Fig. 1
J-pouch with ileoanal anastomosis. After proctocolectomy for ulcerative colitis, a J-pouch is created and an anastomosis made to the rectal cuff creating an ileoanal reservoir for stool. Usually a protective diverting loop ileostomy is created proximal to the J-pouch to allow it to heal (Adapted from: National Digestive Diseases Clearinghouse, National Institutes of Health, NIH, May 2012. http://digestive.niddk.nih.gov/ddiseases/pubs/dictionary/e-k.aspx. Downloaded on 6 Jan 2014)
3.
A temporary loop ileostomy is created to protect the anastomosis.
4.
A water-soluble contrast enema is performed 2 months after pouch creation to ensure that the ileal reservoir has no leaks or sinus tracts at which time the loop ileostomy is usually reversed.
5.
Significantly increased stooling frequency is common which typically gets better in several months.
(a)
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Multiple stools each day is common lifelong.
(i)
Bulking agents and anti-diarrhea medication may help to decrease frequency.
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