Pouches and stomas

Patients may need an ileal pouch or permanent ileostomy if they require proctocolectomy for inflammatory bowel disease or, occasionally, for familial colorectal cancer. An ileal pouch is constructed from the terminal ileum and anastomosed to the top of the anus. This allows evacuation per anus and is generally preferred to an end ileostomy. In contrast to colitis, patients do not have urgency and so are not inconvenienced by the frequency. Some are troubled by pouch dysfunction, most commonly a condition called pouchitis. However, it usually settles quickly with antibiotics. The need for ileostomy or colostomy may be permanent or temporary. Patients with a low rectal cancer where the anus is removed will have a permanent end colostomy. Colostomies are generally easier to manage than ileostomies. Either way, quality of life with a stoma matches that of the general population. The expertise of a specialist stomal therapy nurse is key to the management of these patients.