Pouchy.orgCuffitis
Inflammation of the rectal cuff — a less-talked-about but treatable problem.
What Is the ‘Cuff’?
During most J-pouch operations, a small strip of rectal tissue is left behind to connect the pouch to the anus. This strip is called the rectal cuff. Cuffitis is inflammation of that strip — essentially a small remnant of ulcerative colitis activity.
How It Differs from Pouchitis
Symptoms of cuffitis can feel similar to pouchitis, but the inflammation is in a different location and the treatments are different. Cuffitis usually responds to topical anti-inflammatory therapy (such as suppositories or enemas) rather than antibiotics.
Common Symptoms
- Bleeding with bowel movements (often a key clue)
- Urgency or feeling of incomplete emptying
- Mild lower abdominal or pelvic discomfort
- Symptoms that don’t improve with antibiotics typically used for pouchitis
How It’s Treated
Treatment usually involves topical mesalamine or steroid medications applied directly to the cuff. Many patients respond well. If cuffitis is recurring or severe, your gastroenterologist may consider additional therapy. Diagnosis usually requires a pouch endoscopy so the cuff can be inspected directly.
Last reviewed: June 27, 2026 · Pouchy.org patient education, medically reviewed by Stefan D. Holubar, MD, MS (Cleveland Clinic).