ABSTRACT
This chapter examines the causes of malfunction in the 30% of pouch patients and the ways of improving their quality of life, and whilst maintaining the anal route of defaecation. A prerequisite to understanding pouch dysfunction is an appreciation of normal pouch function and this has to be learnt by experience. Pouch function is extensively described in the literature, and there are scoring instruments that are helpful in providing a picture of function over time and an overall assessment of function in individual patients. Anal assessment of the anastomosis is especially important in the early post-operative phase to exclude a small leak or a cavity at the anastomosis when the pouch is protected by a loop ileostomy. Treatment outcome is influenced by nutrition, the anatomy of the pouch, the risk of bacterial overgrowth, acute or chronic presentation and immunological factors. Antibiotics are the mainstay of treatment of acute pouchitis.
