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11 replies

Try to keep rectum with j-pouch?

D DougFMember
Sub-total colectomy Feb '11, considering j-pouch in coming months. I have 20cm of my rectum remaining and I'm thinking it'd be nice to keep for better functionality and bowel control.

I still have mucous discharge with a bit of blood here and there and I'm told by a GI this is due to diversion colitis. In essence, stool provides nourishment to the colon and without any stool passing through my rectum is essentially starved.

Normally the remaining rectum would be removed for the j-pouch since UC will still be active there. I would have gone along with that but after being diagnosed and treated for Lyme (post colectomy) I'm pretty confident Lyme caused all my problems. In other words now that the Lyme has been treated I don't believe I have UC in my rectum. (Did you follow all that?)

The question is, has anyone maintained their rectum with a j-pouch? If so, any feedback?
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mgmt10mgmt10Member
If you indeed have UC then the rectum has to go. The disease will just attack your rectum at some point. If you never had UC in the first place well then that's another story. I understand what you're saying about the Lyme disease. It could have definately been the culprit. (I had a bout of Lyme's on top of my UC at one point but I did indeed have UC too). Seems like you have to do a wait see and have more testing done before making any decisions. But nobody here with UC would still have their rectum with a j pouch. The procedure just isn't done that way. What you would do is what chiromancer described above.
SpookySpookyMember
If your diagnosis is UC, then most likely the rectum will have to be removed. There is risk of recurrence of the disease in the retained rectum, as well as a cancer risk. Typically a "pull through" (what it is usually called when the rectum remains - no j-pouch is formed in these cases) is reserved for individuals who have a different pre-opt diagnosis such as colon cancer (where the rectum was not involved), a mechanical motility problem, or an injury to the colon.

There is no guarantee your colitis will not recur in the retained rectum, but your situation may be somewhat unique because of the lime disease, and therefore it is best to talk to your surgeon.
CTBarristerCTBarristerMember
I had a diagnosis of UC with dysplasia and have a rectal cuff which was retained. There is definitely a cancer risk in that rectal cuff and because of my pre-colectomy diagnosis of dysplasia, I have been advised to have annual pouchoscopies and biopsies. If cancer strikes, it will more likely be in the rectal cuff than in the pouch. I have now had a J Pouch for 21 years. On my last scope in June a polyp was found in the retained rectal cuff, but all biopsies were negative.

I did kegel exercises after takedown and my continence is excellent. I certainly have better continence now - even during a bout with pouchitis - than I ever did with UC.
Jan DollarJan DollarModerator, RN, retired
I am not seeing the Lyme disease as a real issue here. It could have been a trigger for the UC, but it does not mean you do not have UC. Once UC is triggered, it is there. So even if you are doing much better after treatment of the Lyme disease, it does not mean you are a good candidate for an IRA.

That said, I think it makes sense to talk this over with your surgeon. If you are highly motivated, then maybe an IRA is worth a shot, if you are OK with coming back later for a proctectomy and j-pouch procedure.

Jan Smiler
Mental KaseMental KaseMember
Hello,

Recalling some of my A&P from the past; the Rectum is a muscular column roughly 3-5 inches long that leads to the Sigmoid Colon. I assume that in the construction of the pouch, the Cuff requires some portion of Rectum for attachment and internal sphincter control. How much Rectum is lost to the process probably varies but retaining much of that muscular body I recall is very important for continence.

Correct if wrong.

MK

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