Pouchitis: rifaximin

What is pouchitis?

Some people need to have their large bowel (colon) removed by surgery. This is usually because they have a condition called ulcerative colitis that causes inflammation and ulcers in the large bowel, or because they have another disease in the large bowel, such as cancer. After removing the large bowel, it may be possible for the surgeon to make a 'pouch' out of the last part of the small bowel to connect it to the anus (or back passage) so that people can still pass stools in the normal way. This pouch acts as a 'reservoir' to collect stools before the person is ready to pass them in the normal way through a bowel movement.

When someone has pouchitis, it means that the pouch has become inflamed. A person with pouchitis may have symptoms such as needing to open their bowels even more frequently, feeling they need to get to the toilet urgently, having tummy cramps, and noticing that the stool is even more watery than usual. Some people may also notice blood in the stool, or feel generally unwell and have a high temperature.

People who have pouchitis are usually given a 2-week course of antibiotics (usually either ciprofloxacin or metronidazole). Most people will get better after taking 1 of these antibiotics; however, about 1 in 10 people will not. If the person has not got better after taking a 2-week course of antibiotics and they have been unwell for longer than 4 weeks, then the condition is called 'chronic' pouchitis. This can be a bit harder to treat, and other treatment options may be considered.

Pouchitis also develops again in more than half of people who initially recover. Some people need to have repeated courses of antibiotics, and some people, even when they have recovered, may need to stay on long-term treatment to try and prevent pouchitis from coming back.