Dietary Guidelines | The J-Pouch Group (2023)

Dietary Guidelines for Ileoanal Pouch surgery (Main article)

Dietary Modifications after the first surgery

Dietary Suggestions after second surgery

Foods and Beverages that may cause loose stools

Foods that may cause gas and odor

Foods that may increase output

Foods which may decrease output

Foods which may contribute to anal irritation


(Video) Food Groups And Nutrition


By Linda B. Hurd, RN, MSN and Maryann King, RD

Good nutrition plays an essential role in gaining and maintaining health and vitality. Patients and family members generally have many questions about diet and nutrition following ileoanal surgery. Below are listed guidelines that can assist you in maintaining good nutrition and enable your body to adapt as easily as possible to it's new anatomy and digestive system.
Please keep in mind that each individual responds to surgery and the recovery process differently and therefore will need to find a diet approach that works best for them. For example, a food that causes a problem to one person may not cause a problem for another. There is quite a bit of trial and error that takes place during these months. Try to be patient and assure yourselves that eventually you will find a diet that works for you!
Below are listed some general dietary tips for ileostomy/ ileoanal pouch patients:
1) Eat a balanced diet. (i.e. sensible flood choices from all food groups, break (starches), fruits, vegetables, and proteins)
2) Eat slowly and chew your food well.
3) Drink plenty of fluids each day. (i.e. more than 8 cups of fluid per day)
4) Add foods to your diet gradually to see how your body responds.
5) *Watch food that are high in fiber, sometimes these foods can cause blockages.
6) *Avoid nuts seeds and corn.
*(These items pertain to patients with an ileostomy and to patients during the several months following ileostomy closure.

(with a temporary ileostomy)

Ileoanal surgery is generally performed in two stages. The following will outline dietary considerations for each of these stages.

During your first surgery your colon (large intestine) is removed.One of the primaryroles of the colon is to absorb fluids. With the large intestine gone, larger quantitiesof fluid are lost with the stool from your ileostomy. Your body will adjust to the absenceof the large intestine as your small intestine learns to absorb more fluids. In themeantime, you will need to increase your fluid intake to make up for the fluid loss andavoid becoming dehydrated.

The initial post-operative diet will be clear liquids and gradually advanced to a lowresidue diet. Many patients can eventually tolerate a normal diet; however, someadjustments may be required to prevent obstruction, watery ostomy output, excessive odorand gas. The advantage of this stage for many patients, particularly for those who havebeen very ill or on a very restricted diet prior to surgery, is that once again they canenjoy eating and include foods they have missed for a long time!

Again, because of the large amounts of fluids that are lost through the ostomy,particularly during those early weeks following surgery, patients need to be aware of thesymptoms of dehydration. Symptoms to watch for are:

  • Extreme thirst
  • Dry mouth and dry skin
  • Shortness of breath
  • Decreased urine output or urine that is dark in color
  • Nausea or abdominal cramping
  • AchinessIf you feel you are dehydrated, notify your doctor immediately.

Tips to prevent hydration:

  • Drink at least 6 to 8 glasses of fluids a day. Drink a combination of water and beverages which contain sodium and potassium including Gatorade, Pedialyte or other drinks that contain electrolytes.
  • In warm weather and during exercise, drink extra fluids.
  • Add a beverage to each meal. This allows food to pass through the intestine more easily and can prevent obstruction.
  • Drink caffeine containing beverages in moderation- excessive caffeine can have a "diuretic effect" and cause dehydration.
    Include foods that are high in sodium and potassium.
    (i.e. Sodium: broths/bouillon, soups, crackers, pretzels, salted spices, bacon, ham, tomato and vegetable juice, buttermilk, soy sauce)
    (i.e. Potassium: bananas, orange juice, apricot juices, tomato juice, grapefruit juice, squash, potatoes, tomato sauce, peanut butter (smooth)
    Several weeks after surgery, your physician may indicate that you may eat what-ever you can tolerate. Remember...

1) Add new foods one at a time: by this we mean try only one new food at a time. Thisway if a problem is identified, you can eliminate this food from your diet for the timebeing. This doesn't mean that you won't be able to eat this food eventually only that youshould wait awhile before trying that food again.

Chew foods very well:
The following are lists of foods to be considered when preparing diets for anileoanal/ileostomy patient.

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To prevent obstruction:
Approach the following foods with caution:
  • corn on the cob
  • lettuce
  • bean sprouts
  • peas
  • citrus fruit membranes
  • nuts, coconuts, peanuts
  • tough meats, shrimp, lobster
  • fruits with seeds
  • raw fruits
  • celery
  • coleslaw
  • bamboo shoots
  • tomatoes
  • pineapples
  • mushrooms

Foods and beverages that may cause loose stools:
Approach with caution potential problem foods including:

  • apple juice
  • prune juice
  • baked beans
  • green beans
  • spinach
  • highly spiced foods
  • beer
  • milk
  • cabbage
  • raw fruit
  • broccoli

Foods that may cause gas and odor:
These should be tried again at intervals:

  • asparagus
  • dried beans and peas
  • mustard
  • cabbage family
  • onions
  • carbonated beverages
  • eggs
  • radishes
  • pickles
  • beer
  • fish
  • cucumbers
  • strong flavored cheeses
  • melons
  • spiced foods
  • fatty foods (pastries/deep fried foods)
  • whips and meringues

Other general guidelines: avoid chewing gum,
Do not use a straw, Chew with mouth closed,
Eat regular times; Add cranberry juice, yogurt, and buttermilk.


  • When a food causes a problem, it should be eliminated temporarily, and then tried again at a later date. There is some adaptation in time.
  • Boiled milk, rice, creamy peanut butter, and potatoes may be used as "binding" foods
    in some patients
  • Some foods that can help thicken your stools are: applesauce, bananas, buttermilk, cheese, marshmallows, pretzels, toast, yogurt, and tapioca pudding.
  • The goal of your diet should he to maintain a well balanced diet and make food choices from all the food groups.


For the months following surgery (up to one year) the pouch will go through a period of adaptation. The pouch storage capacity will increase and the number of bowel movements per day will decrease. Stool consistency thickens over time. Diet and medication can help to improve pouch function. You may find that by altering your diet a bit it can help to slow down bowel function and prevent perianal irritation.


1 ) Follow the same diet you were on previously to slow down the digestive process and
allow the pouch to enlarge; this will decrease the number of bowel movement.

2 ) When adding new foods to your diet, you may want to refer to potential problem list and initiate slowly. If a particular food is not tolerated, try it again at a later time.

3 ) Continue to drink six to eight glasses of fluid each day.

4 ) High potassium foods will be needed in the presence of diarrhea.

5 ) Limit the intake of foods high in simple sugars since these can aggravate diarrhea.

6 ) Eat regularly, don't skip meals. Remember, increase gas is produced when bowels are empty.

7 ) Eat small frequent meals.

8 ) Sometimes eating rice, potatoes, or pasta once per day may help reduce stool frequency and perianal irritation.


The following foods can affect ileoanal pouch functioning:

• raw fruits and vegetables (especially broccoli, beans and spinach)

• leafy green vegetables

• spicy foods

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• beer

• alcohol

• caffeine containing beverages

• chocolate


• applesauce

• bananas

• boiled rice, pasta

• cheese

• creamy peanut butter

• tapioca pudding

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• potatoes (without skins)


• certain raw fruits and vegetables (e.g., oranges, apples, coleslaw, celery and corn)

• popcorn

• Chinese/oriental vegetables

• nuts

• coconut

• dried fruits (e.g. raisins, figs)

• food with seeds

• spicy foods

Once again you will find that diet and food tolerances are very individual. The lists above are not meant to make your diet selections a chore, rather to assist you in modifying your selections should you encounter some difficulties. Patience is a virtue during the early weeks following your second surgery. Keep in mind though that you are well on your way to good nutrition and healthy lifestyle.

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1.) Hurd, Linda. Presenting a patients guide to ileoanal reservoir procedure. Ostomy/
Wound Management 1992; 38(5)2-60.

2.) Providence Medical Center Nutrition Services. Nutrition and Dietary Guidelines for use with the ileoanal reservoir (booklet). Sisters of Providence Health System.

3.) Zeman, Francis. Clinical Nutrition an Dietetics. 2nd Edition. NY: Macmillan. 1991; 272-274.

4.) Rolstad, Bonnie Sue and Rothenberger, David. Ileoanal reservoir: a patient resource Minneapolis: The Upjohn Company.

5.) Chapman, Georgina. A patient handbook for the ileoanal reservoir procedure. Calgary
District Hospital Group. Montreal: Convatec.


Dietary Guidelines | The J-Pouch Group? ›

Limit or avoid broccoli, cabbage, baked beans, hot peppers, fatty foods, fried foods, prune juice and dairy. Enjoy foods that can help. You can enjoy lots of foods, especially hard-boiled eggs, applesauce, oatmeal, creamy peanut butter, bananas, plain pasta, yogurt, white rice, toast, and white rice.

What not to eat with a J-pouch? ›

During the first few weeks post-surgery (and, in some cases, permanently) pouchees should avoid nuts, seeds, peas, raw vegetables, mushrooms, sweetcorn, celery, dried fruit and coconut. In time you may be able to reintroduce some of these foods in small amounts.

How do you take care of a J-pouch? ›

For about four to six weeks after J-pouch surgery, avoid lifting and strenuous activities. After that, most any activity you choose will speed the healing process. The level and type of exercise you choose may depend on the exercises you were comfortable with before surgery.

What are the long term complications of J-pouch? ›

Pouchitis is the most common long-term complication of patients with a J-pouch. Clinical manifestations include abdominal cramping, increased stool frequency, urgency, incontinence, nocturnal seepage, pelvic discomfort, and arthralgia.

What is the quality of life after J-pouch surgery? ›

“I know it sounds intense, but when I heard about how it might help me, I was like, 'Where do I sign up? '” says Richman. According to one study, 80 percent of patients said their quality of life five years after j-pouch surgery was much better, and 96 percent said they were satisfied overall with the results.

What is life expectancy with J-pouch? ›

Whether these outcomes remain durable is unknown. Furthermore, follow-up in IPAA patients must still be considered short term, as most of the patients undergoing pouch surgery are young and have life expectancies of another 40 to 50 years.

What foods are good for pouchitis? ›

STARCHY FOODS- energy, vitamins and fibre. Examples include: □ bread, chapattis □ breakfast cereals, oats □ pasta □ rice □ potatoes, sweet potatoes □ plantains, green bananas, yam □ dishes made with maize, millet and corn meal. These foods are reported to help thicken your output.

How do you stay hydrated with J-pouch? ›

Fluids are important to prevent dehydration. Drink enough fluid so your urine is light yellow in color. Avoid fruit juices, carbonated beverages, drinks with caffeine and straws (swallowed air increases gas).

What are the symptoms of J-pouch failure? ›

Patients may present with a sense of obstructed defecation, seepage, pain, or overt external prolapse of tissue. If suspected, examination of the perineum during straining and defecation may identify the problem. Mucosal prolapse may be treated by stool bulking or a local mucosal excision.

How much water should I drink with J-pouch? ›

How much fluid do I need? (2.8-3.6L) fluid a day!

Can you poop normally with J-pouch? ›

Successful J-pouch surgery eliminates the pain and suffering caused by diseases such as colitis and familial adenomatous polyposis. It also allows people who have had the surgery to pass stools normally and not have to rely on an ostomy.

Is J-pouch a major surgery? ›

The pouch is then pulled through the pelvis and sewn to the anal sphincter. That is why it is commonly referred to as the “pullthrough” procedure. The IPAA is a major operation. It may be performed in one, two, or three stages.

Why do I keep getting pouchitis? ›

The cause of pouchitis is not known. Several theories have been suggested, including: an excess of bacteria in the pouch; a recurrence of inflammatory bowel disease in the pouch and misdiagnosis of ulcerative colitis. In a minority of patients, it may be difficult to differentiate between Crohn's disease and Colitis.

How many times do you go to bathroom with J-pouch? ›

J-pouch patients reported a median of 8 bowel movements in 24 hours (IQR 6–10). Approximately 90.4% of patients state that they are sometimes, rarely, or never able to wait 15 minutes to get to the toilet (Figure 1).

What is the survival rate of J-pouch surgery? ›

An effective treatment, j-pouch has a success rate of 90%. In this specialized procedure, surgeons completely remove the colon and rectum.

What is the best hospital for J-pouch surgery? ›

Cleveland Clinic's Digestive Disease & Surgery Institute has performed more operations for Crohn's disease as well as J-Pouch procedures than any other institution. Cleveland Clinic is ranked as one of the nation's top hospitals by U.S. News & World Report.

Can you get a hernia with J-pouch? ›

As such, patients undergoing J-pouch construction are at risk for hernia development and complications of the subsequent repair.

Can you drink alcohol with AJ pouch? ›

As it turns out, yes, you can drink alcohol with nicotine pouches.

What foods help inflamed stomach lining? ›

Foods containing flavonoids like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may stop the growth of H. pylori. Avoid high-fat foods. In animal studies, high-fat foods increase inflammation in the stomach lining.

What foods heal intestinal inflammation? ›

Suggestions for first foods after a flare include:
  • Diluted juices.
  • Applesauce.
  • Canned fruit.
  • Oatmeal.
  • Plain chicken, turkey or fish.
  • Cooked eggs or egg substitutes.
  • Mashed potatoes, rice or noodles.
  • Bread – sourdough or white.

What is the best electrolyte drink for colitis? ›

Gatorade, Pedialyte, and even coconut water are all good options for rehydrating and replenishing electrolytes at home, Dr. Hong says. Finding what you like and don't mind slugging back when needed is your best bet.

How do you prevent pouchitis? ›

PRIMARY PREVENTION — For primary prevention of pouchitis and to promote optimal pouch function, patients with an ileal pouch are advised to: Avoid nonsteroidal antiinflammatory drugs (NSAIDs) because NSAIDs are associated with an increased risk for chronic pouchitis [10].

Why does my J-pouch burn my stool? ›

You'll Experience Butt Burn

Speaking of going to the bathroom a lot, you may experience what is known as “butt burn.” This is because, on top of going to the bathroom more often, without a large intestine your stool will be much more acidic from digestive enzymes.

What are the secondary causes of pouchitis? ›

Secondary causes may include inflammatory pouch disorders (eg, CD, cuffitis, pouch anastomotic sinus, pouch fistula), infection with specific pathogens (eg, cytomegalovirus, Clostridioides difficile); vascular or mechanical factors (such as ischaemia, prolapse and pouch obstruction), nonsteroidal anti-inflammatory drug ...

Can you control bowel movements with AJ pouch? ›

The muscular J-pouch can not only store stool until it is time for a bowel movement, but you will have some or total control over the timing of the bowel movement. The rectum is removed during the J-pouch procedure, but in many ways, the J-pouch is a surgically created rectum.

Why does my J-pouch leak at night? ›

A little leakage is a common side effect of J-pouch surgery, but it's usually temporary, says Dr. Kinzinger. It tends to be worse at night when the muscles around the opening of the anus (sphincters) are most relaxed, so you might want to pop a pad in your underwear at bedtime, or consider sleeping on a small towel.

How do you treat pouchitis at home? ›

A low-carbohydrate and/or low-fiber and high protein diet may help relieve symptoms of chronic pouchitis, or the patient may require therapy with anti-inflammatory agents or even biological agents. Antidiarrheal agents may be used to treat frequent or loose bowel movements.

How big is a J-pouch? ›

A J-pouch is made by using two loops of small intestine, each measuring about 8 inches long (20 cm each). The pouch is connected to the top of the anus to allow for elimination of waste matter. After the pouch is constructed, it holds the stool, which is not solid, until the patient is ready to use the bathroom.

What is the best probiotic for pouchitis? ›

In addition, a double-blind, placebo-controlled trial has shown that the probiotic VSL#3 (VSL Pharmaceuticals, Inc., Ft. Lauderdale, FL) is successful in maintaining remission in patients with chronic, recurrent pouchitis.

Does probiotics help with pouchitis? ›

In refractory pouchitis, patients should be treated with other antibiotics or prolonged combined antibiotic treatment. Again, in case of response, maintenance probiotic treatment after stopping of antimicrobial agents is suggested.

How long does pouchitis last? ›

Defined as clinical symptoms that last longer than four weeks, chronic pouchitis is categorized as antibiotic dependent or antibiotic refractory. Patients with chronic antibiotic dependent pouchitis respond well to antibiotics, but experience greater than three relapses per year when antibiotics are withdrawn.

What is the 2nd step of J-pouch surgery? ›

The second part of the procedure occurs about 3-4 months later depending on the patient's performance status. This step involves removal of the rectum, creation of the J-pouch from the terminal ileum (about 20 cm) and temporary loop ileostomy to divert the fecal stream proximal to the J-pouch (Figure 2).

Why is it called J-pouch? ›

The name comes from the fact that the pouch is created by taking the small intestine (the ileum), folding it back on itself in the shape of a letter J, and then using surgical stapling to create a small reservoir that functions like a new rectum.

How do I know if my J-pouch is failing? ›

Patients may present with a sense of obstructed defecation, seepage, pain, or overt external prolapse of tissue. If suspected, examination of the perineum during straining and defecation may identify the problem. Mucosal prolapse may be treated by stool bulking or a local mucosal excision.

What are the symptoms of a partial blockage in the J-pouch? ›

A partial blockage usually displays itself through cramping abdominal pain, watery output with a foul odour, and possible abdominal distension and swelling of the stoma followed by nausea and vomiting.

What percentage of J pouches fail? ›

The long-term failure rate for RPC is reported to be 10–15% [2,3,4]. The most common causes of pouch failure have been pelvic sepsis, poor pouch function, pouchitis and Crohn's disease [4,5,6]. The factors leading to pouch excision are still poorly understood.

What triggers pouchitis? ›

What causes pouchitis? The cause of pouchitis is not entirely clear, but it almost always occurs in patients with ulcerative colitis or another form of colitis, and sometimes in those with familial adenomatous polyposis (FAP), a genetic (inherited) condition in which many polyps form in the colon.

What is the failure rate of J-pouch? ›

Incidentally, all 663 patients had mucosal proctectomy with a hand-sewn ileoanal J-pouch-anal anastomosis. The Cleveland Clinic series presented today suggested an overall failure rate over this 20-year period of about 4%, although they stratified the failures by time during the overall study period.

Will a partial blockage go away on its own? ›

Most partial blockages get better on their own. Your doctor may give you a special diet that's easier on your intestines. Enemas of air or fluid can help clear blockages by raising the pressure inside your bowels.

Can you swim with J-pouch? ›

You can swim or be in the water while wearing your pouching system. Remember, your pouching system is water-resistant and is designed not to leak with the proper seal. Water will not harm or enter your stoma.

Are probiotics good for AJ pouch? ›

Pouchitis is usually treated with a 7 to 14-day course of antibiotics. Your healthcare provider may also recommend probiotics (“good” bacteria that normally live in the digestive tract) such as Lactobacillus, Bifidobacterium and Thermophilus, and medicine to manage diarrhea.

What are symptoms of pouchitis? ›

Signs and symptoms of pouchitis can include diarrhea, abdominal pain, joint pain, cramps and fever. Other signs and symptoms include an increased number of bowel movements, nighttime stool leakage, difficulty controlling bowel movements and a strong urge to have a bowel movement.


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