J-Pouch Diet After Surgery: Tips and More

Ileal pouch-anal anastomosis (IPAA) surgery is also known as J-pouch surgery. People with ulcerative colitis (UC) may have this surgery when medications haven’t helped manage the condition.

J-pouch surgery typically involves two or three separate surgeries.

In the first part of this procedure, a surgeon will remove your colon, also known as the large intestine, and your rectum.

Then, to create a new rectum, the surgeon will form the lower part of the small intestine into a J-shape and reattach it to the rectum. This allows stool to pass through the anus as usual.

The term “J-pouch” comes from the shape of the new rectum. UC affects only the colon and rectum. That’s why removal of these body parts is considered to be a cure for UC.

Over time, many people with a J-pouch can eat a fairly standard diet. However, you may find that certain foods still cause some digestive symptoms.

As you heal after surgery, you should be able to gradually increase the texture and variety of foods in your diet.

Read on for more information on eating after J-pouch surgery.

Your diet right after J-pouch surgery

Your digestive system will need to rest after surgery. At first, you’ll only be able to have fluids. Then, you’ll gradually introduce more solids into your diet as your body is able to tolerate them.

What’s safe to eat or drink

After surgery, you’ll start with a clear fluids diet. This allows your body to get some nutrients, while letting your digestive system rest and heal.

A clear fluids diet includes:

  • gelatin
  • sports drinks
  • clear juices, without pulp
    • tea
  • broth
  • popsicles

After a few days, many people can transition to a full fluids diet. This includes everything that is part of a clear fluids diet, plus:

    milk
  • yogurt
  • nutritional supplement drinks
  • puddings
  • fully pureed soups

A full fluids diet provides a bit more variety and texture. But it’s still easy for your digestive system to handle.

Once you can tolerate a full fluids diet, you’ll transition to a low fiber diet. This is also known as a low residue diet.

This adds more solid foods into your diet without adding bulk. It includes a variety of foods that your body can still digest easily.

A low fiber, or low residue, diet includes the foods and drinks in a full fluids diet, plus:

  • well-cooked vegetables without any skin or seeds
  • soft fruit without skin or seeds
  • soft starchy foods like white bread, white rice, and white pasta
  • soft and well-cooked meats, poultry, and fish
    • milk, cheese, and yogurt as well as non- dairy alternatives
  • smooth nut butters
    • eggs
Foods to avoid

Your digestive system needs time to heal and adjust to life without a colon. During this time, some foods can cause irritation or other digestive symptoms.

Anything high in fiber should be avoided for the 1 or 2 months following surgery. High fiber foods create more work for your digestive system.

Foods that are high in fiber — and harder to digest — include:

  • whole grains and bran
  • the skin or seeds of fruits and vegetables
  • raw vegetables or tough fruits
  • nuts and seeds
  • beans and lentils

Some people also find that spicy foods or those high in fat irritate their digestive system. Caffeine and alcohol can also cause irritation.

What to eat

In the weeks and months after surgery, your J-pouch will stretch. This allows it to hold more stool, reducing the frequency of your bowel movements. Your stool will also become firmer over time.

After the J-pouch has healed, many people find they’re able to eat a variety of foods, including:

  • fruits and vegetables (though cooked vegetables may be more easily tolerated than raw)
  • both refined and whole grain products
  • milk, cheese, and yogurt as well as non-dairy alternatives
  • meats, poultry, and fish
  • meat alternatives, including soy
  • eggs, nut butters, and beans

Learn more

Getting enough fluid is important so you can stay hydrated. You may find you tolerate fluids better between meals. When you drink fluids with meals, it can speed up digestion and cause loose stools.

If you have ongoing diarrhea, eating more of these foods can help firm up your stools and reduce frequency:

  • cheese and plain yogurt
  • oatmeal
  • white starchy foods, such as white bread, white rice, potatoes, pretzels, and crackers
  • bananas and applesauce
  • peanut butter or other smooth nut butters

The ultimate goal is for you to be able to eat a variety of foods, though there may still be some foods your digestive system can’t tolerate well.

If you still have digestive symptoms, it could be helpful to keep a food and symptom journal. You may find some patterns.

It’s also a good idea to introduce new foods gradually and monitor for any symptoms or side effects.

If your symptoms don’t improve after making adjustments or if they’re impacting your quality of life or causing serious discomfort, you should talk with a healthcare professional.

What to avoid if you still have symptoms

There’s no one single diet that works for everyone with a J-pouch. Making dietary changes can be helpful if you’re having any ongoing symptoms.

For example, dietary changes can help if you are experiencing excess gas, diarrhea, or anal irritation.

Keep in mind that it may take a while to figure out what works best for you. However, if after making some changes, your symptoms don’t improve or seem to get worse, you should talk with your doctor.

Foods more likely to cause gas

Some foods can cause excess gas, which may lead to bloating and discomfort. Here are some foods to avoid if you have a lot of gas:

  • carbonated drinks
  • milk and milk products
  • broccoli, Brussels sprouts, cauliflower, and cabbage (even when cooked)
  • beans and lentils
  • onions (raw or cooked)

A low FODMAP diet may also be helpful with gas and bloating symptoms. FODMAP is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

This diet cuts back on a group of sugars that may be poorly absorbed by your gastrointestinal (GI) tract. According to the Crohn’s & Colitis Foundation, it can help improve symptoms. However, research doesn’t support its use for reducing inflammation.

Foods that may cause diarrhea

Diarrhea occurs when food moves through your digestive system too quickly. The colon is responsible for reabsorbing extra water from stool. And when you don’t have a large colon, stool tends to be looser.

Diarrhea, which is when stools are very watery and frequent, can also lead to dehydration. This can be dangerous, particularly for a person recovering from surgery and unable to eat a full diet.

The following foods are more likely to cause diarrhea:

  • high fat or fried foods
  • spicy foods
  • high sugar foods and drinks, especially sodas or juices
  • foods and drinks with caffeine, including coffee, teas, chocolate, or energy drinks
  • alcohol
Foods that can cause anal irritation

Learn more

Anal irritation can occur in people with a J-pouch. The following foods are more likely to cause anal irritation:

  • spicy foods
  • certain raw fruits and vegetables, including oranges, apples, coleslaw, celery, and corn
  • tough foods, such as whole grains, the skin of fruits and vegetables, popcorn, dried fruit, nuts, and seeds
  • coffee or tea

Determining the best diet with a J-pouch

It can take up to 1 year after J-pouch surgery for your digestive system to heal. This means there will be some trial and error during that first year. Many people may find they do best with a lower fiber diet in the first several months.

The way you eat over the long term with a J-pouch will depend on a few things. You may need to adjust your diet if you have digestive symptoms or other health conditions.

If you’re starting to introduce some new foods, it’s always best to do this gradually. This way, if you get cramping, excess gas, bloating, or diarrhea, it’ll be easier to identify what caused it.

Keeping a food and symptom journal can be helpful.

Healthy eating tips

The ultimate goal is for you to eat a variety of foods. Here are some tips to help you figure out the way of eating that works best for you:

  • Your digestive system may tolerate small meals and snacks better than larger meals.
  • One of the main jobs of your colon is to reabsorb water from your stool. So, when you don’t have a colon, it’s important to drink enough fluids to stay hydrated as your body adapts.
  • It’s best to consume fluids in between meals, since drinking with meals can speed up digestion and may lead to loose stools.
  • Experiment with different ways of preparing vegetables. You may find that you tolerate cooked vegetables better than raw ones. This may change over time.
  • Remember that digestion starts in your mouth. Take small bites and chew your food well to help the rest of your digestive system process it more easily.
  • If you start having more frequent stools or diarrhea, you may want to try going back to a low residue diet and see whether your symptoms resolve.
  • If you’re having a lot of digestive symptoms or symptoms that don’t resolve with dietary changes, talk with a doctor. You may consider working with a dietitian as well. This person can support you in finding a diet that works for you.

Supplements

Supplements can help if you’re not able to get enough nutrients from your diet. If you’re eating a variety of foods, you may not need any supplements.

Talk with your doctor to decide whether you need any supplements. Here are some common supplements used by people with a J-pouch:

  • Fiber supplements. If you have ongoing diarrhea, a soluble fiber supplement may help thicken up your stool.
  • Nutritional supplement drinks. If you have trouble eating enough calories, these can add nutrients and calories to your diet.
  • Probiotics. There’s ongoing research into the potential benefits of probiotic supplements. Probiotics can help if you have to take antibiotics or have pouchitis. Pouchitis is an infection in the J-pouch that occurs in up to 50 percent of patients, usually within 2 years of surgery.
  • Calcium. If you have trouble tolerating dairy products, it may be hard to get enough calcium. Calcium supplements can help ensure you’re getting enough to keep your bones strong.
  • Vitamin D. Vitamin D helps with the absorption of calcium, among other benefits, and it helps reduce intestinal inflammation. In addition, according to a 2013 study, it’s common for those with ileal pouches to have low levels of vitamin D.

Takeaway

Many people with UC have improved quality of life after J-pouch surgery.

After the procedure, you’ll start on a clear fluids diet, then move to a full fluids diet. You’ll slowly try to introduce more solid foods as your digestive system heals.

Dietary changes can help if you have excess gas, loose stool, or diarrhea. It’s a good idea to make any dietary changes gradually. A food and symptom journal may also help you see any patterns in eating and symptoms.

Read more on: diet