Post Operative Ileostomy Care
Whether you are a patient who undergoes conversion of an existing conventional ileostomy or ileoanal J-pouch to the BCIR, or who undergoes a one-stage operation to remove the diseased large intestine and create the BCIR at the same time, this is considered major abdominal surgery. Time must be given for you to recover in the hospital and for your pouch to heal solidly before starting the intubation (draining of the internal pouch) process.
At the time of surgery a catheter is placed through the stoma opening into the pouch and stitched to the skin, and connected to a gravity drainage bag. After your system recovers (a period of 5-7 days) and you heal, you will be started on a liquid diet and gradually advanced to solid food. Two of these first seven days are the last 2 days in the hospital prior to discharge.When healing is well underway, the catheter is removed and you spend 2 more days in the hospital being instructed by our expert nursing staff in learning how to care for your pouch for the rest of your life. Written materials are provided and reviewed carefully with you both by myself as your Surgeon and by the nurses.
Initially the pouch has a limited capacity (3-4 ounces) and must be given time to expand. Once the catheter is removed, the first week you will be draining your pouch every two hours from awakening until bedtime and again at 2 a.m. The first two days of that week are the last two days of your hospital stay. The next week your schedule will change to draining the pouch every three hours, and not during the night at all.
The following week an hour is added to the interval between emptying (every four hours which is five times per day). Each succeeding week a little more time is added to the interval, up to your individual tolerance. Some people are fortunate and only empty twice a day, while others empty three, four or five times a day (most people urinate five times a day at least). Ultimately, the pouch will hold 500cc to 1 liter.
Under normal circumstances it will not be necessary to empty more often unless you eat a large amount late into the night before bedtime. Each "intubation" should take five minutes or less from entering the bathroom until leaving. The catheter (there are several different types available) is simply rinsed out with tap water and allowed to air dry. Intubation can easily be done in any public restroom. If there is concern about rinsing the tube at the sink when other people are around, carry a Ziploc bag into the stall and put the tube in it, rinsing it out later when more convenient! Many types of carrying cases can be used to keep your catheter clean and dry. It will quickly become a part of your daily care routine that you don't even think about.