A significant number of people who have undergone removal of their large intestine (colon) and rectum for Ulcerative Colitis or Polyposis with creation of an ileoanal J pouch do not do well. That means they have to deal with multiple bowel movements every day (the normal range for a well-functioning J pouch is 4-7) and during the night. In addition, it means they may not have perfect control (continence), causing soiling or the need to wear a pad at all times. The cause of these difficulties include stricture of the intestine leading to the pouch or stricture of the pouch connection to the lower rectum/anal canal. When a stricture is found, often the diagnosis of Crohn’s disease is made, even though the entire length of the small intestine is normal. Most strictures are not due to Crohn’s disease and do not respond to treatments for Crohn’s. Instead, they are “surgical strictures” due to lack of blood supply over the years or poor initial healing from infection or fistula. A fistula is an abnormal connection between the J pouch and the skin around the anal opening.
People living with a failed J pouch generally have a poor quality of life, and yet they wish to avoid the type of ileostomy that requires always wearing an external appliance. (Patients often refer to the appliance as an external pouch, and some simply call it “the bag”). Since the small intestine is a continuous flow system, the conventional ileostomy (Brooke ileostomy) produces waste and gas all of the time. Many people have a high quality of life with this type of ileostomy and have unlimited activities. However, there is another option.
Removal of a failed J pouch with creation of a BCIR (Barnett Continent Intestinal Reservoir) gives the patient control over their evacuations of waste and gas, and freedom from wearing an external pouch.
The Kock Pouch is the original continent ileostomy, and has been substantially modified by Dr. Barnett 30 years ago, and includes the intestinal collar wrap. Having a BCIR means intubating the pouch (painlessly inserting a tube through a small, flat, button-hole size stoma into the interior of the pouch) several times a day. At no time will any waste or gas come out of the stoma, and external water cannot enter the internal pouch. This is due to the self-sealing nipple valve, fashioned from your own small intestine, as is the entire pouch. Only a small covering is worn over the stoma to absorb any mucous.
If you have an ileoanal J Pouch with a poor outcome and poor quality of life, you owe it to yourself to consider the Barnett Continent Intestinal Reservoir continent ileostomy.