PURPOSE: This study aims to investigate the phenomenon of high-amplitude pouch contractile waves and their impact on functional results in patients undergoing ileal pouch-anal anastomosis following total proctocolectomy for ulcerative colitis. METHODS: This is an observational cohort study evaluating pouch manometric data at an early (study 1, < 6 months s/p ileostomy closure) and delayed (study 2, > 5 months after study 1) time point. High-amplitude contractions were defined as peaks >/= 20 mmHg over baseline. Pouch functional measures and quality of life outcomes were correlated with contractile amplitude and frequency. RESULTS: Thirty-three patients were included in this study. Contractile frequency decreased from study 1 to study 2 (0.14 vs. 0.07 contractions/min). Peristaltic contractility was absent in 18/33 patients (55%) on their early examination (study 1) after stoma takedown and 23/33 patients (70%) on study 2. A significant association was observed between increased pouch contraction and nighttime spotting (p = 0.05) during study 1. Increased amplitude was associated with increased nighttime spotting (p = 0.03) and an increased number of 24-h bowel movements (p = 0.038) during study 1. There were no significant associations with pouch function with study 2. Contractions had no significant impact on quality-of-life outcomes. CONCLUSIONS: Nighttime spotting is associated with increased contractile frequency and amplitude early in pouch life following ileostomy takedown. Contractility decreases over time, with no evidence of contractile waves in the majority of patients at greater than 1 year post-IPAA. High-amplitude contractility is an additional factor contributing to early pouch functional results.