For a study, researchers sought to determine the frequency of nonspecific acute pouchitis in patients with familial adenomatous polyposis. This study was carried out at a large academic medical center’s hereditary colorectal cancer center. Patients with familial adenomatous polyposis who had IPAA were included in the study. Symptoms, proctoscopy, pouch radiography, and a pouch biopsy were all performed. The presence of nonspecific acute pouchitis and the alternative diagnosis of pouch dysfunction were the primary outcomes assessed. There were 250 patients with familial adenomatous polyposis who had undergone IPAA; 38 (15.2%) were diagnosed with “pouchitis,” with 23 men and 15 women affected. The median age was 55 years (the range was 18–90 years). According to the criteria, no patient had nonspecific, acute pouchitis. The diagnosis was derived in 9 cases from benign ulcers found in ileal pouches. The most common symptom associated with the “pouchitis” label was stool frequency. Still, actual causes of the frequency included poor pouch emptying, poor eating habits, poor bowel habits, and afferent limb syndrome. The average number of stools per day was 9, ranging from 4 to 15. Every patient had at least 1 pouch endoscopy, with the median number being 19 (1–21). Pouch biopsies were performed on 9 patients to rule out inflammation; all of them had chronic active enteritis, a common finding in ileal pouches. In patients with familial adenomatous polyposis, investigators could not confirm any cases of nonspecific acute pouchitis. Those caring for patients with familial adenomatous polyposis who had a pouch should look for causes other than “pouchitis” for pouch-related symptoms.