What is the modified Pouchitis Disease Activity Index?

It is a score that combines four symptoms with what is seen at a pouchoscopy, without a biopsy. A total of 5 or more counts as pouchitis, and in its 2003 validation it matched the full index with 97% sensitivity and 100% specificity.

What mPDAI score means pouchitis?

A combined symptom and endoscopy score of 5 or more, recorded at a pouchoscopy. The symptom part scored here at home cannot confirm pouchitis however high it is, because the same symptoms happen with other pouch problems.

Can you tell pouchitis from symptoms alone?

No. In one study of 61 people with pouch symptoms, 42.6% had no inflammation at all, and cuffitis and infection can feel the same. That is why pouchitis is confirmed with endoscopy.

Does pouchitis cause a fever?

Rarely. Fever is one of the scored items, but no one of 61 symptomatic people in one study had one, and only one of 103 in another. A measured fever with pouch symptoms is a reason to contact your team the same day.

Is bleeding a sign of pouchitis?

It is less typical than people expect. In one study, visible bleeding was seen only in cuffitis, not pouchitis. Bleeding should always be reported, and heavy bleeding or bleeding with dizziness needs urgent care.

How many bowel movements a day are normal with a j pouch?

Once settled, the AGA guideline expects an average of 4 to 8 a day and 1 to 2 at night. The pouchitis index scores the change from your own usual number, so your baseline matters more than the average.

When should I call my pouch team about symptoms?

When your counts, urgency or cramping stay above your normal for more than a few days, or straight away for a fever, daily bleeding, vomiting, cramping with little output or a swollen tummy.

Pouchitis Symptom Checker (mPDAI Symptom Score)

Score your j pouch symptoms the way the pouchitis index does.

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About 2 minutes
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Updated October 3, 2026

The short answer

The modified Pouchitis Disease Activity Index scores four symptoms: stool frequency above your usual (up to 2 points), daily rectal bleeding (1), urgency or abdominal cramps (up to 2) and fever above 37.8°C (1), for a symptom score out of 6. Pouchitis itself is diagnosed by looking inside the pouch: the full modified index adds an endoscopy score, and 5 or more combined is the cut-off. A high symptom score is a reason to contact your pouch team, not a diagnosis.

First: is any of this happening now?If it is, do not wait for a score. Contact your pouch team or GP today or go to urgent care, and call emergency services if you feel faint, very unwell or confused.

Feeling faint, very unwell or confusedCramping with little or no output, or you cannot pass anythingVomitingA swollen, tense or hard abdomenSevere, constant or worsening abdominal painMore than a small amount of blood, or any bleeding with dizziness or a racing heartSigns of dehydrationVery dark or very little urine, dizziness when you stand, unusual thirst.New pain, swelling or discharge around the anus, or a new opening near it

Compared with your usual settled number, how many bowel movements a day are you having?Use your own normal once your pouch had settled, not an average. The index scores the change.

Rectal bleeding (blood from the pouch)

Faecal urgency or abdominal crampsA sudden, hard-to-delay need to go, or cramping in your tummy.

Fever: a measured temperature above 37.8°C (about 100°F)Only count a thermometer reading, not feeling hot.

How long has this been different from your usual?

How long ago was your pouch connected (the final operation)?

How to use the Pouchitis Symptom Checker

1Tick anything urgent first. If something is, contact your team or get urgent care rather than waiting for a score.
2Compare your daily bowel movements with your own settled number, and rate bleeding, urgency or cramps, and any measured fever.
3Add how long things have been different and how long you have had your pouch.
4Get your symptom subscore out of 6, what it can and cannot tell you, and how soon to call your pouch team.

The four symptoms the modified PDAI scores

The Pouchitis Disease Activity Index was developed at the Mayo Clinic in 1994 and combines symptoms, endoscopy and biopsy findings. The modified version, tested at the Cleveland Clinic in 2003, drops the biopsy and keeps the same four symptom items. Frequency is scored against your own usual number, which is why knowing your settled baseline matters. The points below are as set out in a 2024 University of Chicago analysis.

Symptom	Answer	Points
Stool frequency	Usual	0
	1 to 2 stools a day more than usual	1
	3 or more stools a day more than usual	2
Rectal bleeding	None or rare	0
	Present daily	1
Faecal urgency or abdominal cramps	None	0
	Occasional	1
	Usual	2
Fever above 37.8°C	Absent	0
	Present	1

How pouchitis is actually diagnosed

Symptoms alone are not enough, which is why every version of the index includes a look inside the pouch. The AGA's 2024 guideline says symptoms of pouchitis do not necessarily match what is seen on endoscopy or biopsy, and that a scope is not always needed for typical, infrequent episodes that respond to usual treatment, but is for frequent recurrences, poor response or atypical symptoms.

Score	What it includes	Pouchitis cut-off
PDAI (Sandborn 1994)	Symptoms, endoscopy and biopsy, 18 points	7 or more
Modified PDAI (Shen 2003)	Symptoms and endoscopy, no biopsy	5 or more (97% sensitivity, 100% specificity against the PDAI in 58 people)
This checker	Symptom part only, out of 6	None: a home symptom score cannot diagnose it

Why a high score is not the same as pouchitis

Frequency, urgency and cramps are common to several pouch problems. In a Cleveland Clinic study of 61 people with pouch symptoms, about half had pouchitis, and frequency, urgency and cramps were the most common symptoms in every group. Bleeding was seen only in cuffitis, and nobody had a fever. What does pouchitis feel like walks through each symptom.

Finding in 61 people with pouch symptoms	Share
Pouchitis (PDAI 7 or more)	50.8%
Irritable pouch syndrome (symptoms, no inflammation)	42.6%
Cuffitis (inflammation of the rectal cuff only)	6.5%
Fever in any group	None

When to call your pouch team

After the first months, the AGA guideline expects an average of 4 to 8 bowel movements a day and 1 to 2 a night. Change from your own settled number matters more than where it sits in that range. How many bowel movements a day with a j pouch and how to track symptoms with a j pouch show how to set a baseline and log changes.

What is happening	What to do
Counts, urgency or cramping above your normal for more than a few days	Contact your pouch team or IBD nurse
Daily bleeding	Report it to your pouch team
A measured fever above 37.8°C	Contact your team the same day
Fever with cramps or pain; cramping with little or no output; vomiting; a swollen tummy; heavy bleeding; dehydration	Same-day care or urgent care
Feeling faint, very unwell or confused	Call emergency services

Frequently asked questions

What is the modified Pouchitis Disease Activity Index?: It is a score that combines four symptoms with what is seen at a pouchoscopy, without a biopsy. A total of 5 or more counts as pouchitis, and in its 2003 validation it matched the full index with 97% sensitivity and 100% specificity.
What mPDAI score means pouchitis?: A combined symptom and endoscopy score of 5 or more, recorded at a pouchoscopy. The symptom part scored here at home cannot confirm pouchitis however high it is, because the same symptoms happen with other pouch problems.
Can you tell pouchitis from symptoms alone?: No. In one study of 61 people with pouch symptoms, 42.6% had no inflammation at all, and cuffitis and infection can feel the same. That is why pouchitis is confirmed with endoscopy.
Does pouchitis cause a fever?: Rarely. Fever is one of the scored items, but no one of 61 symptomatic people in one study had one, and only one of 103 in another. A measured fever with pouch symptoms is a reason to contact your team the same day.
Is bleeding a sign of pouchitis?: It is less typical than people expect. In one study, visible bleeding was seen only in cuffitis, not pouchitis. Bleeding should always be reported, and heavy bleeding or bleeding with dizziness needs urgent care.
How many bowel movements a day are normal with a j pouch?: Once settled, the AGA guideline expects an average of 4 to 8 a day and 1 to 2 at night. The pouchitis index scores the change from your own usual number, so your baseline matters more than the average.
When should I call my pouch team about symptoms?: When your counts, urgency or cramping stay above your normal for more than a few days, or straight away for a fever, daily bleeding, vomiting, cramping with little output or a swollen tummy.

What Does Pouchitis Feel Like? Signs and Symptoms
Pouchitis usually feels like more frequent, urgent trips with cramping and pelvic discomfort, building over days. What each symptom means, and what is unusual.
How Many Bowel Movements a Day With a J Pouch?
Large pouch series average about 5 to 6 a day plus 1 to 2 at night once settled. Where those numbers come from, why sites disagree, and what your own count means.
How to Track Symptoms With a J Pouch
With a j pouch, frequency is normal and Bristol types stop helping. Track change from your own baseline: day and night counts, urgency, emptying, blood, fever.
Sleeping With a J Pouch: Night Trips and Leaks
Most people with a j pouch get up once or twice a night, and night leakage is more common than day leakage. Why sleep weakens continence, and what helps.
What to Expect After J Pouch Surgery
Recovery after j pouch surgery runs in stages: the operations, the temporary stoma, takedown, then a pouch that keeps adapting for a year or more. What is normal at each step.

Sources

Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, Phillips SF. Pouchitis after ileal pouch-anal anastomosis: a Pouchitis Disease Activity Index. Mayo Clin Proc. 1994;69(5):409-15. doi:10.1016/s0025-6196(12)61634-6
Shen B, Achkar JP, Connor JT, Ormsby AH, Remzi FH, Bevins CL, et al. Modified pouchitis disease activity index: a simplified approach to the diagnosis of pouchitis. Dis Colon Rectum. 2003;46(6):748-53. doi:10.1007/s10350-004-6652-8
Akiyama S, Cohen NA, Ollech JE, Traboulsi C, Rodriguez T, Rai V, et al. A comparative analysis of clinical symptoms and modified pouchitis disease activity index among endoscopic phenotypes of the J pouch in patients with inflammatory bowel disease. Crohns Colitis 360. 2024;6(3):otae045. doi:10.1093/crocol/otae045
Shen B, Achkar JP, Lashner BA, Ormsby AH, Brzezinski A, Soffer EE, et al. Irritable pouch syndrome: a new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis. Am J Gastroenterol. 2002;97(4):972-7. doi:10.1111/j.1572-0241.2002.05617.x
Barnes EL, Agrawal M, Syal G, Ananthakrishnan AN, Cohen BL, Haydek JP, et al. AGA clinical practice guideline on the management of pouchitis and inflammatory pouch disorders. Gastroenterology. 2024;166(1):59-85. doi:10.1053/j.gastro.2023.10.015

Cite this tool

Clairop. Pouchitis Symptom Checker. www.clairop.com/tools/pouchitis-symptom-checker. Updated October 3, 2026.

Clairop is a general wellness app for people living with a diagnosed digestive condition. It does not replace professional medical care, diagnosis, or treatment. Always follow your healthcare provider's advice.

Clairop logs meals, symptoms and stool in seconds, then looks for the foods your gut reacts to, including reactions that land days later.

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