Pouchy.orgAnastomotic Leak
What it is, why it matters, and what happens if one occurs.
What Is a Leak?
An ‘anastomotic leak’ means the new connection (anastomosis) between the pouch and the anus has a small gap or break. This is one of the more serious early complications of pouch surgery. Most leaks happen in the first few weeks after surgery.
Why It Matters
When stool or fluid escapes through a leak, it can cause infection in the pelvis (sometimes called ‘pelvic sepsis’). Beyond the immediate health risk, leaks are also one of the most important factors affecting how well the pouch will function in the long term and how long it will last.
Signs to Watch For
- Fever, especially with chills
- Worsening pelvic or rectal pain
- Unusual drainage from a wound or drain
- Increased heart rate or feeling generally unwell
- Symptoms developing or worsening rather than improving in the early recovery period
How Leaks Are Managed
Treatment depends on the size of the leak and how the patient is doing. Smaller leaks may be managed with antibiotics, drainage, and time. Larger or symptomatic leaks may require additional surgery, such as draining an infection or temporarily diverting stool through an ileostomy to give the pouch time to heal. A leak does not always mean a pouch will fail — many pouches do well long-term after a leak is properly treated.
Last reviewed: June 27, 2026 · Pouchy.org patient education, medically reviewed by Stefan D. Holubar, MD, MS (Cleveland Clinic).