12 cm of rectum....do I need a Jpouch or not?

The average length of the human rectum is about 10-12 cm. The point of a j-pouch is to replace the rectum if it is removed. Most of us have had our rectum removed due to IBD or cancer (or related disease). If you are lucky enough to not require removal of your rectum, there would be no need of the j-pouch.

What you would be having is an ileorectal anastomosis, and is what is appropriate in your situation. There is no reason to undergo the additional surgery and face the significant increased risks.

Yes, 6-8 bowel movements per day will be an adjustment after living with chronic constipation, but it should be a welcome relief. There should not be an issue with continence. Also, understand that initially, you will have a higher frequency, but things will slow in the first 3-12 months.

Jan

Hi Rob!

I intially just had an ileorectal anastomosis after having my colon removed (6 years ago). I might have been a rare case, because they thought I wouldn't need a J-Pouch. But I was going to the bathroom about 15 or more times a day (after trying multiple meds) so my GI doc and colorectal surgeon suggested I get a J-pouch (that surgery was 3 years ago and they kept my rectum). After that surgery I went down to 6-8 times per day. I only bring it up because my original colorectal surgeon thought that with the ileorectal anastomosis I would be going 6-8 times per day (as yours suggested). But every person's body is different.

Good luck!

I think the difference is that Robert does not have IBD, so rectal disease was not the issue. His reason for colectomy was chronic constipation. That was why I thought retaining the rectum made sense. They don't make a j-pouch in addition to a retained rectum.

Jan

Rob, it's a tough question.
I think you should focus to your general health (are you feel weak, tired, anemic, low-iron levels,) and more important your urgency issues, there are people who find difficult to go out from home because of urgency and fearing not to find a bathroom which will also make them costantly over-anxious.

Ileo-rectal anastomosis is advised when you had colonic crohn's as keeping the rectum is much more critical for you to avoid in your whole life an ostomy (ostomy is mandatory if you don't have a working rectum, or a j-pouch), because if you have crohn's and you take a j-pouch, they say that crohn's will, before or after, attack your j-pouch, and you will be at more risk of ostomy.
that said, there's at least a paper in which a french equipe say that in selected crohn's cases, "uc-like" cases when ileum is not diseased and when there is only inflammation, not fistula, or abscesses, j-pouch procedure give good results.
my doctors had some doubt on my diagnosis, so I was in doubt for long whether having IRA or IPAA, but my gastroenterologist said it would have been both good, as the rectum is "easier" to manage using local drugs (included steroids);
in the end I had IPAA, and although I'm experiencing some pouchitis-like relapse (2 in a year at the moment) I have to say that I feel more normal than in 13 years of ulcerative colitis, really really well indeed.

EDIT: only after posting I read Jan post, I'll leave this info as I researched extensively before my surgery and could be helpful for someone.