What is Ileal Pouch Anal Anastomosis (IPAA)

Ileal pouch-anal anastomosis is a procedure to attach a tube (ileal pouch) made of part of the small intestine (ileum) to the anus. The ileal pouch is where stool is stored before you have a bowel movement.

IPAA is done after the large intestine (colon) and the rectum are surgically removed (proctocolectomy). IPAA allows waste to pass through the anus and into the ileal pouch. After IPAA, you will still be able to control when you have a bowel movement (will have continence).

IPAA is preferred over procedures that create an opening (stoma) in the abdomen for waste removal (ileostomy surgeries). However, a temporary ileostomy surgery may be done with IPAA to give the ileal pouch time to heal. When the ileal pouch heals, you will have a procedure to reverse the ileostomy. Ileostomy reversal is usually done 8–12 weeks after IPAA.

IPAA is often done to relieve inflammatory bowel disease (IBD), such as ulcerative colitis or familial polyposis coli. Other names for this procedure include ileoanal pouch, pelvic pouch, and ileoanal reservoir procedure.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs, such as the intestines.
• Skin irritation or swelling around the anus or the stoma.
• Obstruction or blockage of the anus or stoma.
• Dehydration.
• Leakage at the connection between the ileal pouch and the anus.
• Difficulty controlling how often you have bowel movements.

What happens before the procedure?

• You will have a physical exam, which may include a rectal exam.
• You may have tests, such as:
  • Blood tests.
  • Stool tests.
  • X-rays.
  • Colonoscopy.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• Do not use tobacco products, including cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Do Kegel exercises as told by your health care provider. These can strengthen the muscles in your anus.
• You may be asked to use antibiotic wipes, or to bathe or shower using a soap that kills skin bacteria.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• One or more incisions will be made in your abdomen.
• If your colon and rectum have not been removed, a proctocolectomy will be performed.
• Part of your ileum will be removed and formed into a pouch. The pouch may be shaped like a J, W, or S.
• The pouch will be connected to your anus.
• If you are having a temporary ileostomy done, a stoma will be made in your abdomen, and part of your ileum will be connected to the stoma. This allows waste to pass through the stoma instead of the anus. This will be reversed after your ileal pouch heals.
• A small tube (catheter) may be inserted into one of your incisions to drain excess fluids from your surgical area.
• Your incisions will be closed with stitches (sutures) or staples.
• Bandages (dressings) may be put over your incisions.

What happens after the procedure?

• You may continue to receive fluids and medicines through an IV tube.
• You will have some pain. Medicine will be available to help you.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may not be able to drink fluids normally or eat solid food until at least 24 hours after your procedure. You may be given ice chips to suck on until you are able to drink fluids normally.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You may have a catheter draining fluids from your surgical area.
• You may have loose or watery stools. You may be given medicines to thicken your stools or reduce bowel activity.
• The frequency of your bowel movements will be recorded.
• Do not drive for 24 hours if you received a sedative.
• If you had a temporary ileostomy done:
  • Your waste will be collected in an external bag (ostomy pouch) that is connected to your temporary stoma.
  • You will be taught how to care for your stoma and ostomy pouch.
  • You may have liquid draining from your stoma and your anus.
  • Your stoma may be dark-colored, swollen, and bruised.

Care After Ileal Pouch Anal Anastomosis

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• A small amount of blood or clear fluid coming from your incision. If you had an ileostomy done, you may also have some blood or clear fluid coming from your incision or your stoma.
• Dark bruising and some swelling near your stoma, if you had an ileostomy done.
• Loose, watery stools for up to a week after your procedure.
• Moderate pain in your abdomen.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Incision care

• Keep your incision area clean and dry.
• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. If you had an ileostomy done, check your stoma, too. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions.
• Pay attention to which foods and drinks cause problems with digestion, such as gas, constipation, or diarrhea.
• Avoid spicy foods and caffeine while your ileal pouch heals.
• Eat meals and snacks at regular intervals.
• Drink enough fluid to keep your urine clear or pale yellow.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Rest as much as possible while your ileal pouch heals.
• Avoid intense physical activity for as long as told by your health care provider.
• Do not lift anything that is heavier than 10 lb (4.5 kg) for 6 weeks or for as long as told by your health care provider.
• Do Kegel exercises as told by your health care provider.

Driving

• Do not drive for 24 hours if you received a sedative.
• Do not drive or operate heavy machinery while taking prescription pain medicine.

If You Had an Ileostomy Done:

• Follow instructions from your health care provider about:
  • How to care for your stoma and your ostomy pouch.
  • How to shower and bathe with your stoma.
• Keep supplies to care for your stoma and ostomy pouch with you at all times.

General instructions

• Keep track of your bowel movements as told by your health care provider.
• Keep the skin around your anus clean and dry.
  • Wipe your anal area only with cotton balls that are moistened with warm water.
  • Wear cotton undergarments.
  • If you have fluid leaking from your anus, wear sanitary pads. Change pads frequently.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• (Women) If you plan to become pregnant or if you take birth control pills, discuss this with your health care provider. Menstrual cycles may be irregular for up to a year after surgery.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain around your incision, ileal pouch, stoma, or anus.
• You have more fluid or blood coming from your incision, ileal pouch, stoma, or anus.
• Your incision, ileal pouch, stoma, or anus feels warm to the touch.
• You have pus or a bad smell coming from your incision, ileal pouch, stoma, or anus.
• You have a fever or chills.
• You vomit.
• You feel nauseous.
• You had an ileostomy done, and you:
  • Have difficulty caring for your stoma or ostomy pouch.
  • Notice a sudden change in the size or color of your stoma.
• You have:
  • Pain, bloating, pressure, or cramping in your abdomen.
  • Loose stools that do not get firmer after several weeks.
  • Bowel movements more often or less often than your health care provider tells you to expect.
  • Frequent diarrhea.
• You experience sexual dysfunction.

Get help right away if:

• You feel dizzy or light-headed.
• You have abdominal pain that does not go away or becomes severe.
• You vomit more than one time.
• You had an ileostomy done, and you:
  • Have internal tissue coming out of your stoma (prolapse).
  • Have bleeding from your stoma that does not stop.
• You are not passing stool through your stoma or anus.
• You have an irregular heartbeat.
• You have chest pain.