J-Pouch Surgery 101

Over the course of the past several months, I have had many conversations where I would try to explain what kind of surgery I was having and what the end result was supposed to be.  As well as I thought I had explained it, I would get questions moments later like "So, is your backside is all stitched up now?"  or "Is the bag now going to be inside of you?"  There is nothing wrong with these questions, they just helped me realize that having your plumbing reconfigured can be really confusing.  Especially to people that really don't know the difference between large and small intestines and there functions (you could put my pre-UC self in this camp).  So, the way it made the most sense to me was by seeing a few cartoon sketches.  So here goes, J-Pouch Surgery 101.

J-Pouch surgery is done in either two or three surgeries.  Mine is being done in 3 because I was way to sick to handle it in two (and I was on prednisone at the time which slows down healing).

Step One Surgery - Entire large intestine (colon) is removed.  A portion of the rectum is left in place to be removed during the next surgery.  The small intestine is brought through an incision in the abdomen forming the stoma.  All stool exits the stoma and is collected in an ostomy bag.

Step Two Surgery - Rectal stump is removed.  A portion of small intestine is stapled together to form a J-Pouch.  The J-Pouch is then connected to the anus.  A new stoma is formed farther up the small intestine.  This is called a loop ileostomy (see picture below).  Even though the J-Pouch is created, it needs a couple months to heal before it can be used.  The loop ileostomy continues to divert the stool through abdomen into a colectomy bag while the J-pouch heals.

Step Three Surgery - Loop ileostomy is closed up.  The J-Pouch will start functioning as a small colon.  After this surgery there is no longer a stoma and a colectomy bag is no longer needed.  

(I get that this cross section is for a female.  The J-pouch set up is basically the same for dudes)

So there you go.  Those are the basic steps and process.  There are lots of fun details about dealing with each step but, I'm not getting into that today.  Let's just say by the end of it, the hope is you get to return to a normal lifestyle The new normal having to empty the J-Pouch 6 or so times a day.  Going number-two that many times a day may seem like a lot to the average human with a colon,  but when you have experienced raging  UC and had to deal with  20+  demon BM's a day, six seems like paradise.     I have been told it takes time to adjust to the new plumbing (can be around a year).  So another opportunity to exercise patience!