"Normal" or acceptable pouch function is hard to define since it varies from one person to another and from day to day in the same individual. Most patients with pouch dysfunction have an increased stool frequency, which is often associated with small amounts of stools. Incontinence may be the predominant symptom or may occur in association with frequency and urgency. The causes of pouch dysfunction can be divided into four categories: septic complications, mechanical or surgical complications, functional disorders and inflammation, mainly pouchitis and, to a lesser, extent cuffitis. Diagnosis is based on accurate history and physical examination combined with one or more auxiliary assessments, such as evaluation under anaesthesia, pouch endoscopy, anorectal physiology tests and various imaging techniques. The major conditions that may result in pouch dysfunction are described below.
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