Ileal Pouch Anal Anastomosis (IPAA)

An Ileal Pouch Anal Anastomosis can also be known as an ileo-anal pouch, ilean-anal pullthrough and a restorative proctocolectomy. The purpose of the ileal pouch is to provide an internal reservoir situated where the rectum would normally be. An anastomosis is a surgically-created connection between tubular structures (intestines) in the body.

Is The Procedure Right For You?

Ileal Pouch Anal Anastomosis is for people who have had their large intestine surgically removed. Reasons for this removal can include Ulcerative colitis, Colon Cancer, Toxic megacolon, familial adenomatous polyposis, and in some cases, Crohn’s disease.

How The Procedure Is Performed

During an ileal pouch anal anastomosis procedure the patient’s large intestine is removed and the small intestine is connected to the anus. The last inches of the small intestine are used to create an internal pouch that serves the function of the rectum. This allows the patient to continue eliminating waste through the anus.

IPAA is usually performed in two separate steps. In the first surgery the colon and rectum are removed and the pouch is created by folding back the last section of the small intestine. After the pouch is made, the patient will have an ileostomy for approximately two months. The interval between the surgeries allows for the bowel and the new pouch to heal.

It is in the second surgery that the ileostomy is reversed and the pouch will now assume the role of storage area for stool.

Complications

When an IPAA is performed to manage colitis it is possible to develop a condition called “pouchitis”, which is an inflammation of the ileo-anal pouch. Symptoms of pouchitis are similar to symptoms of colitis but usually less acute. These symptoms can include diarrhea, difficulty or urgency in passing stool, and possibly pain. Treatment for pouchitis usually includes a seven to ten day course of combination drugs.

Post-Procedure

Immediately after the procedure you will tend to pass liquid stool with urgency and may have eight to fifteen bowel movements per day but this number will decrease. The pouch is a smaller reservoir than the colon so it is common to have to go to the bathroom more often. The stools are also less formed and the normal pouch output over time can be described as having a consistency similar to porridge. There are also drugs available to thicken stool and slow bowel movement.

After undergoing an IPAA you will have control of the muscles in the anus. You will also have four to six bowel movements per day, which is more than the average individual, but is manageable and interferes little with normal daily life.

Your diet will also have to be slightly altered post IPAA. Patients can easily get dehydrated and suffer from salt deficiency so it may be recommended that you drink electrolyte mixes and add salt to meals. Soon after surgery patients are encouraged to eat high protein/carb meals and little fiber. Some patients find that “grazing” on food rather than having three full meals a day is more beneficial and that eating after 6 and 7 pm should be avoided so as to not have to get up in the night to go to the bathroom. There are some foods that are thought to irritate the pouch, and the doctor will discuss these foods with you. Certain foods can increase stool output, cause anal irritation, increased gas, and odor.