The ileal pouch anal anastamosis (IPAA) is usually a two-stage procedure. During the first surgery, the entire colon is removed. The pouch is created by sewing together pieces of small intestine and then attaching that new pouch to the rectum. A temporary loop ileostomy is created to allow time for the pouch to heal. After about three months, you will have a scanning test (pouch-o-gram) to verify that the pouch has healed and you are ready for the second procedure. During the second surgery, the loop ileostomy is taken down.
Recovery from the first surgery is the same as for the ileostomy procedure. After the ileostomy is taken down (the second procedure), you may have 8 to 15 stools per day at first. Your doctor will prescribe medication like Imodium or Lomotil to help decrease this frequency. Gradually the number of stools will improve to 6 to 8 stools per day and you will reduce the need for antidiarrheal medication. It’s advisable to try to resist the urge to go to help expand the capacity of the pouch. Be careful to protect the skin around your anus with some ointment because it is likely to become irritated. It is also not unusual to have some issues with continence at first; this will improve too.
There really aren’t limitations on your diet after the second surgery, but it’s a good idea to include foods that will thicken stool and decrease the number of stools.
No pouch is needed after the second surgery.