Periodically, let out your breath and inhale as deeply as you can, let the air out slowly. Repeat 3 times in a row. You will probably be given a small breathing exercise device that will help you with this.



• If you need to cough, bend your knees up, and press a pillow to your stomach and hug it as you cough.

Remember: Everyone heals at his or her own pace. Try to eat sitting up in the chair, rather than in bed. Walk as much as you can. Don't be shy to ask the nurse for assistance if you need it. Every step, however large or small, counts towards your recovery.

Ostomy Nurse
During your hospital stay the enterostomal therapist (ostomy nurse), will teach you how to care for your stoma, advise you where to buy your ostomy supplies, and address any other personal concerns you may have.

Remember: If you have any questions, your ostomy nurse is just a phone call away.

Reaching Out
It is normal to have periods of depression, either while in the hospital or after you return home. It may be reassuring to know that your enterostomal therapist is there to provide support and can even arrange for you to meet someone else who has had J-pouch surgery.

Sometimes, talking to someone who has "been there" and is now living a happy, active life may be a great source of comfort and encouragement to you.

Remember: You have just had a major operation -- a grieving process is normal. Don't keep feelings bottled up. Express your feelings and go with your emotions. Talk to your spouse, a close relative or friend who can listen. Most important, be patient with yourself, adjusting to a different lifestyle takes time and perseverance.

We're Here for You
Your doctor, her nurse and assistants are always happy to answer any questions you or your family may have about ileal J-pouch anal anastomosis surgery and the recovery process.

Remember: Read and discuss the postoperative instructions with your nurse. Ask questions if you are unsure about something or need further explanation. There is no such thing as a "stupid question." If it's important to you, it's important to your doctor.

Going Home
You will be discharged in three to five days, when you are eating and not showing any sign of infection. You will be given a prescription for pain medication. Before you are discharged, your physician and nurse will arrange for home healthcare, if needed in your case.

You also should be given the name of the home healthcare agency and its telephone number should you need assistance before the first visit.

Remember: Call your physician or nurse if you experience any problems after you get home.

Postoperative Appointment
Be sure to contact your surgeon's office if you have not received a postoperative appointment. Most appointments are within two to three weeks after you have been discharged from the hospital.

Remember: You must bring with you all of the ostomy supplies that you need to change your ostomy pouch to your surgeon's office so that he or she can examine your stoma. Your pouch may also need to be refitted.

Being informed about your surgery, asking questions, and sharing your feelings will help your recovery go as smoothly as possible.

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