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-pouch 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 K-Pouch or Continent Ileostomy?
The best way to prevent problems is to drain your K-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 three to four weeks to allow the pouch to mature. After the catheter is removed you will drain the pouch several times per day. The number of times you need to drain the pouch each day becomes 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.
General Guidelines for Draining the K-Pouch
As mentioned above, please discuss your individual case with your health care providers. The following are general guidelines for draining the K-pouch. Constant drainage is recommended for the first three to four 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, change positions and try again.
- During this initial period, you will need to irrigate the catheter serveral times 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 it. Flush the catheter with cool tap water then reinsert it.
After the first three to four weeks you can stop the continuous draining and start draining several times per day or as instructed by your doctor or health care 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 two hours during the day while you are awake.
- Drain at bedtime and first thing in the morning.
- Do not drink or eat within two hours of bedtime.
- During the night, you will usually set the catheter to constant drainage. You may also choose to set your alarm clock to wake you to empty the pouch.
Over the next several weeks, the time interval between pouch drainages will increase. At night, you may be able to stop the constant drainage and go for longer periods without waking to drain the pouch.
Three months after surgery, there are usually no specific restrictions. Sound practice is to empty the pouch four to six times per day and use irrigation on two 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.
How Do I Care for the Continuous Draining Catheter or Tube and my Skin
Good skin and catheter care need to be continued after you go home from the hospital. It is important to keep the skin around the catheter clean and protected, as well as make sure the catheter is open and draining. The following guidelines will help you properly care for your catheter.
1. Gather the following supplies
- Washcloths or paper towels
- Non-oily soap (Ivory and Dial are recommended brands)
- Plastic bag or newspaper
- Irrigation supplies: tap water, bulb syringe, and basin
2. Wash your hands with soap and warm water and dry them with a clean towel.
3. Irrigate the catheter
- Remove the dressing over the stoma and discard it.
- Separate the catheter from the drainage bag and drain the contents of the catheter into the basin.
- Collect 30 cc (1 ounce) of tap water into the bulb syringe. Tip: Highlight the 30 cc mark on the bulb syringe with permanent marker or nail polish for accurate, easy measurement.
- Insert the 30 cc of tap water into the catheter by slowly squeezing the bulb syringe to release the water.
- While holding the syringe bulb down with your thumb, pinch the catheter and separate the bulb syringe from the catheter.
- Unpinch the catheter and drain its contents into the basin. Do not withdraw the fluid from the catheter into the syringe.
- If the fluid you just put in seems to be taking a long time to come back out, or if mucus blocks the catheter, repeat the previous irrigation steps as needed until stool flows freely through the catheter. If water doesn't go in or come back out, the tube may be blocked. You may have to remove the catheter from the stoma and rinse it with cool tap water to clean any mucus built up inside the catheter. Then reinsert the catheter. Do not put in more than 60cc (or 2 ounces) of water without the pouch contents emptying.
- When the stool flow has stopped, continue to step four.
4. Reconnect the catheter
5. Cleanse the skin around the stoma and catheter
- Wash the skin around the stoma and catheter with non-oily soap and warm water.
- Rinse the skin thoroughly with warm water.
- Pat the skin dry with a soft towel or paper towel.
- Apply two layers of "split" dry gauze dressing around the catheter and over the stoma. Secure with tape as needed.
- Discard the waste.
- Wash the basin and the bulb syringe with soap and warm water. Let the supplies air dry, or dry with a clean towel.
- Wash, rinse, and dry your hands.
Other Helpful Tips About K-Pouch Care
These other tips can help you properly care for your K-pouch:
- Inspect the catheter frequently to be sure drainage is flowing freely through the tube.
- Irrigate the catheter twice a day, or as instructed by your ET nurse or doctor. Irrigate with 1 ounce of tap water, and let it drain off.
- As a general rule, most patients will have continuous drainage into a drainage bag until their first follow-up appointment after surgery. During this time, you should not experience: Pressure beneath the pouch; Absence of stool draining from the catheter; Stool leaking around the catheter.
- If any of these signs or symptoms occur: Check the catheter for kinks; Irrigate the catheter; Pinch the catheter between your finger and thumb and check if a fluid or air column can be seen moving up and down. If the above steps do not work to relieve symptoms, remove the catheter, clean it, and replace it. Call your doctor if problems continue.
- Inspect the stoma daily. It should look shiny, moist, and red. Report any changes to your doctor.
- If stool becomes too thick and movement through the catheter appears slow or difficult, increase your fluid intake to 10-12 eight-ounce glasses of fluid daily. Include water, juice, and other non-caffeinated beverages.
- Never take laxative preparations, as they can cause diarrhea and lead to dehydration.
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Reviewed by Arnold Wax, MD on September 19, 2009