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| Internal Urinary Pouches |
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| Internal urinary pouches (continent reservoirs) are made from various sections of gastrointestinal organs (usually bowel segments). A catheter is then used to drain the urine from the pouch through an abdominal stoma. Self-catheterization for irrigation is required to prevent mucous plug formation inside the pouch. These are done for bladder removal (cystectomy) — usually for cancer. |
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| Some examples are the Kock, Indiana, Mainz, Miami, Studer, and Mitrofanoff Pouches. |
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| After a cystectomy, it's a wise idea to carry medical identification with you at all times such as a bracelet or necklace with the information engraved on it. And you should also keep a card with this information in the glove compartment of your car and ensure all family members also know what to communicate in case of emergency. |
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| Individuals preparing for bladder removal need to make a decision concerning how the new function of removing urine from their body will happen. Some type of reservoir must be provided to collect the urine before its discharge. Assuming there is no medical reason that decides one option over others, patients may be asked to choose whether the pouch is desired outside their body or inside. |
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| If an internal pouch is chosen, there are more decisions to make concerning the exit route for the urine. Some possibilities are through the rectum, through the penis for men, reconnecting the urethra for women, or by inserting a catheter into the pouch through an opening in the abdomen called a stoma. This type of stoma is commonly known as a Florida Pouch or an Indiana Pouch. |
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| There are potential problems after surgical procedures like these in the longer term. Possible problems can be pouch or kidney infection. The pouch, being a section of bowel, continues to act as a bowel, manufacturing mucous. The colon also has natural 'grooves' and uneven surfaces like pockets, which can be difficult to keep clean. This adds up to making an environment that can encourage bacterial growth. |
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| Any signs of urinary tract infection, such as back pain, foul smelling urine, discolored urine and raised temperature should be investigated by a physician and treated to avoid further complications. |
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| Internal Fecal Pouches |
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| Also known as ileoanal reservoirs, internal fecal pouches are surgical procedure options for disease processes such as Ulcerative Colitis (UC), Familial Polyposis Coli (FPC) and some colon cancers. |
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| Made from small bowel, these pouches provide a storage place for stool in the absence of the large intestine. Anal sphincter muscles assist in holding in the stool. Several times a day, stool is passed through the anus. Depending on the surgeon's preference, the pouch construction may be of several types with the 'J' Pouch being the most common as it is generally the easiest to construct. Other shapes such as 'W' and 'S' can provide greater internal capacity but are performed less frequently. |
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| The benefit of an internal fecal pouch is that it can give a person control of bowel movements and does not require a permanent ileostomy. Each patient considering this surgery is carefully evaluated to determine if this procedure is appropriate. This procedure can be performed in one, two or three stages, depending on the patient, the surgeon or the disease process, but is most often done in two stages, usually two to three months apart. Approximately four to six weeks after the first surgery, an x-ray study of the pouch is performed (sometimes called a pouch-o-gram). If the study shows that the pouch is healed, then the second surgery can be scheduled, which is the reversal of the stoma that was made to divert the fecal flow while the pouch healed. |
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| Once stool is passed through the anus, stools are frequent and liquid. There may be accompanying urgency and leakage of stool. This generally improves over time as the anal sphincter muscles strengthen and the pouch adapts to its new function. Stools become thicker as the small intestine absorbs more water. In addition, medications to decrease bowel activity and bulk-forming agents to thicken the stool may be prescribed. |
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| As for reversals, to help during this adaptation, it's a good idea to avoid foods that may cause gas, diarrhea and anal irritation. Careful skin care around the anus will protect the skin from the irritation of frequent stools. Practicing anal sphincter muscle exercises during this time is also beneficial. |
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| After about six months, most people can expect about five to six semi-formed bowel movements per day. The pouch can take up to a whole year to fully adapt. In most people, functioning of the pouch continues to improve over time. |