The standard treatment for patients with ulcerative colitis (UC) is medical therapy including steroids and immunosuppressive drugs. Many patients do not respond well to medical treatment and after a period of time there can be very serious side effects. About 30-50% of patients with UC eventually require surgery, which cures the disease. In those who fail medical treatment or develop an intolerance to the medicine, or develop precancerous changes (seen in long-standing ulcerative colitis), a restorative procto-colectomy can offer a greatly improved quality of life.

Historically, surgical options for ulcerative colitis were limited. Normally the entire colon, rectum and anus had to be removed and it was impossible to restore normal gastrointestinal function. Bowel movements were through a permanent ileostomy fashioned through the abdominal wall. This required an appliance, or "bag" to collect the stool.

The best option for many patients needing complete removal of the colon and rectum for UC is a restorative procto-colectomy with ileal-pouch anal anastomosis or "J-Pouch". Depending on the situation, this is typically a staged procedure that requires two or three separate operations. The "J-Pouch" is created from the last part of the small intestine and is connected to the anus and surrounding muscles. The anus and surrounding muscles are preserved and a temporary ileostomy is created during the first operation to facilitate healing of the J-Pouch. About 3-6 months later, the ileostomy is reversed and bowel movements are then normalized through the anal opening.

After the J-Pouch procedure, most patients have 3-5 loose bowel movements during the day and one or two at night. Most patients feel this is an acceptable to avoid having a permanent ileostomy or "bag", particularly since they feel otherwise normal and no longer require taking debilitating drugs, since the entire colon is removed.

The same procedure can be used for certain polyp syndromes such as Familial Adenomatous Polyposis, but it cannot be used for Crohn’s Disease of the colon. This is because in Crohn's disease the small intestine is usually involved, along with the colon, which leads to an unacceptably high rate of complications and repeat operations when a pouch is constructed. Insurance companies generally recognize the operation as one which is part of the standard of care for UC and Polyposis, so they will authorize the procedure as a medical necessity.