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In Layman’s Terms: A Breakdown of Ileoanal Anastomosis (aka J-pouch Surgery)

Posted Jan 07 2014 7:41pm

Hello, friends. 

I would like to be more proactive on the blog here in 2014 (a resolution I intend to keep this year). I get a number of inquiries regarding my experience with the surgery and most of you who have followed my journey understand my deeply rooted belief in self-education. I thought I would assist with some links, photos, and illustrations that I found helpful throughout my multiple surgeries. It is my sincere wish to provide some insight medically into what the ileoanal anastamosis is and what it means to have one. I feel like I have covered much of the emotional/physical aspects of the j-pouch (see my previous entries for more details ;) 

My first visit was to  where I found myself staring in the face of what suspiciously resembled my high school anatomy book. Nevertheless, the website provided a great set of simple illustrations to break down the procedure. Here is what they taught me.

Figure #1  

So here, the illustration shows us what a normal GI tract looks like. We eat our food, it passes through the esophagus and into our stomachs where all those digestive enzymes shake it up. Then the food heads into our small intestine for nutrient absorption and digestion. After that, the digested stuff makes it way to the large intestine (colon) and water is absorbed. The waste hangs out in our rectum until we finally have to poop which, of course, exits through the anus. I wish I could do this like the “Magic School Bus” with Miss Frizzle! Anyone remember that show? Am I aging myself right now…? Moving on!

Figure #2  

This surgery for me took about 6 hours total. Okay so the first step of the surgery goes like this: the large intestine and lining of the rectum is taken out (that’s all the stuff you see in the picture that is darker in color). The surgeon tries to save the sphincter because that is how we control our bowels. Without it, we would have to wear diapers pretty much all the time (which is kind of how I felt when I had ulcerative colitis). It took practice after my surgery to retrain myself to “hold” my bowels but I can go for about two-three hours comfortably now. The urgency is not nearly as bad as it was when I was ill. 

So during this part of the procedure, the j-pouch itself is created using a part of your small intestine (labelled the “reservoir” in the illustration). The pouch basically replaces your colon as its function is to hold waste until you need to go to the bathroom. Surgeons will then create the temporary loop ileostomy. This means that a little part of your small intestine is diverted and brought out in a small opening made in your abdomen so that your body has a place to evacuate waste while the j-pouch heals (Experience has dictated usually 2-6 months for most. I had mine for two years and I was perfectly fine). You have a small bag that is attached your abdomen for you to poop. It is strange at first but there is honestly nothing you cannot do with an ostomy! Doctors will let you go once your bowels wake up and they are sure the ileostomy works. You will see an ostomy nurse before you are discharged and they will give you equipment and accessories as well as teach you how to take care of your new temporary buddy. 

Figure #4  

This second step surgery took about 45 minutes for me. So after you have been kicking it with your ileostomy for a few months, the surgeon brings you back in one more time and then tucks your little friend back into your guts (the ileum) and reattaches the intestine to your healed j-pouch. So from now on when you eat, your food goes through the esophagus, stomach, small intestine, j-pouch, and out your anus. Boom! Relatively normal (albeit a little more frequent) bowel movements! 

I will go into more details about the ileostomy itself next time. If you guys found this information helpful, let me know! If there is something you would like me to cover in a future post, comment below or shoot me an email. 

I am hoping to shift gears here and provide a solid resource of information to help make the idea of surgery less overwhelming. Making the decision to have surgery is a huge deal. I’d like anyone going through the same experience to have as much information at their fingertips as possible. Thank goodness for the internet, eh? 

Best of Health and special shout out to for their images. If you have a chance, check them out. Lots of good info floating around over there. 

Take care! 


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