The recent thread on whether or not pouch folks have their rectums or not has become even more baffling...I was wondering if someone out there might to be able to explain what would the criteria be to keeping the rectum.
Is it the rectum that would normally hold the stool??
Julie

The jpouch replaces the rectum. We all have varying lengths of rectal tissue left but none of us have a rectum. You might still have your rectum because you did not have UC. It's very possible that you don't have a jpouch at all; you might have a straight connection from the small intestine to the rectum.

Sue

The Large Intestine has several sections. The Ascending, Descending, Traverse, and lastly the rectum (sigmoid). So for those of us who have had a total colectomy, we have no rectum.

However, what is left behind is the sphincter muscle, and glands at the anus. This allows the "pull through" portion of ileal anal pouch.

Hope that helps clarify a bit.

Julie - I think this has been mentioned numerous times. Perhaps you could contact the surgeon who performed your surgery and ask him/her what procedure was done. Or you could get your medical records from him/her.

kathy

The amount of disease in the rectum (UC or polyps) determines whether they leave it in or take it out. They say that people who retain their rectum are able to differentiate between stool and gas and have better function than those with the jpouch.

OK, here is my take on the question.

The rectum is removed only if you have UC, rectal cancer, or FAP. If you have other diagnoses, then it depends on whether the rectum is involved or not. If you retain your rectum, then a j-pouch is not necessary, since it is supposed to replace the function of the rectum.

A total colectomy does NOT include removal of the rectum, but does include removal of the entire colon- cecum, ascending, transverse, descending and sigmoid colon segments. In this case, the ileum is attached to the rectum without a pouch (ileorectal anastomosis).

A total proctocolectomy includes removal of the entire colon and rectum. There usually is a very small rim of rectal tissue left behind to attach an ileal j-pouch. In some cases this is not wise or possible, and there is no rim of rectal tissue left. In those cases, the risk of incontinence is higher, since the nerves that serve the function of incontinence are at the junction of the anus and rectum (dentate line).

If you only have your rectum removed due to low rectal cancer or damage to the rectum only, this is a proctectomy. In that case you have a coloanal j-pouch.

What was once known as the pull-through procedure, is seldom, if ever, done anymore, and was a very early technique done decades ago. But, some people still call the modern procedure a pull-through. This was where the rectum is left intact, but the mucosal layer is stripped. Then, the ileum is pulled through the retained and stripped rectum, and attached to the anus. This is not done anymore because it was found that the muscles of the rectum were not necessary and if any mucosa grew back, it could not be monitored for dysplasia or cancer.

As you can see, there can be many variations of colecctomy and anastomosis (connection).

So, Julie, in your case, I really am not sure what was done, since your colectomy was due to bowel death from lack of blood supply. It is possible that you had only your rectum and part of your colon removed or kept your rectum and had the colon removed. You really would need to get the info from your doctor or medical records, and it is sort of important to know what, if any, portion of your colon and/or rectum remains.

Jan

THANK YOU JAN!!!!
This is the first time someone has taken the time to list the various procedures and the reasons for them. Your explantation has helped me tremendously.
It's hard to understand all of this when questions are asked and seperate answers are given for each specific case. That is the reason, I feel, that the question has come up more than once.
Julie

Have you contacted your surgeon to find out exactly which procedure you had done? What did s/he say?

kathy

I didn't need to contact them since, with Jan's explanation, I was able to figure it out on my own. As it turns out I did have the ileorectal- anastomosis. My main confusion was between the straight pull through vs the ileorectal since both kinds made sense in my case.
Thanks for asking Kathy. It's nice to know some people still care..
Julie

Jan

That's brilliant thanks.

would you mind explaining something further to me.

I had A total colectomy. UC. I know I don't have a rectum.

But I am confused to the many terms people use for the colon, large bowel, small bowel.

Do I have a small bowel?
It is my understanding that I have no bowel what-so-ever but people are confusing me to the point where I not so sure anymore

JMT- If you had your entire colon and rectum removed, it is a total proctocolectomy (procto for rectum, col- for colon, ectomy- removal of). Even if you are told it was a total colectomy, that is incorrect if the rectum was removed too.

Jan

I think it was. I was always under the impression that the J-pouch replaced the rectum. Since I had UC I assumed this would be my case.

Even if I had a total colectomy that removes the small bowel also doesn't it?

My consultant has retired and I not liking the new guy so far, Maybe I will discuss with my wonderful GP instead. I am sure she knows.

No, the small bowel is the small intestine. You still have all of it with the exception of the 9" or so that your surgeon used to make your jpouch. Large bowel =colon, small bowel= small intestine.

Sue

You may just want to ask for a copy of your operative report. That way you will know for sure exactly was was done, regardless of what you have been told it was called.

But, yes, a j-pouch replaces the rectum.

Jan

Well that's a brilliant idea!
Y didn't I think of it - Dugh

Thanks