Pouchitis is the most common complication following ileal pouch-anal anastomosis. It is characterized by pouch inflammation and symptoms resembling ulcerative colitis. The aetiology is thought to involve a combination of genetic factors, a dysregulated immune response, and alterations in the gut microbiome. Pouchitis is classified as acute if symptoms less-than 4 weeks or chronic if symptoms > 4 weeks. Acute pouchitis is typically treated with antibiotics, while chronic pouchitis may require cyclic antibiotics or immunomodulatory therapy. This review indicates that more research is needed to improve understanding and treatment.