Pouchitis sufferers typically experience:

• Frequent passing of stools (poo).
• Bloody diarrhea.
• Urgency when passing stools.
• Discomfort while passing stools.
• Blood loss and dehydration resulting from frequent passing of stools.
• Nausea.
• Sometimes pain in area of inflammation.

Causes and likelihood of pouchitis
There have been a variety of mechanisms suggested for pouchitis, though the cause of the disease is still unknown. Pouchitis becomes a progressively more likely side-effect of an ileal pouch as time passes. The likelihood of pouchitis, one year after a pouch is surgically created is 15% of patients, after five years this increases to 33% of patients and then around 50% of patients are likely to suffer after ten years.

Testing for Pouchitis
Pouch patients can be assessed for pouchitis with an endoscopy (telescope inserted into the anus). Pouchitis sufferers usually have a reddened pouch mucosa, loss of normal vascular pattern, a mucosa that bleeds when touched, and sometimes ulcers in the pouch. Biopsies (tissue samples) show evidence of inflammatory cells in the lining the pouch.

Treatment
There is presently no approved treatment for pouchitis.

First line treatment is usually with antibiotics, specifically with ciprofloxacin and metronidazole. Administration of antibiotics over a prolonged period can cause various side effects limiting their use.

Other therapies which have been shown to be effective in randomised clinical trials include probiotic therapy.

There are a number of other drugs used to control an episode of pouchitis and their use depends on the severity of the flare up. These may be delivered using enemas applied directly into the pouch through the anus or may be given as tablets or liquids taken by mouth. Some drugs are given by injection or infusion in to a vein or under the skin.

What to expect
There is no known cure for pouchitis, and as the disease becomes progressively more likely in pouch patients over time, some challenges can be expected.

Rarely, where pouchitis is chronic and does not respond to treatment, it may be necessary to perform another surgical operation. This may be to divert stool away from the pouch, to allow the pouch to rest, or in severe cases to remove the pouch completely. When this happens a patient is given a temporary or permanent ileostomy depending on whether the pouch is being rested or removed. An ileostomy is where the ileal tissue is drawn out of the front of the belly or abdomen to receive the bowel contents in to a plastic bag called an ileostomy bag.

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