{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:52:48Z","timestamp":1789728768755,"version":"4.0.1"},"reference-count":12,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with an ileal pouch have a new system of defecation. The expulsive peristalsis of the rectum is replaced by the inertia of the pouch. Defecation becomes dependent on gravity and patients are prone to inefficient pouch\u2010emptying. Several factors can impact pouch emptying and here we review a series of patients to illustrate these factors and their variable presentations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective, descriptive study of a series of patients who had undergone total proctocolectomy with ileal pouch anal anastomosis and presented with pouch dysfunction. Patients underwent investigations including, pouchoscopy, pouchography and anorectal physiology testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 34 patients, 18 men, mean age 48.4\u2009years. Thirty\u2010one had a J\u2010pouch and 3 an S\u2010pouch. Twenty\u2010eight had a stapled and 6 a hand\u2010sewn anastomosis. Presenting complaints included difficulty emptying the pouch (<jats:italic>n<\/jats:italic>\u00a0=\u200917), high stool frequency (<jats:italic>n<\/jats:italic>\u00a0=\u20098), clinical bowel obstruction (<jats:italic>n<\/jats:italic>\u00a0=\u20097), and nocturnal incontinence (<jats:italic>n<\/jats:italic>\u00a0=\u20093). Diagnoses were anal stenosis (11), afferent\u2010limb syndrome (<jats:italic>n<\/jats:italic>\u00a0=\u20097), pouch twist (<jats:italic>n<\/jats:italic>\u00a0=\u20094), paradoxical puborectalis contraction (<jats:italic>n<\/jats:italic>\u00a0=\u20097), efferent\u2010limb spasm\/stenosis (<jats:italic>n<\/jats:italic>\u00a0=\u20092), mega\u2010pouch (<jats:italic>n<\/jats:italic>\u00a0=\u20093), pouch prolapse (<jats:italic>n<\/jats:italic>\u00a0=\u20091), and pouch\u2010rectal anastomosis (<jats:italic>n<\/jats:italic>\u00a0=\u20091). Treatments included anal dilation (<jats:italic>n<\/jats:italic>\u00a0=\u200911), disimpaction (<jats:italic>n<\/jats:italic>\u00a0=\u20092), biofeedback (<jats:italic>n<\/jats:italic>\u00a0=\u20092), pouch excision (<jats:italic>n<\/jats:italic>\u00a0=\u20092), laparotomy with lysis of adhesions (<jats:italic>n<\/jats:italic>\u00a0=\u20096), Botox injection into puborectalis (<jats:italic>n<\/jats:italic>\u00a0=\u20096), catheter drainage (3), and miralax (<jats:italic>n<\/jats:italic>\u00a0=\u200911). All patients with a stenosis had some improvement after dilation, and surgery restored pouch function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Accurate diagnosis and effective treatment of pouch dysfunction is based on an appreciation of pouch physiology, correction of anatomic abnormalities that impair emptying, and management of stool consistency.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.17998","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T14:18:59Z","timestamp":1663769939000},"page":"3237-3241","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["When pouches cannot empty: a cohort study of the symptoms this causes, the reasons it's happening, and the treatments needed"],"prefix":"10.1111","volume":"92","author":[{"given":"Emmeline","family":"Nugent","sequence":"first","affiliation":[{"name":"National Surgical Training Centre Royal College of Surgeons in Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3489-4140","authenticated-orcid":false,"given":"James M.","family":"Church","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery Columbia University Medical Center, Herbert Irving Pavilion  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-018-3011-0"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2017.1390601"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.5217\/ir.2020.00047"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v25.i31.4320"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-010-0143-y"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2018.1454508"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13431"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13352"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001257"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001842"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004829"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001543"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.17998","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.17998","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.17998","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T01:16:01Z","timestamp":1692494161000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.17998"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,21]]},"references-count":12,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1111\/ans.17998"],"URL":"https:\/\/doi.org\/10.1111\/ans.17998","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,21]]},"assertion":[{"value":"2022-04-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}