What is an Internal Pouch?

Internal pouch surgery is increasingly being offered to suitable candidates who require surgery to remove their colons and rectums, it is a reconstructive technique that avoids the need for an abdominal stoma. Instead of bringing the ileum out of the abdomen the surgeon fashions a reservoir, the 'pouch', from the end part of the ileum which is then attached to the anus restoring bowel continuity.

After surgery is complete the patient will defecate in the normal way and there is no need to wear an appliance. The lack of a colon means that motions will be loose and more frequent than is normal, an average pouchie will need to visit the toilet around 4 to 6 times a day though urgency is not normally a problem.

The surgery is often done in two stages, the first forms the pouch and forms a loop ileostomy to divert the faecal flow while the pouch heals. A few weeks later the patient will go for an examination called a pouchogram where contrast material is passed into the pouch and X-rays taken to ensure the pouch has no leaks. Once the surgical team are happy that the pouch is ready surgery for takedown of the stoma will be arranged and the pouch put into use.

Pouches come in various forms depending on the surgeons technique, the original was a 3 limbed pouch known as the s-pouch. A number of problems with this initial design means it has fallen out of favour and the most commonly performed surgery these days is a 2 limbed design known as the j-pouch. A four limbed pouch known as the w-pouch with a slightly higher capacity is also made but is not as common as the j-pouch. The surgery has a variety of often bewildering names, its technical name is restorative proctocolectomy with ileal pouch anal anastomosis, but in common parlance you will likely hear terms such internal pouch or ileo-anal pouch as well as the s-pouch, j-pouch, and w-pouch terms.

IA's Internal Pouch Subcommittee represent the interests of those with internal pouches and the Internal Pouch Coordinator sits on the National Executive Committee.

If you are considering internal pouch surgery and would like to speak in confidence to somebody who has already had the surgery our Visiting Coordinator will be able to arrange this for you (see the Contacts Page for details), also your medical team should also be able to arrange similar.

The Internal Pouch Group now also have a presence on Facebook and you may like to check out their page.