There are three main ostomy options available today for anyone who needs to undergo removal of the colon and rectum, usually due to ulcerative colitis or familial adenomatous polyposis.
After removal of the colon and rectum, a surgeon must create a new path for eliminating intestinal waste. There are currently three ways to do this and they are BCIR, a traditional ostomy, and the J pouch.
The conventional ostomy, known as the Brooke ileostomy or Koch Pouch, has been around since the 1950s. The surgeon removes the large intestine and brings the end of the small intestine through the abdominal wall. The doctor then sews it to the skin, creating a stoma that allows intestinal waste to flow directly into an appliance glued to the skin. Stool flows continually, so the patient must wear an appliance at all times.
In the J pouch option, also known as the ileoanal J-pouch, IPAA, or the pull-through, the surgeon removes the colon and rectum but leaves the anal sphincter muscle intact. The surgeon then creates an internal pouch from the small intestine and connects it to the anal sphincter muscle.
Individuals with a J-pouch typically have four to seven stools per day. One of the benefits of the J-pouch is that the person can delay a bowel movement for as long as an hour after experiencing the first urge. Unfortunately, many patients who try the J-pouch have a poor outcome, with a failed J-pouch producing an excessive number of stools each day, incontinence, irritation and pain. Many patients with a failed J-pouch benefit from BCIR.
BCIR is an acronym that stands for Barnett Continent Intestinal Reservoir. BCIR is similar to the original Kock Pouch Continent Ileostomy but with several important modifications. The primary modifications include a collar made from the patient’s small intestine, a valve and a pouch. The modifications reduce the risk for the most serious complications of the Kock Pouch, especially slipped valves and fistulas. The intestinal valve creates a self-sealing pouch that prevents the escape of gas and stool.
To drain stool, the patient inserts a thin, flexible catheter through the stoma and into the pouch. Emptying the pouch in this manner causes no pain for patients. Most patients empty the pouch two to five times each day, but some people empty the BCIR pouch more frequently.
These ostomy options are also available to people who have already had surgery and are living with an ileostomy. Patients with a failed J-pouch or, for example, malfunctioning Kock pouch may also find freedom with the BCIR.