Colitis Treatment Without the External Bag

Ulcerative colitis is a complex disease that affects over 700,000 Americans and in one quarter to one-third of these cases, some type of surgical solution is necessary. Traditional surgeries used to treat ulcerative colitis can seriously affect patients’ self-image and freedom of movement, but a new option is now available that reduces side effects and restores a familiar sense of bodily comfort. Here’s a quick overview of traditional surgical colitis treatment, and an explanation of how patients who have had their entire colon removed can avoid the need for an external bag:

Traditional surgical treatments

• 1. Ileo-anal “J pouch:” Some patients who have retained the lowest part of the rectum and anal canal choose the J-pouch option. While this approach became popular because it allowed patients to avoid external appliances, it is now recognized as highly problematic. According to the National Institutes of Health, “The procedure has undergone many improvements and modifications since its first original description. Despite these modifications, [the J-pouch] is frequently accompanied by early and late complications.” These complications include infections, leakage, small bowel obstruction, postoperative adhesions, pouch bleeding, inflammation, and more.
• 2. Conventional “Brooke” ileostomy: This is the classic surgical solution to dealing with body waste following the removal of the entire colon (large intestine) and rectum. Developed in 1952, the ileostomy takes the end of the small intestine and brings it through the abdominal wall, creating a nipple-shaped outlet that protrudes from the abdomen. An external bag is attached to this outlet and worn at all times, since the small intestine processes material continuously. Many people have learned to live with ileostomy appliances, but this involves serious lifestyle adjustments.
• 3. The Kock Pouch or K-Pouch: This procedure, first developed in 1969, involves creating an internal pouch or reservoir from the patient’s small intestine. This pouch leads to an external opening in the abdominal wall, through which the patient can insert a tube several times a day when they go to the bathroom. Dr. Kock, the originator of this method, updated it in 1972 to include a nipple valve made from the end of the intestine. Unfortunately, while this solution seemed promising at first, in practice it often leads to difficulties inserting the tube, resulting in slippage and incontinence. Fistulas and pouch infections are also not uncommon with the Kock pouch, and many patients have undergone surgical transitions from the Kock pouch to a traditional ileostomy.

A new long-term colitis treatment solution

The Barnett Continent Intestinal Reservoir (BCIR or “Barnett Pouch”) is a revised version of the traditional Kock pouch. Dr. Barnett developed a new method of creating and suturing the internal pouch, which significantly reduces the incidence of fistula and infection. Also, the BCIR involves building the valve in a direction that works with the natural movements of the small intestine, so that intestinal mucous is directed toward the pouch, rather than the opening. Most importantly, the BCIR constructs the valve in a far stronger manner, so that it naturally seals off more tightly as the pouch fills with gas and waste. Leakage and infection are reduced and a normal lifestyle is once again possible.

If you currently have an external appliance or other ostomy solution, or you are just now approaching your first surgery, the BCIR is available to you. Contact Dr. Don Schiller, The Ileostomy Specialist, today to learn about your options.