This topic is about making a decision between having an ileostomy or a J-pouch after a total colectomy for someone with ulcerative colitis. Will, who has been dealing with ulcerative colitis for over a decade, is facing this decision. He is familiar with the idea of a permanent ileostomy because his mother has one, but his doctors are suggesting a J-pouch. Will is concerned about the complexity of the J-pouch surgery and potential issues like incontinence. He is looking for advice based on others' experiences to help him decide.

Here are some insights and advice shared by others:

1. Success Rates and Revisions:
- Some surgeons have mentioned that only about 25% of J-pouch patients keep their pouch long-term, with many eventually opting for a permanent ileostomy.

2. Functional Differences:
- A J-pouch can result in loose stools and frequent, urgent trips to the bathroom both day and night.
- A permanent ileostomy removes the urgency but requires ongoing stoma care, including managing hydration, protecting the skin, changing appliances, and watching for leaks and hernias.

3. Experiences with J-pouch Failures:
- Some people have experienced issues like pouchitis, nighttime accidents, painful urgency, and loud emptying, leading them to switch to an ileostomy, which improved their quality of life.
- Additional surgeries for a J-pouch can lead to more scar tissue and longer recovery times.
- One person suggested having a complete proctectomy at the time of ileostomy to prevent future rectal issues.

4. Decision-Making Tips:
- Trust your instincts and clearly communicate your preferences to your surgeon.
- Gather real-world data by asking your surgeon for long-term outcomes and meeting patients with successful J-pouches.
- Explore all reconstructive options if avoiding a permanent bag is important to you.
- Make sure Crohn’s disease is ruled out before considering continent reservoir procedures.
- Keep in mind that online forums may have more negative stories, as satisfied J-pouch patients might not share their experiences as often.

5. Medical Treatment Considerations:
- Biologics can take 6–8 weeks to show full effects, but early changes in blood markers can be a sign. Lack of improvement after two infusions led one person to choose surgery.

6. Personal Reflections:
- Many people reported improvements in weight, nutrition, and energy levels after switching to an ileostomy.
- One person made the decision for an ileostomy by flipping a coin at 19 and has no regrets, though they don't recommend making a decision that way.