How is pouchitis diagnosed?

The doctor will consider the patient’s symptoms and the results of an endoscopy (examination of the inside of the pouch with an instrument called an endoscope). A pouchoscopy (endoscopy of the pouch) can show how widespread the inflammation is, whether or not the ileum is irritated, or if the patient has Crohn’s disease or Crohn’s-like disease of the pouch.

Endoscopy can also show if the patient has cuffitis (inflammation at the anal transition zone, or cuff), or abnormalities such as narrowed passages or cavities or openings. Patients who have cuffitis often have bright red blood (mild to moderate, or on wiping) in stool.

The doctor may take a biopsy (sample of the tissue) during the endoscopy to look for other unusual things, such as polyps, infection, any inflamed granulated (grainy) tissue, or a restricted blood supply.

Imaging studies such as contrast pouchography, CT (computed tomography), gastrografin enema, barium defecography, and/or MRI (magnetic resonance imaging) of the pelvis or abdomen may also be used to help with diagnosis. A test called anorectal manometry is helpful in learning if the pelvic floor is not functioning properly, especially in patients who strain during defecation.