Caring for a Continent Ileostomy
What Is a Continent Ileostomy?
The continent ileostomy, or K-pouch, is a connection of the end of the small intestine, called the ileum, to the skin of your abdomen. It allows waste to be drained. Unlike other ileostomies, the K or Kock ileostomy, has a valve made by sewing the intestine in a special way so that waste material doesn't leak out but rather a tube called a catheter is inserted when it's time to empty the pouch.
As the pouch fills with intestinal contents (liquids, partly digested food, etc.), pressure builds up on the pouch and its many stitches. If this is not relieved the pouch could perforate or tear from the excessive stretching or the valve could slip or leak.
How Often Do I Drain the Pouch or Continent Ileostomy?
The best way to prevent problems is to drain the pouch as instructed by your doctor. How often to drain the pouch varies from person to person but there are some general guidelines. Right after the operation you will have what doctors call an indwelling catheter. Meaning that the drainage tube will be left in the pouch to drain continuously. This will last for about 3 weeks to allow the pouch to mature. After the 3 weeks you should drain the pouch about 4-6 times per day. However, this varies from person to person and how often will become less over time.
Please discuss you specific needs with your doctor, surgeon, or enterostomal therapist (ET), a nurse who specializes in the care of stomas. Most likely this person will meet or has met with you before the operation and has or will be instructing you on how to take care of your stoma, ostomy, or pouch.
Guidelines for Draining the Pouch
Constant drainage is recommended for the first 3 weeks for a new pouch. If the catheter or tube accidentally falls out before that time, you can easily put it back with these simple steps.
- Relax your abdominal muscles. It may be helpful to bend your knee as you relax your muscles.
- Relubricate the catheter with water-soluble lubricant (such as K-Y Jelly, Surgical Lubricant or Surgilube; DO NOT use Vaseline or products containing petroleum jelly).
- Reinsert the catheter up to the preset mark. If you have difficulty with this, relax, walk around for 20 minutes and try again.
During this 3-week period, irrigate the catheter twice a day with 1 ounce of tap water and let it drain off. (See below "Instructions for Catheter Care" for a step-by-step guide to skin and catheter care.)
If, at any time, you think pouch drainage has stopped during the course of the day, then check by:
- Irrigating the catheter
- Pinching the catheter between your finger and thumb and check if a fluid or air column can be seen moving up and down
- Checking for fluid return
- "Wiggling" the catheter in and out for about an inch
If you still think pouch drainage has stopped, remove the catheter in case food particles or debris have blocked the catheter. Flush the catheter with cool tap water then reinsert it.
After 3 weeks you can stop the continuous draining and start draining several times per day or as instructed by your doctor or healthcare providers. Though you usually make this change after seeing your doctor for the first time after the operation, sometimes your doctor will tell you to start doing the following earlier.
- Drain the pouch every 2-3 hours during the day while you are awake.
- Drain at bedtime and first thing in the morning.
- Do not drink or eat within 2 hours of bedtime.
- During the night, you may set the catheter to constant drainage or set your alarm clock for about 3-4 hours to wake you to empty the pouch. Either technique is fine.
During weeks 4 and 5, follow these guidelines:
- Drain every 3-4 hours during your waking "day."
- Drain at bedtime and first thing in the morning.
- Do not drink or eat within 2 hours of bedtime.
- During the night, draining is not usually necessary unless a full pouch is found when you awake in the morning. If there are any concerns, set your alarm clock for about 3-4 hours to wake you to empty the pouch.
During week 6, follow these guidelines:
- Drain about every 4 hours during the day while you are awake.
- Drain at bedtime and first thing in the morning.
- Do not drink or eat within 2 hours of bedtime.
- During the night, drainage is not necessary unless the pouch is full in the morning when you wake. If there are any concerns, set your alarm clock for about 3-4 hours to wake you to empty the pouch.
Three months after surgery, there are no specific restrictions. Sound practice is to empty the pouch 4-6 times per day and use irrigation on 2 of these times. However, any time you feel full, bloated or distended, drain the pouch. Just as you would empty your bladder before engaging in physical activity or going to bed, so should you empty the continent ileostomy.
Next: How do I care for the continuous draining catheter or tube and my skin »
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