Keck : Department of Colorectal Surgery : Clinical Activities : Digestive System : Ileo-Pouch Anal Anastomosis Guide

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Ileo-Pouch Anal Anastomosis Guide

Digestive System Digestive System Disorders Surgical Options Preparing For Surgery Ileo-Pouch Anastamosis After The First Surgery Discharge To Home Sphincter Exercise Stoma Management		Ileostomy Closure Perianal Skin Care Medications Diet Transition Period Potential Complications Long-Term Complications Conclusion Resource List

To understand the ileoanal procedure, you must first understand the digestive system.

The digestive system starts at the mouth where food is ingested and breakdown begins. Muscle contractions propel the food down the esophagus into the stomach where it is mixed with various digestive enzymes.

By the time the food leaves the stomach, it is a ground-up slurry. Once out of the stomach, the food mixes with other enzymes from the liver and pancreas, all of which continue to break the food down into its molecular components. These substances are then absorbed through the small intestine, or small bowel.

A normal individual has about 15 feet of small bowel, but can get by with substantially less. Food is absorbed as it travels through the small bowel in about four hours. The food then passes into the large intestine, also known as the colon. By now, all of the nutritional substances have been absorbed.

The primary function of the colon is to absorb water and store the waste, called stool. The average person has about eight feet of colon. Stool enters the right colon in a liquid state and then travels to the left colon where most of the water is absorbed. This may take one or two days, during which time most of the water is removed. The stool is then pushed into the rectum causing the urge to have a bowel movement.

The function of the rectum is primarily storage. To be an adequate storage area, the rectum must have capacity and it also must be flexible. This means that as the rectum distends (stretches), there should be very little increase in pressure-much like an old balloon that inflates easily. If the rectum is rigid and does not expand easily (as with inflammatory bowel disease), it does not have good capacity, generates high pressure in the rectum, and the patient is plagued by stool urgency and frequency.

The anus is essentially a plug that offers resistance so that stool can be stored in the rectum until there is a socially convenient time to eliminate it.

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