The standard for surgical treatment of patients with ulcerative colitis (UC) is proctocolectomy with ileal pouch anal anastomosis (IPAA). The rate of complications after IPAA remains high in long term follow-up, with most common complications due to inflammation, specifically pouchitis, or mechanical dysfunction. This chapter aims to describe the medical and surgical management of complications related to the pouch after IPAA based on the literature. There is a high degree of support for medical therapy directed at acute and chronic pouchitis. Surgery is reserved for very select cases, with overall poor outcomes described. Reoperation for pouch problems have better outcomes when it is performed for mechanical dysfunction or outlet obstruction, although there is currently no high-quality evidence to support reoperation for pouch problems specifically in the pediatric population.