Many people with serious ulcerative colitis end up having their diseased colon removed and the bowel reconnected with a surgical procedure known as ileoanal anastomosis (IPAA) . This surgery creates an internal pouch (from the small intestine) to hold waste before it's eliminated. Pouchitis is an inflammation of the lining of this pouch. This complication occurs in up to half of people who have this operation. They experience symptoms such as abdominal pain, cramps, increased number of bowel movements and a strong feeling of the need to have a bowel movement.

  • Experience. Mayo Clinic surgeons perform large numbers of IPAA procedures. As a consequence, Mayo doctors are experienced in managing pouchitis, treating more than 400 people who have this condition each year.
  • Expertise. Mayo Clinic has the expertise and tools to distinguish pouchitis from other possible causes of your symptoms and to effectively treat the kind of disease you have.
  • Teamwork. Surgeons, digestive disease specialists, pathologists and others who specialize in treating pouchitis work together to find the best option for your situation.
  • Efficiency. In Mayo's integrated practice, you can see all the specialists you need in one convenient location, usually during the same visit.

Mayo Clinic in Rochester, Minn., ranks #1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., is ranked among the Best Hospitals and Mayo Clinic in Jacksonville, Fla., is ranked high performing for digestive disorders by U.S. News & World Report.

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Specialists in gastroenterology and colon and rectal surgery care for people who have pouchitis. A special Inflammatory Bowel Disease Clinic brings together a variety of experts to find solutions for people who have inflammatory bowel-related diseases, including pouchitis.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology and colon and rectal surgery care for people who have pouchitis. An Inflammatory Bowel Disease Clinic helps coordinate care for people who have pouchitis and other inflammatory bowel diseases.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology and colon and rectal surgery care for people who have pouchitis. Mayo Clinic in Minnesota has a special Inflammatory Bowel Disease Clinic devoted to diagnosis, treatment and research on inflammatory bowel diseases, including pouchitis.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Mayo Clinic has the expertise and tools to distinguish pouchitis from other possible causes of symptoms. Most of the time, suspected pouchitis can be accurately diagnosed with the following combination of methods:

  • Medical history of symptoms
  • Physical examination
  • Stool tests for infections
  • Endoscopic examination of the pouch
  • Biopsy of tissue from the lining of the pouch

The endoscopic exam can also detect cuffitis — an inflammation of the connection created between the intestinal tissue and the anus. Cuffitis is a recurrence of the ulcerative colitis in the small amount of original tissue that remains in most people after the ileoanal anastomosis procedure.

X-rays and a pelvic MRI may be needed to detect other possible causes of symptoms, such as pouch leak, Crohn's disease, an abscess or a fistula (an abnormal opening).

After diagnosis, additional testing may be needed to monitor the disease, its complications or the side effects of medications. Some people may also be monitored for precancerous changes.

In most cases, a short course (one to two weeks) of antibiotics such as ciprofloxacin or metronidazole will decrease or eliminate the symptoms (remission). Improvement in symptoms usually occurs in one to three days. People generally have fewer side effects with ciprofloxacin, and it may be more effective than metronidazole.

About 10 to 20 percent of people develop chronic pouchitis. Many of these people require long-term continuous antibiotic therapy to maintain remission. Supplements of probiotic bacteria can be helpful in preventing pouchitis from returning once it has been treated.

In some people, pouchitis does not respond to antibiotics (called refractory). Mayo Clinic's expertise is often helpful in finding solutions for these difficult problems. Treatment options include:

  • Assuring that there's not another explanation for your symptoms
  • Topical mesalamine (suppository or enema)
  • Oral and topical corticosteroids, such as budesonide
  • Immunosuppressive medications, such as infliximab

In rare cases when pouchitis does not respond to any medications, it may be necessary to remove the pouch.

Cuffitis is treated with the same medications used to treat ulcerative colitis, most commonly in the form of a mesalamine suppository (Canasa).

Mayo maintains a database of treatment information about patients, which helps doctors study disease trends and tailor individual treatment plans.

Publications

See a list of publications by Mayo Clinic doctors on pouchitis on PubMed, a service of the National Library of Medicine.

Nov. 20, 2012