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Ileo-Pouch Anal Anastomosis Guide
Whether you have a one- or two-stage procedure, you will experience an adjustment period. This is the time needed by your new rectum (J-pouch) to expand and soften and increase in capacity. This is often likened to a new balloon, which is initially difficult to inflate, but after each inflation becomes more pliable and easier to blow up.
If you have had a one-stage procedure, your adjustment period is usually about six to eight months. For a two-stage procedure, you will experience an adjustment period of three to six months after your ileostomy closure.
During the time when the pouch is small, your stools will be more frequent and slightly more urgent than they will be when the pouch is stretched to its final capacity.
While your pouch is small, you must empty it more often. In order to stretch the pouch, we would encourage you to hold on to your bowel movements as long as you can. This builds up a back pressure and causes the pouch to stretch.
During the transition period you will be instructed to take an anti-diarrhea medication (Lomotil, a prescription drug, or Imodium, which can be purchased over the counter). This medication reduces loose stools by decreasing the activity of the gut.
You will also be instructed to take a fiber supplement such as Metamucil or Citrucel. This will assist in increasing water absorption and increase the bulk of the stool. If you are taking fiber supplements, you do not need to take a large amount of water, as the instructions on the package may suggest. There is already enough water in the stool, and the fiber supplement is meant to absorb some of this extra moisture and make the stool thicker.
We would expect continued improvement over at least the first year, although the improvement is more dramatic in the first three to six months. During this time the stool frequency and urgency should decrease. You may use medications such as Lomotil and fiber supplements to help thicken the stool.
Once you are discharged from the hospital, complications are rare. It is important that you contact us if you are having any concerns or symptoms that you do not understand.
Generally, if you are wondering if you are having a problem, you are not. Symptoms of significant problems after a major surgery are not subtle, and you will know that there is something abnormal occurring.
Returning to Work
Most likely, you will be able to return to work approximately six weeks following surgery. You may need to transition back to full-time work by starting out working fewer days per week or fewer hours per day. If you have a job that does not require a lot of activity or require long hours, you may find you can return to work as early as three to four weeks following surgery.
Overall, let your body be your guide. If you feel worn out or tired, you are doing too much too soon.
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