Pouchitis remains the most common complication after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (IPAA). Despite the burden of pouchitis, our ability to recognize the patients at greatest risk for pouchitis and to offer early intervention for the prevention or early treatment is limited. In this review, we will discuss the diagnostic categories of pouchitis, as well as the common approaches to treatment. We will then discuss gaps in research and clinical care. These include opportunities to improve our understanding of the risk factors associated with the development of pouchitis as well as the role that primary and secondary prevention may play in the management of patients after IPAA to prevent pouchitis. We will then discuss future research goals to decrease the burden of pouchitis. Although the burden of pouchitis is well recognized, we have an opportunity to improve our methods of risk stratification to offer early intervention to those patients at the greatest risk for developing pouchitis. Understanding which preventive therapies, in which populations, and under which treatment settings offer the most benefit will be critical issues to address in the near future to improve care of patients after IPAA for UC.