Fistula and cuffitis

A fistula is a track that is formed when an anal abscess pushes through the tissue as it makes it way to the surface. In the case of people with a jpouch, an anal fistula will either open up on the outside near the sphincter, or drain into the pouch itself. They can be difficult to deal with, as cutting into the anal sphincter can lead to incontinence, and they can sometimes come back.

Cuffitis is when the "cuff" of the rectum, the small piece they left after the colectomy becomes inflamed. The cuff is what connects the pouch to your anal muscles. Since this is still technically "colon" material, it can sometimes become inflamed the same way your colon did with UC. It's treated the same way as well, usually with a steroid suppository, which usually puts it into remission. People who have severe chronic cuffitis sometimes a pouch advancement surgery, which removes even more of the cuff, pretty much attaching the pouch as low as possible.

Once you have cuffitis, do you normally go back to having an ilealostomy? I had temp. ileostomy l7 years ago, and then a J pouch ever since. I now have cuffitis and UC, as well as the remaining 5 feet of small bowel is all inflamed. Being treated with Rowasa. Biopsy results next week. Any insight?

Sally,

I also have cuffitis and I am being recommended for pouch advancement surgery. My pouch is in pretty good shape I am being told.

I think you need to wait on your biopsy results before you can make any further decisions. They are most likely testing for crohn's if your small intestine is inflamed. They can treat the cuffitis with rectal meds and the inflammation with antibiotics and other IBD meds (entecort etc).

I am wondering why they are not treating your inflammation more aggressively? If the cuffitis is bad, you can use cortifoam or anucort versus canasa.
I am not sure how bad the small intestine inflammation is, but how would enemas reach the area above your pouch if it is inflamed?

sallyjpouch I was just dx with crohn's after the j pouch surgery (5 mos. takedown). I have ileitis and originally was told UC in the anus. I am on steroidal suppositories for now. Not sure what the next step is for me. I go back to GI in a month. I am finding the suppositories are helping, right now. Good luck in your biopsy results.

Jeane I hope you are doing okay.

Roberta

Roberta, I am still trying to figure out this site . . .I tried to respond to Jeane and couldln't find the "reply button". Anyway, you poor thing. I had no idea we could get crohn's as well as UC. I am so curious about what the doc is going to recommend tomorrow with my UC cuffitis (I guess it is called), etc. Jeanne, thhat was a very good point about getting the Rowasa to the small intestines??

Sally don't get nervous...get the rectal meds..they should help you. Mine are now starting to work.

I have been home for 9 years. I used to be a computer software developer.

I just took two weeks of Rowasa enemas, now they started antibiotics. Anyway, I hope you feel better. Bye.

Keep us posted as to you you make out Sally. Hope you feel better also.