Excessive Bowel Frequency in Patients with Established Pouches General Approach

Several large series have reported excellent long term functional outcomes of IPAA for UC; these have been summarized and reviewed (Dean and Dozois, 1997). Ten years after IPAA, incontinence had not occurred during the day in 73% of patients, nor at night in 48% (Meagher et al, 1998). However, many IPAA patients, at some time after construction of the pouch, experience increased bowel frequency, urgency or incontinence, all symptoms that may be presented as "diarrhea" (Table 90-2). Pouchitis is the most common, but not the only, cause of these symptoms. Disorders of the pouch other than pouchitis include disorders of pouch emptying, diseases in the prepouch ileum, and any of the causes of diarrhea that may occur in patients with an intact bowel. In the majority of cases, a correct diagnosis should provide a management strategy that brings about improvement. Ten years after IPAA surgery, pouch failure requiring pouch excision or permanent ileostomy occurs in less than 5% of patients.

TABLE 90-2. Approach to Patients After Ileal PouchAnal Anastomosis Who Complain of Excessive Bowel Movements 6 or More Months After Reanastomosis


Diagnostic Approaches


Normal pouch

Exclude pathology

Treat intercurrent diseases

Consider unrelated causes of



Fiber supplements,

Preexisting irritable bowel



Stool culture, microscopy

Endoscopy ± pouchogram

Defective anal

Physical examination

Fiber supplements,


Anal manometry



Pouch outlet

Physical examination




Pouchoscopy and biopsy

Mesalamine, steroids


Pouchoscopy and biopsy

Antibiotics, mesalamine

Crohn's disease

Pouchoscopy and biopsy

Antibiotics, azathioprine,



Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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