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Ileo-Anal Pouch What is an Ileo-Anal Pouch? The ileo-anal pouch (or reservoir) operation is a procedure which is performed in the management of chronic ulcerative colitis or multiple familial polyposis - both being conditions of the large intestine - which offers the retention of the anal sphincter muscles and therefore avoids a permanent artificial opening (ileostomy). How is the the Ileo-Anal pouch formed? The ileo-anal pouch operation is a major and complex operative procedure and is usually a two-staged operation. The large intestine is removed and the pouch or reservoir is surgically constructed and joined to the anal sphincter muscles. To ensure that complications, which may be associated with poor healing of the joint between the pouch and the muscles are minimised, a temporary artificial opening is established. This is referred to as a temporary loop ileostomy and would usually be in position for something in the order of three (3) months after the operation. During this period the faeces would come away from the ileostomy and be collected in a bag or appliance which is readily and easily managed by all patients. After healing of the pouch and that join between the pouch and the anal canal has occurred, ie. at approximately 3 months, the ileostomy is closed. It is quite probable that during stage 1 and stage 2 of the operative procedures, that you would be well enough to partake in normal social activities and even return to work. What should I expect in the Immediate Post-Operative Period? Following each operation there is a period of time where intravenous fluids are necessary, and after Stage 2 frequent fluid bowel actions may occur. During this time it may be difficult to control the stools and medication to thicken and slow down the bowel activity may be necessary. After the operation your health is likely to improve dramatically because the diseased bowel has been removed. During the recovery phase adequate rest as well as a satisfactory diet and exercise are important. Walking is a particularly good exercise and it is easily tolerated and provides an opportunity to get out of the house. In hospital it may be that you could have up to 10-20 bowel actions in a 24 hour period, but usually by the time you leave it would be down to 6-10 motions a day. Within a few months it should be 5-7 actions in a 24 hour period. The number of bowel actions however does vary from individual to individual, as does the necessity for medication. In the early post-operative period after either Stage 1 or Stage 2, complications associated with abdominal surgery can occur, and you will be in possession of separate information on this subject. Complications which can occur at sometime later in association with the pouch include minor bleeding from the anal canal and sometimes an inflammatory condition of the pouch referred to as "pouchitis". This can present as diarrhoea and discomfort in the pelvis, but will usually settle with appropriate antibiotics and other treatment. Discomfort around the anal area may be a nuisance and under these circumstances the avoiding of harsh toilet paper may be useful. Substitutes such as moist cotton wool or baby wipes can be very helpful. Showering or bathing regularly can also reduce discomfort. Appropriate ointments may be required and nylon underwear may be best avoided. You may notice sometimes that there is a small amount of leakage from the anal canal and at certain times for extra security, some patients prefer to wear a pad to protect clothing. One of the benefits of your operation is that you'll be able to return to a more normal diet. There are no specific do's or don'ts in regard to diet, however some foods may be associated with overactive functioning of the pouch, and you may need to experiment so that you can identify which foods are causing the trouble. High fibre diets may be associated with excessive gas and abdominal colic and are generally not necessary after ileo-anal pouch operations. When you do eat high fibre foods it is important to chew them extremely well and limit the quantity. You should always have something to drink with your meal. If a large amount of high fibre food is eaten and poorly chewed, it is possible that it may cause a blockage of the intestine. What are the surgical alternatives to Ileo-Anal Pouch? In the past only two procedures have been available to surgically cure or control these diseases. This is total removal of the large intestine, including the rectum and the anal sphincters with the establishment of an artificial opening (stoma) on the abdominal wall necessitating a bag or appliance to contain the faeces, and this stoma is referred to as an "ileostomy". 2. Colectomy and ileo-rectal anastomosis This operation involves removal of all of the colon, but retention of the rectum and anal sphincter muscles. The small intestine (ileum) is joined (anastomosed) to the rectal stump so that the bowel motion is passed in the normal way. The stools however are usually quite liquid and frequent bowel activity is common. The disadvantage of this procedure is that the condition being treated ie. inflammatory bowel disease or polyposis of the bowel is not cured. The condition is controlled and improved, but certain risks which may be associated with the disease, such as bowel cancer, are not prevented. Continuing surveillance of the lining of the rectum will then be necessary. The new operation of ileo-anal pouch or reservoir does obviate that problem as much as in possible, given that all of the large intestine other than for the anal sphincters is removed.
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