Overview
Pouchitis is a complication that occurs in about one-quarter to nearly one-half of people who undergo J-pouch surgery. It is a type of inflammation that affects the lining of the pouch created during the surgery, which is typically made from the end of the small intestine. Pouchitis can cause symptoms such as diarrhea, abdominal pain, cramps, fever, increased number of bowel movements, nighttime stool leakage, difficulty controlling bowel movements, and a strong urge to have a bowel movement.
Understanding the disease
Symptoms
The symptoms of pouchitis can include diarrhea, abdominal pain, joint pain, cramps, fever, an increased number of bowel movements, nighttime stool leakage, difficulty controlling bowel movements, and a strong urge to have a bowel movement. Other symptoms may include nausea, vomiting, stomach pain or cramps, watery or loose diarrhea, feeling ill, low-grade fever, muscle pain, itchiness, numbness, tingling, burning, or weakness in the hands, feet, arms, or legs, a feeling of fullness soon after eating, bloating or pain in the left upper abdomen due to an enlarged spleen, unusual bleeding, such as a nosebleed or bleeding gums, and painful swelling of one joint, often the big toe.
Development
Pouchitis is a complication that occurs in about one-quarter to nearly one-half of people who have undergone J-pouch surgery. It is inflammation in the lining of the pouch created during the surgery, which is typically performed to treat ulcerative colitis or other diseases. The exact cause of pouchitis is not known, but it is believed to be related to inflammation, bacterial imbalance, or an overactive immune response in the pouch. Symptoms of pouchitis may include diarrhea, abdominal pain, joint pain, cramps, fever, increased number of bowel movements, nighttime stool leakage, difficulty controlling bowel movements, and a strong urge to have a bowel movement.
Assessment and Diagnosis
Triage
It is recommended to consult a physician knowledgeable about pouchitis and related conditions if you or your child experiences symptoms such as diarrhea, abdominal pain, joint pain, cramps, fever, an increased number of bowel movements, nighttime stool leakage, difficulty controlling bowel movements, or a strong urge to have a bowel movement. Additionally, if pouchitis symptoms persist or worsen, it is advisable to seek medical attention promptly.
Management and Treatment
Complications
Pouchitis is a potential complication of intestinal surgery, such as colectomy or ileostomy. It refers to inflammation of the pouch created during the surgery. The following are potential complications of pouchitis:
- Dehydration: Severe diarrhea associated with pouchitis can lead to significant fluid and electrolyte loss.
- Kidney failure: Dehydration caused by pouchitis can rapidly deteriorate kidney function.
- Fistulas: Inflammation from pouchitis may extend through the intestinal wall, creating fistulas, which can become infected and form abscesses.
- Abscesses: Pouchitis may lead to the formation of infected pockets of pus, known as abscesses.
- Toxic megacolon: Pouchitis can cause the pouch to rapidly widen and swell, leading to a potentially life-threatening condition called toxic megacolon.
- Perforated colon: In some cases, pouchitis may cause a hole in the colon, which can occur on its own or as a complication of toxic megacolon. It is crucial to seek prompt medical attention if you experience symptoms of pouchitis or any of these complications.
Treatment
Treatments for pouchitis include antibiotics, corticosteroids, and surgery. In some cases, changes to the diet may also be recommended. Antibiotics are typically the first line of treatment for pouchitis, and may be administered orally or intravenously. Corticosteroids, such as prednisone, may also be prescribed to reduce inflammation in the pouch. Surgery may be considered in severe cases or if other treatments are ineffective. Consult with a healthcare professional for personalized advice and treatment options.