Are you someone who has had your entire colon and rectum surgically removed due to a medical condition and an 'ileal pouch' created in its place? If so, you may also experience some discomfort related to this pouch at times. One of the most common problems that can arise is what we are talking about today, 'Pouchitis'. Don't be scared when you hear this. Let's talk about everything clearly and simply.
What is Pouchitis? Let's understand it simply.
First, let's look at what this 'ileal pouch' is. After your colon and rectum are completely removed (total proctocolectomy), you need a new way to get your stool out of your body. One solution to that is the ileal pouch surgery. What happens here is that surgeons use the last part of your small intestine (ileum) to create a small pouch-like structure.
So, what your large intestine used to do, which was temporarily collect and store stool before it leaves, is now done by that pouch. In other words, part of your small intestine now acts like a large intestine.
Pouchitis is when the pouch becomes swollen or inflamed from the inside. It is a condition similar to colitis (inflammation of the colon) or proctitis (inflammation of the rectum). This is a common condition for someone with a pouch.
For most people, this is temporary (acute pouchitis), but for some people it can be a persistent (chronic pouchitis) or recurring condition.
What are the symptoms of pouchitis?
If you have pouchitis, you may experience one or more of these symptoms. It's important to be aware of them.
| Symptom | Description |
|---|---|
| Lower abdominal pain and limping | A strange pain in the lower abdomen or a feeling of being grabbed and turned over. |
| Frequent and sudden need to go to the toilet | You need to go to the toilet more often than usual. You also suddenly have an unbearable need to go to the toilet. |
| Going to the toilet at night | Having to wake up and go to the toilet. |
| Difficulty controlling bowel movements (incontinence) | Passing a small amount of stool without realizing it. |
| Difficulty passing stools | Straining to defecate when going to the toilet (dyschezia). |
| The feeling of not being able to completely empty the toilet after going to the toilet | Feeling like you still have a bowel movement even after passing stool (tenesmus). |
| Slight blood in the stool | Seeing streaks of blood in the stool. |
| Fever or chills | Feeling feverish or shivering. |
Why does Pouchitis occur?
The exact cause of this is still not 100% known, but the main theory is that there is an imbalance in the types of bacteria that live inside the pouch.
Imagine, when part of your small intestine is now functioning like a large intestine, new types of bacteria come in. There's a little 'battle' between these new and old bacteria. This change can cause the body's immune system to think there's an infection there. So in response to that, inflammation occurs, meaning the pouch swells.
Sometimes, pathogenic bacteria can overgrow and cause an infection. This bacterial balance changes after surgery, giving harmful bacteria a better chance to grow.
It is common to develop pouchitis shortly after surgery. This can often be treated with antibiotics. However, in some people, it can recur.
Other factors that contribute to persistent pouchitis
For some people, pouchitis persists or does not respond well to treatment. This can be due to other factors.
- Pre-existing medical conditions (IBD): If you had to have your colon removed due to an inflammatory bowel disease (IBD) such as Ulcerative Colitis or Crohn's disease, you are at higher risk of developing pouchitis. This is because the same underlying mechanism that caused that disease can also affect the pouch.
- Antibiotic-resistant bacteria: Some bacterial infections, such as C. difficile, are difficult to control with antibiotics. Also, with continued use of antibiotics, some bacteria become resistant to them. This can also increase the bacterial imbalance in the pouch.
- Other infections: Sometimes, inflammation of the pouch can also be caused by viral (cytomegalovirus) or fungal (candidiasis) infections.
- Weakened immunity: If your body's immune system is weakened due to other medical conditions or certain medications, your ability to fight infections is reduced.
- Use of painkillers (NSAIDs): Long-term and excessive use of painkillers such as ibuprofen and aspirin (Nonsteroidal anti-inflammatory drugs - NSAIDs) can damage the inner layer of the pouch.
- Reduced blood supply (Ischemia): Although very rare, inflammation can occur due to a blockage of the blood supply to the pouch.
- PSC disease: `(Primary sclerosing cholangitis - PSC)` is a disease that causes inflammation of the bile ducts of the liver. People with this condition are at increased risk of developing pouchitis.
What are the possible complications of pouchitis?
Temporary pouchitis rarely causes major complications, but if the condition persists or does not respond to treatment, it can cause some problems.
| Complication | Description |
|---|---|
| Change in bowel habits | Inflammation of the pouch can cause long-term problems, such as difficulty holding stool or difficulty passing stool due to swelling. |
| Declining standard of living | The inconvenience of going to the toilet frequently can lead to problems such as stress and decreased social relationships. |
| Narrowing of the pouch (Stricture) | Long-term inflammation can cause scarring of the pouch, narrowing its opening. |
| Ulcers | Inflammation can cause the inner layer of the pouch to become irritated and bleed. |
| Nutritional deficiencies | Damage to the inner layer of the pouch can lead to reduced absorption of nutrients from food (malabsorption), leading to malnutrition. |
| Pouch Failure | Very rarely, persistent problems may make the pouch unusable, requiring its removal and other surgical procedures, such as an ileostomy. |
How do you know exactly if you have pouchitis?
After listening to your symptoms, your doctor will perform several tests to confirm the condition. The most important test is a pouchoscopy (endoscopy) .
This involves inserting a very thin tube with a camera attached through your anus and examining the inside of the pouch. The doctor can then check for any inflammation or lesions inside the pouch. At the same time, a small piece of tissue (biopsy) may be taken for examination.
In addition, the following tests may be performed to check the condition of the pouch and surrounding structures:
- Contrast Pouchography `(pouchogram)`
- `CT scan`
- `MRI`
What are the treatments for pouchitis?
Treatment options depend on the type of pouchitis you have.
Treatment for Acute Pouchitis
The first treatment is a two-week course of antibiotics. For many people, this will almost completely clear up their symptoms. Even if your symptoms improve, it is important to take the full course of medication prescribed by your doctor.
Treatment for Recurrent Pouchitis
If pouchitis recurs after treatment, the doctor will likely prescribe the same antibiotics. However, if it occurs more than three times a year, it is considered a chronic condition and maintenance therapy may be started to prevent recurrence. For this,
- Giving antibiotics for a long time at low doses.
- Use of Probiotics: Probiotics, which contain beneficial bacteria, can help restore the bacterial balance in the pouch.
Treatment of pouchitis that does not respond to antibiotics (CARP)
If antibiotics do not help, or if they did help before, the condition is called ``Chronic antibiotic-resistant pouchitis (CARP)''. Here, the doctor will look for other causes and decide on treatment accordingly. There are various treatment options for this.
- Enemas containing drugs such as `Mesalamine` or `Bismuth`
- Corticosteroids, which reduce inflammation
- Immunosuppressants that control the functioning of the immune system
- Modern drugs like `Biologics`
- Specialized treatments such as `Fecal microbiota transplant (FMT)`
The most important thing is that your doctor should decide what treatment is best for you. So if you have symptoms, seek medical advice immediately.
Can pouchitis be controlled with food and drink?
Yes, to some extent it is possible. Your diet can help prevent pouchitis from developing and also help manage symptoms when they occur.
| Foods that help prevent pouchitis (antioxidant-rich foods) | Foods that aggravate pouchitis symptoms (temporarily stop) |
|---|---|
Include fruits and vegetables rich in antioxidants that reduce inflammation in your diet.
| When symptoms are present, relief may be obtained by temporarily reducing certain foods that stimulate gut bacteria and are difficult to digest (Low FODMAP Diet).
|
Important: The low FODMAP diet is not something you should follow on a permanent basis. It is something you should follow for a short period of time, when you have symptoms, under the guidance of a doctor or nutritionist.
Although life is much easier after ileal pouch surgery, it's normal to feel anxious when problems like pouchitis arise. But remember, this is a treatable condition that affects many people. You can work with your doctor to find the best solution for you.
Take-Home Message
- Pouchitis is an inflammation of the pouch that is common among people who have undergone ileal pouch surgery.
- If you experience symptoms such as lower abdominal pain, frequent trips to the toilet, or blood in your stool, pay attention to them.
- Most cases of pouchitis can be successfully treated with antibiotics.
- Don't ignore the symptoms. See your doctor as soon as possible for advice.
- A balanced diet and possibly probiotics can help maintain the health of the pouch.
- Persistent (chronic) pouchitis conditions may require specific treatment, and your doctor will provide you with the most appropriate treatment plan.
💬 අදහස් (0)
තවමත් කිසිදු අදහසක් පළ කර නොමැත. ඔබේ අදහස පළමු වරට මෙහි එක් කරන්න.
ඔබේ අදහස එක් කරන්න