Pouchitis is an inflammation of the lining of a pouch that is surgically created in the treatment of ulcerative colitis and certain other diseases. Many people with serious ulcerative colitis end up having their diseased colon removed and the bowel reconnected with this procedure, called ileoanal anastomosis (IPAA) or J-pouch surgery.

Surgeons use the end of the small intestine (ileum) to create a pouch shaped like the letter J. The pouch is attached internally to the area just above the anus to hold waste before it's eliminated.

Pouchitis is a complication of IPAA that occurs in 23 to 46 percent of people who have the procedure. Symptoms can include diarrhea, abdominal pain and joint pain, cramps, fever, increased number of bowel movements, nighttime fecal seepage, fecal incontinence, and a strong feeling of the need to have a bowel movement.

  • Experience. Mayo doctors are experienced in managing pouchitis, treating more than 500 people annually who have this condition.
  • Expertise. Doctors at Mayo Clinic have the expertise and tools to distinguish pouchitis from other possible causes of your symptoms and to effectively treat the disease you have. We listen closely to your concerns and explain our findings in plain language.
  • Teamwork. At Mayo Clinic, a multidisciplinary team of experts including surgeons, digestive disease specialists, pathologists and others work together to find the best option for your situation.
  • Efficiency. At Mayo, we run all necessary tests ourselves. You can see all the specialists you need in one convenient location, usually during the same visit.

Mayo Clinic in Rochester, Minn., ranks No. 1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for digestive disorders by U.S. News & World Report.

Mayo Clinic has the expertise and tools to diagnose pouchitis. In part, the diagnosis involves ruling out other possible causes of signs and symptoms. Most of the time, suspected pouchitis can be accurately diagnosed with the following combination of methods:

  • Medical history of signs and symptoms
  • Physical examination
  • Stool tests to exclude infections as the cause of signs and symptoms
  • Endoscopic examination of the pouch, in which the doctor will insert a tube containing a light and a tiny camera to view the inflamed area
  • Biopsy of tissue from the lining of the pouch
  • Abdominal and pelvic imaging, which may include X-rays, computed tomography enterography (CTE) or magnetic resonance enterography (MRE)
  • Ultrasound
  • Water-soluble contrast pouchogram (Gastrografin enema)

These tests and procedures will rule out, among other conditions:

  • 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 colon tissue that remains in most people after the ileoanal anastomosis procedure.
  • Pouch leak
  • Crohn's disease, in which a new occurrence of the disease develops in the pouch
  • Abscess, opening (sinus), or abnormal connection between tissue or organs (fistula)
  • Infectious diarrhea
  • Irritable pouch syndrome

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

Most people with pouchitis are treated with 10 to 14 days of antibiotics such as ciprofloxacin (Cipro) or metronidazole (Flagyl), usually given orally. Ciprofloxacin generally produces fewer side effects and may be more effective than metronidazole.

Other antibiotics used include rifaximin (Xifaxan) and amoxicillin/clavulanate (Augmentin). Sometimes antibiotics are given in combination.

While most people respond well to treatment, 5-19 percent develop relapsing or treatment-refractory disease. This form of pouchitis might require long-term, continuous antibiotic therapy. Probiotic bacteria supplements have been found helpful in preventing pouchitis from returning once it has been treated, although more studies are needed.

Chronic antibiotic refractory pouchitis (CARP)

In some people, pouchitis does not respond to antibiotics. Doctors at Mayo Clinic can help find solutions, which include ruling out other causes for your symptoms. Medications include:

  • An anti-inflammatory drug, mesalamine (Apriso, Asacol, others), either oral or as a suppository (Canasa) or enema
  • Oral and topical corticosteroids, such as budesonide or hydrocortisone
  • Immunosuppressive (anti-tumor necrosis factor or TNF) medications such as infliximab (Remicade) or adalimumab (Humira)

No data is available on fecal transplantation in CARP.

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

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.

At Mayo Clinic's campus in Phoenix and Scottsdale, Arizona, specialists in gastroenterology and hepatology as well as colon and rectal surgery treat 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 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.

At Mayo Clinic's campus in Jacksonville, Florida, specialists in gastroenterology and hepatology as well as colon and rectal surgery treat 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.

At Mayo Clinic's campus in Rochester, Minnesota, specialists in gastroenterology and hepatology as well as colon and rectal surgery treat 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 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.

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

June 11, 2015