What is "Irritable Pouch Syndrome"?
While ileal pouch-anal anastomosis surgery after colectomy provides individuals with a way to maintain continuity of the GI tract for defecation, pouches are not without problems. In a previous blog, the issue of pouchitis, or inflammation of the pouch was discussed. Another pouch problem encountered by some individuals is a recently recognized condition called "irritable pouch syndrome" or IPS for short.
IPS is a condition of the pouch that is akin to irritable bowel syndrome (IBS) of the intestine. Symptoms of IPS are similar to pouchitis and include: change in stool consistency, abdominal pain or cramping, and perianal or pelvic discomfort. A diagnosis of IPS is considered when pouch patients with such symptoms are found to have normal intestinal lining on endoscopic exam but remain symptomatic. As opposed to pouchitis which is due to inflammation of the pouch, IPS is believed to be secondary to changes in nerve sensation to the pouch after surgery.
Symptoms may be relieved by dietary changes, such as low fat and low carbohydrate diets. Avoidance of diary products or excessive caffeine and alcohol may also be of benefit. Treatment with antidiarrheals (diphenoxylate, loperamide, cholestyramine), anti-spasm medication (dicyclomine, hyoscyamine), or medication for chronic abdominal pain (amitriptyline) may help alleviate symptoms that do not respond to dietary changes.