Reflecting on 18 Months with a J Pouch - Cory Fleming’s IBD Journey
By Cory Fleming
Many of us with ulcerative colitis have faced—or at least thought about—the possibility of surgery. If there comes a point when medication no longer works, a common path is to have your colon removed and your small intestine reworked into a “J pouch” so it can, as much as possible, serve in the colon’s place. The process often requires three tough surgeries over about nine months, and living with an ostomy between the first and final procedures. Then, once the procedures are complete, most folks are told to expect a year or two to pass before regaining a meaningful sense of normality.
Of course, when considering surgery, our doctors and surgeons can answer our medical questions, but we also want to hear from those who have lived with a J pouch. How close can a J pouch get me to a normal life, really? How soon? What about athletics? Social events? I’ve begun the procedures and gotten used to my ostomy—is continuing onto a J pouch even worth it?
The internet is full of answers, and though the vast majority of folks are happy with their J pouch, there’s a strong negative bias: someone’s more likely to take to the internet when there’s an issue than when everything is working smoothly, and there’s certainly no guarantee that the J pouch will work as well as intended. You can find positive stories, too, like the ones I’ve told through a few blog posts chronicling my journey from J pouch to Ironman in six months (Pt. I, Pt. II) and my 100k ultramarathon win last month. What’s missing are examples of just how complete life can be with a J pouch, and how far any preconceived limits can be pushed after the surgeries.
Eighteen months might not be a whole lot of time, but here’s a snapshot of how I’ve lived and what I’ve accomplished since completing my final J pouch procedure at the beginning of 2024.
My First Year
Detailed in an earlier post, my surgical path was complicated. To keep it short, there was a complication that nearly killed me, four and a half months spent being fed through a tube, and other issues that made it unlikely I’d ever have a functional J pouch. Fortunately, right before my final J pouch surgery was scheduled, a couple of medications turned things around, and I was able to undergo that last surgery in January 2024 and leave the hospital with a working J pouch.
Ironman Lake Placid, July 2024
Despite my fraught surgical experience, I’ve had as great a time adapting to my J pouch as anyone could hope. Not everyone is so lucky. I was back to working from home within a week of my final surgery, exercising within three weeks, and putting in 15-hour (or longer) training weeks within two months. Other than a bout of anemia and subsequent iron infusions, my first year with the pouch saw steady improvement. I quickly advanced my diet, became comfortable being out of my apartment for longer periods, and pushed myself athletically and socially. Trips to the bathroom became fewer and non-urgent, and my life quickly felt less and less limited by my gut. In the earlier months, I’d take fiber supplements and fast before leaving my apartment for more than a couple of hours; by the end of my first year, I stopped doing these things and hardly changed any of my behaviors.
I wouldn’t have called my life totally normal during 2024, the first year with my J pouch, but it wasn’t too far off. Here are some of the highlights:
Showed my parents around New York City within a month and a half of the final surgery
Completed a half-distance triathlon in June, and then a full Ironman in July (and placed quite well!)
Won a local 50k ultramarathon in November
Traveled throughout the US, including going to a friend’s wedding and spending a long weekend wine tasting with my parents
Saw 15 concerts, went to plenty of nice dinners, had some late nights out with friends, and spent a lot of quality time with my fiancée
Changed roles at my company and logged a very successful year
If you’d have asked me, as I was being wheeled into the operating room at the beginning of the year, whether 2024 would shape out even half this well, I wouldn’t have bet on it. I didn’t have a strong sense of what was possible. There are simply too few people sharing what life can look like with a J pouch, especially early on.
2025 So Far—and Beyond
Though 2024 was much better than I expected, my already-high quality of life has accelerated in the first six months of 2025. As I write this in July 2025, my J pouch really only affects me in a few small ways: I wake up (usually only) once each night to go to the bathroom, use the bathroom more than an average person and make sure decent public bathrooms are available if I’m going out for a long time, avoid a few specific foods and chew well, take medications that fortunately don’t have any side effects on me, and … I think that’s it!
Malibu Canyon 100k, June 2025
For anyone who has lived with severe IBD, these small things are tantamount to nothing. I hardly think about my J pouch at all, and I can now say life is normal—not necessarily the same as before my ulcerative colitis diagnosis four years ago, but normal. Only six months into 2025, the highlight reel is already looking better than last year’s:
Moved from New York City to Los Angeles, continued to perform well at work, and have gotten in the best shape of my life (bike power PRs, more running endurance than I’ve ever had)
Began writing for an online music publication and have published over 20 album reviews so far
Won a mountainous 100k ultramarathon while breaking the course record
Spent more time with friends, had more late nights out, and had fewer health-related worries than at any time since my ulcerative colitis diagnosis
Most importantly, I got married—in Greece! My wife and I then honeymooned throughout Europe, where we went to a couple of music festivals, ate at some amazing restaurants, and spent many long days out exploring.
Other than making sure I had my medications, international travel was no different with my J pouch than before my diagnosis. It was the trip of a lifetime, without any health-related worries or incidents.
My wedding in Athens!
Looking ahead to the rest of the year, I’m planning to get into even better shape and push my body further, go to a bunch more concerts, continue spending lots of quality time with my wife and friends, and consider starting a family. Of course, somewhere in the back of my mind is always the thought that my IBD could return aggressively and derail all these plans, but that thought is infinitely more distant than it was a year and a half ago.
When Things Go Right
For me, surgery has worked out as well as anyone could dream. I would say it was clearly the right choice, but I didn’t actually have a choice—my ulcerative colitis was completely unmanageable, so surgery was my only option. And although this article paints a rosy picture of post-surgery life, my surgical path to the completed J pouch was particularly brutal and full of dreadful uncertainty. Still, it has all been worth it—without question.
I recognize that some have a vastly different experience with their J pouch. A story like mine isn’t guaranteed. And while statistically the vast majority are satisfied with their pouch, I’ve likely had an especially good experience even within that cohort. So the point of this post isn’t to push anyone toward beginning surgery—or from ostomy to J pouch—without further thought, but to show what’s possible when things do work out. Hopefully this post weighs in the balance for those considering surgery, or provides some inspiration and positivity to those who, like me, don’t have a choice.