Also called a K-pouch, a continent ileostomy is a connection of the end of the small intestine, called the ileum, to the skin of your abdomen. A surgeon makes it so that waste can leave your body, because it can't leave the usual way.
Unlike other ileostomies, the K-pouch has a valve that the surgeon makes. She sews the intestine in a special way so that waste material doesn't leak out. Instead, you insert a tube called a catheter when it's time to empty the pouch.
As the pouch fills with what’s in your intestines (such as liquids and partly digested food), pressure builds up on the pouch and its many stitches. Without relief, the pouch could tear or develop a hole, or the valve could slip or leak.
How Often Do I Drain It?
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 the surgeon will leave a tube in the pouch to drain continuously. This will last for about 3 to 4 weeks to allow the pouch to mature. After that, 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.
Talk with your doctor, surgeon, or enterostomal therapist (ET), a nurse who specializes in the care of stomas. Most likely, you will have met them before the operation. They can remind you of how to take care of your stoma, ostomy, or pouch.
How to Drain the K-Pouch
Constant drainage is best during the first 3 to 4 weeks for a new pouch. If the catheter or tube accidentally falls out before that time, you can put it back in with these simple steps:
- Relax your abdominal muscles. It may be helpful to bend your knee as you do that.
- Relubricate the catheter with water-soluble lubricant. Don’t use Vaseline or other products containing petroleum jelly.
- Reinsert the catheter up to the preset mark. If you find this hard to do, relax, change positions and try again.
During this initial period, you will need to irrigate the catheter several times a day with 1 ounce of tap water and let it drain off.
If, at any time, you think pouch drainage has stopped, do these four things:
- Irrigate the catheter.
- Pinch the catheter between your finger and thumb and check to see if a fluid or air column is moving up and down.
- Check for fluid return.
- Wiggle the catheter in and out about an inch.
If you still think pouch drainage has stopped, remove the catheter in case food particles or debris has blocked it. Flush the catheter with cool tap water, then reinsert it.
After the first 3 to 4 weeks, you can stop the continuous draining and start draining several times per day, or as instructed by your health care provider. 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 hours during the day while you are awake.
- Drain at bedtime and first thing in the morning.
- Don’t drink or eat within 2 hours of bedtime.
- During the night, you will usually set the catheter to constant drainage. You may also set your alarm clock to wake you to empty the pouch.
Over the next several weeks, you can wait longer between pouch drainages. At night, you may be able to stop the constant drainage and go for longer periods without needing to drain the pouch.
Three months after surgery, there are usually no specific restrictions. You’ll probably need to empty the pouch four to six times per day and use irrigation two of these times. But anytime you feel full or bloated, drain the pouch. And do it before you work out or go to bed.
Take Care of the Catheter and Your Skin
You’ll need to keep the skin around the catheter clean and protected, and make sure the catheter is open and draining.
First, gather these supplies:
- Washcloths or paper towels
- Soap that isn’t oily
- Plastic bag or newspaper
- Irrigation supplies: tap water, bulb syringe, and basin
Wash your hands with soap and warm water, and dry them with a clean towel.
Irrigate the catheter. To do this:
Remove the dressing over the stoma and throw it out.
Separate the catheter from the drainage bag and drain the contents of the catheter into the basin.
Collect 1 ounce of tap water into the bulb syringe. Tip: Mark this spot on the bulb syringe with permanent marker or nail polish for accurate, easy measurement.
To insert the ounce of tap water into the catheter, slowly squeeze the bulb syringe to release the water.
While you hold 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. Don’t withdraw the fluid from the catheter into the syringe.
If the fluid you just put in seems to take a long time to come back out, or if mucus blocks the catheter, irrigate again 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. Don’t put in more than 2 ounces of water without the pouch contents emptying.
When the stool flow has stopped, reconnect the catheter. Cleanse the skin around it and the stoma. Use a non-oily soap and warm water to do that. Rinse, and pat dry with a soft towel or paper towel.
Put two layers of "split" dry gauze dressing around the catheter and over the stoma. Secure with tape as needed.
Throw out the trash. 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
Check the catheter often to be sure drainage flows freely through the tube. Irrigate it twice a day, or as instructed by your ET nurse or doctor.
You should also inspect your stoma daily. It should look shiny, moist, and red. If you see any changes, tell your doctor.
If your stool becomes too thick and movement through the catheter slows down or has problems, you may need to drink more water, juice, or other beverages that don’t have caffeine. Go for 10-12 glasses -- 8 ounces each -- per day.