Pouchitis – Symptoms and Causes

Overview

Pouchitis is an inflammation affecting the lining of a surgically created pouch. This condition occurs after a procedure to remove the colon, commonly performed to treat ulcerative colitis and certain other bowel diseases.

Nearly half of all patients who undergo J-pouch surgery experience pouchitis at some point.

The inflammation causes discomfort and is considered one of the most common complications following this type of surgery. Symptoms may vary in severity from person to person.

Symptoms

Pouchitis symptoms are varied and may change as the condition progresses. Some people experience sudden flare-ups, while others deal with chronic or recurring symptoms over time.

Common signs include:

• Increased bowel movements
• Urgent need to use the bathroom
• Watery stool
• Mild to severe abdominal pain
• Cramping
• Bloating

Rectal bleeding is another symptom that might occur. Some patients report fever and general fatigue. Joint pain sometimes happens as well, making daily activities harder.

Other symptoms may include mucus in the stool or a persistent feeling of needing to pass stool (tenesmus).

Dehydration can develop due to frequent loose stools. Weight loss might happen because of decreased appetite and poor nutrient absorption.

When to Get Medical Help

Call your doctor right away if you have:

• Severe or worsening abdominal pain
• High fever (over 101°F or 38.3°C)
• Increased or bloody bowel movements
• Signs of dehydration (extreme thirst, dry mouth, dizziness)
• New or worsening symptoms that don’t improve

Don’t wait to seek care if symptoms interfere with daily life. Your healthcare provider might adjust your treatment plan based on symptom severity.

Causes

Pouchitis happens when the pouch made during surgery for ulcerative colitis becomes inflamed. Several factors can trigger this condition.

Bacteria changes play a major role in pouchitis. After surgery, new bacteria grow in the pouch that can cause inflammation. This change in gut bacteria upsets the normal balance.

The immune system also contributes to pouchitis. People who get this condition often have immune systems that overreact to normal bacteria. This overreaction leads to swelling and irritation in the pouch lining.

Risk Factors

Several factors may increase the chance of developing pouchitis after J-pouch surgery.

People with a history of ulcerative colitis face higher risks, particularly if they experienced frequent flare-ups before surgery. Approximately 30-50% of patients develop pouchitis within 10 years after their operation.

Genetic factors play a role in pouchitis development. Those with specific genetic markers or a family history of inflammatory bowel disease may have increased susceptibility. Non-smokers also seem to have a higher risk compared to current smokers.

Other risk factors include:

• History of other immune disorders
• Previous serious ulcerative colitis
• Previous antibiotic use that disrupts normal gut bacteria
• Non-steroidal anti-inflammatory drugs (NSAIDs) consumption
• Primary sclerosing cholangitis, a liver condition often associated with inflammatory bowel disease

Some studies suggest that diet choices may influence pouchitis development. Foods high in fat or low in fiber might trigger inflammation in some people. Maintaining gut health through probiotics may help reduce risk in susceptible individuals.

Stress and poor sleep habits might also contribute to pouchitis flares, though research remains ongoing.

Complications

Pouchitis can lead to several complications if left untreated or if it becomes chronic.

Persistent inflammation may cause ulcers in the pouch lining, leading to bleeding and pain. Some patients experience dehydration from frequent watery bowel movements that prevent proper fluid absorption.

Weight loss commonly occurs when severe pouchitis reduces appetite or makes eating uncomfortable.

Nutritional deficiencies may develop as the inflamed pouch struggles to absorb essential vitamins and minerals.

For some individuals, pouchitis becomes chronic, requiring long-term antibiotic therapy or other treatments.

In rare but serious cases, pouch failure may occur, potentially requiring removal of the pouch and creation of a permanent ileostomy.

Pouchitis can significantly impact quality of life through:

• Increased bathroom urgency
• Disrupted sleep patterns
• Limited social activities
• Emotional distress
• Work productivity challenges

Joint pain and skin problems sometimes develop alongside pouchitis as extra-intestinal manifestations.