I had my j-pouch made in 1987. Over the next 3.5 years I had constant battles with pouchitis and rectal abscesses so I gave up. Had a total of 14 surgeries, which includes the two step j-pouch surgery. Seemed like every time I had problems I had to have a temp ileostomy made to allow things to heal, then the takedown. After the takedown I'd go months without any problems but then they'd start all over again. Final straw was when after my third attempt (had two prior j-pouches removed and started from scratch) all the problems came back within one month.
The reason we kept trying is that the problems could have been caused by the disease still being in the stump of rectum that was left behind. Well, 23 years later after having a permanent ileostomy made, I get diagnosed with Crohns disease just inside my stoma. So, I was one of those people (a very small percentage of us) that were originally diagnosed with UC but actually had Crohns Colitis. The unfortunate side is that if Crohns Colitis had been diagnosed originally (which can be impossible to do, as I and others are living examples of) then I would have gone straight to the ileostomy back then- surgeons, especially back then, would not have made a j-pouch when it's Crohns).
That's the tricky part- finding out why you have problems. I gave up after giving it more than f air shot and am very glad I did. I had over 25 years of remission with no meds until the Crohns diagnosis last year. But I also have a friend who had the same diagnosis issues as me, yet she is able to keep her j-pouch for now. She had lots of problems early, but not pouchitis or other issues like fistuals which can be due to the disease. Her problems were all fixed, but she spent MONTHS in the hospital getting to that point. Her remicade keeps the disease in check for now which is why she can keep her pouch.
Once I had my permanent ileostomy made it was amazing how quickly my body recovered. Kind of the same feeling when you get four new tires on your car at the same time. Talking with your surgeon and doctor about when to consider giving up on the j-pouch I always encourage people to ask earlier rather than later. Not to jinx anyone, but there are some doctors out there who will not recommend an ileostomy unless you ask for one, and I don't think that's a great approach. You never really know what can happen but not all problems mean you need to give up on the pouch. That's why I think it's important to have that discussion with a doctor early.