Different kinds of pouching systems and urostomies

There are two kinds of urostomy surgery termed urinary diversion. The name of this diversion is given on the basis of pathways of urine diverted from the bladder. The two main diversions are:

• Incontinent diversion, often termed as standard or conventional urostomy.

• Continent diversion, often called a continent urostomy or continent urinary reservoir.

  Incontinent diversion:

This type of diversion is performed in case of bladder cancer, any birth defect, or chronic illness.

An ileal conduit is created for this type of urostomy.  A small pouch that holds the urine is called an ileal conduit. It is created by using a small portion of an intestine.

A 6 to 8-inch piece is taken from the lower part of the ileum and cut at the point where it connects with the large intestine and the other region of the ileum is then re-attached with the large intestine. Then the ureters are disconnected from the bladder and connected with the part ileum that was removed. In some cases, the bladder may be removed and in some cases, it remains safe. The last end of the part of the ileum serves as a stoma. And the other end is used to make a pouch or a pocket inside the body that stores the urine. This surgery is life lasting and the patient can’t control his urine. The patient needs to wear an Ostomy bag all the time.

The small intestine has a natural ability to produce mucus. The part of the ileum that was used in the production of the urine pouch will also continue to produce mucus. This mucus will be collected in the pouch along with the urine. There is nothing to worry about this.

Continent diversion:

In this type of surgery, the surgeon needs to create a pouch too. But in this case, the pouch has an addition in the form of valves. These valves prevent the backflow of the urine until it passes out of the body. A catheter is used to drain this pouch 4 to 5 times daily. Your doctor or Ostomy nurse can guide you about the usage of catheters and drainage of the pouch.

• Types:

There are many types of continent diversion surgery depending on the parts that are used to make the pocket or the pouch.

Kock Pouch:

End of the small intestine is used to make the pouch, valves, and outlet.

Indiana pouch:

Ascending colon(large intestine) is used for making the pouch. The last part of the small intestine is used to make the outlet. And in this surgery the natural illoce

Valve is used.

Mitrofanoff Procedure:

This procedure offers different choices. The surgeon can use the bladder, large, small intestine or both for making a pouch. And appendix, fallopian tube, or any part of the ureter is used to make the outlet.

Illeal neobladder:

The ileum is used to make the pouch. In the case of a neobladder, there is no Ostomy performed. The urine simply passes through the urethra. You will not feel the urge for urinating normally so you must make a schedule for urination.

Types of Pouches:

There are different styles and sizes of Ostomy pouches. You can ask help from your Ostomy nurse for the selection of pouch according to your condition. All the pouches involve a collection pouch that is used to collect the urine and an adhesive barrier that gets attached to your skin. This barrier is often called a flange. There are basically two pouching systems.

One-piece pouch: It consists of a pouch and skin barrier both connected together in the same place. When the patient removes the pouch the barrier also gets removed.

Two-piece pouch system: It has a pouch and a separate skin barrier. When the patient removes the pouch and the barrier remains in its place.

During your stay in the hospital, following the surgery, the nurse can guide you about the pouching system and its selection. Some patients can use this pouch throughout the life and some may need to jump to another pouching system in case of weight gain or any other reasons. It’s not necessary to stick with the recommended pouch if you are not comfortable with it. You can try various types till you get the best one for you. 

What is a skin barrier?

There is a constant flow of urine following the surgery that can irritate the skin around the stoma. This can be avoided by using the skin barrier that comes along with the pouching system. It is very gentle and protects the skin from urine and itching. Some brands offer the barrier with a cut but sometimes you need to make a cut according to the size of your stoma.

The stoma looks swallowed just after the surgery, but with the passing days, it will get shrink. During these 6 to 8 weeks the stoma must be measured. There is a possibility that you get a measuring card along with the pouching system otherwise you can create your own. 1/8 inch is the standard size for the orifice on the skin barrier, otherwise, it will be difficult to avoid urine off the skin,.

It totally your choice of you wants to wear an Ostomy belt in order to keep the pouch in place. The belt serves as a wrap around your waist and gets attached to the pouching system.

Using Ostomy belt or tape:

Some people consider it a good choice because they feel more secure and organized. And some people find it embarrassing and they prefer to use tape rather than the belt. The tape can be used just like a frame around the skin barrier in order to prevent the movement of the pouching system.

A pouching system is used to collect the urine and skin barrier is helpful in preventing the urine to touch the skin,

Selection of a pouching system:

It is recommended to consult with an Ostomy nurse or any person who is a certified Ostomy caretaker while choosing your pouching system for the first time.

While you are ready to leave the hospital it's good if you get a referral of an Ostomy nurse or an expert in order to contact them in the future. This will help you to take better care of yourself.

There are many factors such as the size of your stoma, shape of abdomen, scars, or folds near the stomal skin that should be revised while selecting a pouching system. The stomas with the location on hipbone, groin, or wounds need special consideration for the selection of the pouching system. Some brands offer products that can be used in any situation.

The qualities of a good pouching system are:

• Have a good seal that prevents leakage for 7 to 8 days.

• Odor resistant

• Provide protection to the parastomal skin

• Hardly seen under the clothing

• Easy to wear and put off

• Enables you to have a shower or bath wearing them

Factors that can affect the pouching system seal

It is important that the pouching system sticks with your skin properly. It must be changed before any kind of leakage or loosening. Factors such as skin type, scars, weight, climate, diet and activities decide the time period of the pouch to remain sealed. Other factors that can affect the sticking of the pouch are:

• The number of days you can wear a pouch depends on the sweating. Sweating can shorten this period. The heat released by the body will loosen the pouch and let it detach quickly.

• The skin type that is oily or moist can also, reduce the wearing time period.

• Following surgery, there might be a change in your weight. This can also affect the time period of a pouch to remain stick

Application of drainage bag at night:

You can use a night drainage system if you want to be undisturbed during the night. This system is connected with your pouch system that allows urine to pass through the stoma and enter the drainage bag continuously over the night. It prevents the outburst or removal of your stoma pouch. It also helps to protect the kina and stoma from urine pressure.

You should leave a little urine in the pouch before connecting it with the drainage bag. This will prevent the occurrence of a vacuum. Only one inch of the tube should be allowed to enter the bag and should be hanged above the bag. If the urine starts to flow back into the tubes it will stop draining. You can hang a drainage container on the side of your bed.

You can also use a small dustbin. The tubing and drainage collector should be clean regularly. Use vinegar and water mixture for cleaning purposes. More instructions are provided with drainage systems

Closed-end pouches: Maybe a better option for colostomies

People with colostomy have a good option in the form of closed-end pouches. These pouches are without the clips, all the ends sealed. It is supposed to be changed when the pouch is almost 1/3rd filled with feces and needs to be replaced with a new pouch. Some of the closed-end pouches have an additional feature of charcoal filter that enables the gas or flatus to exit the pouch. This charcoal filter helps in the deodorization of the gas, while other pouches are also available without these filters. Many of the companies offer different ranges for the size of the pouches. Starting from the smallest one that can store feces up to 60 ml to the largest one with the storage capacity of 375 ml. These pouches are also accessible as 1 piece system along a light barrier. In this article, our focus is to discuss the advantages and disadvantages of closed-end pouches in detail.

Advantages of closed-end pouches:

The ease and simplicity that come with a closed-end pouch make it the best option for ostomy care. You can simply remove a closed-end pouch and discard it in a waste bin instead of sitting on a toilet seat and drain out feces from your pouch. After the removal of a closed-end pouch, you can immediately apply a new pouch and get a burden down your shoulders. If you are concerned about public places and your social activities there is nothing to be worried about. You can simply remove your filled closed-end pouch place it in a Ziploc bag and throw it in a waste bin. 

 Things you must consider for selecting a closed-end pouch

Size:

Even though there are different sizes of pouches accessible in the market, but not all brands or companies have every size available for each of their product. You might require a take a decision while opting for another product if you are very much concerned about the variety. It completely depends upon the amount and frequency of your feces that which product will suit you best. If you have a routine bowel movement or let’s say if you have predictable bowel movements then you can choose a large bag. Then replace this bag with a stoma cap. But in case of frequent and small bowel movements, you need medium size bag that can be changed once or twice a day.

Gas filters:

Your selection of the closed-end pouch may also depend on the quality of the gas filters. All filters have different functions. In case of loose feces or periods of liquid feces the filter can’t work. It will cause the leakage of stool through the filter that may leave a stain on your clothes. Even though, the moisture does not affect the filter i.e. showering or bathing. For this kind of problem, some companies offer adhesive filter protectors that can easily attach and detach. A little compression in the pouch can also enhance the activity of the filter by enabling gas to enter the filter. In such a situation when you don’t want to use a filter another method called burping is used. Burping is the release of an edge from the flange so that gas can pass out quickly.

Costs of closed-end pouches

One more crucial point that makes a difference is the cost of a closed-end pouch, Most people need 1 -2 pouch daily instead of 1-2 drainable pouches per week. Your financial state can also be considered while choosing closed-end pouches. Creativity can bring any relief in the costs. 

Thin plastic liner

Thin plastic liners can work along with closed-end pouches. They are cheaper as compared to closed-end pouches. And it can leave with you thinking that closed-end pouches are not much expensive. These liners can be lodged inside the closed-end pouch and when the liner gets filled you can simply remove the pouch, take out the liner and place a new liner in the pouch for using the same pouch again. 

Limitations of a plastic liner

If you use a liner it will not allow the filter to be effective. It can also disturb the sealing between the flange and the pouch. There are chances that you may not like closed-end pouches as an option for traveling and going out in public places and pursue using drainable pouches.

Other applications of closed-end pouches:

Though it has been mentioned earlier that closed-end pouches can be an option for colostomies but ileostomy patients can also go for it. The people who undergo the issue like poor hand strength or dexterity may face difficulty in using clipping bags. The closed-end bag can bring them more comfort and ease. In the case of colostomies, many possibilities draining the pouch can be a better option than emptying the bag.

Also, there are one-piece closed-end pouches available in the market. There is no need to apply a stoma paste for using them. They can simply be removed and discarded completely and you can easily cleanse your stoma regularly. This is the best option for people with formed feces. It is recommended not to wear them for more than 1-2 days and then the complete system can be discarded.

Closed-end pouches can help you to manage your colostomies or an ileostomy in a better way. You can seek help from your ET nurse for more details.

What to expect Throughout J Pouch Surgery

J pouch surgery is a complex one, used to treat colitis and other diseases. The procedure is done to remove the damaged colon tissue and allowing the patient to have “normal” movements of the bowel, with the stool going through the anus. During this surgery, you will get multiple procedures where the colon gets removed, the small intestine is reconstructed, and then stool leaves in a controlled manner. 

The Procedure Itself 

This is usually created from the end of your small intestine, creating a J shape for it to wait until you get a bowel movement. 

Like the rectum that’s removed during this, the J pouch doesn’t just store stool, but usually the patient controls the bowel movement, and it eliminates the need for an ileostomy. J pouch surgery is usually done in a couple of steps, with two surgeries performed about 2-3 months between each other. The first step is colon removal, the ileostomy formation, and sometimes the J pouch creation. 

By this point, the small intestine and the large intestine are separate, and leave via the stoma. For the next few months after the J pouch is healed up, the patient lives with an ileostomy, and then when ready, they then get the next procedure, which is where stool is formed, traveling through your small intestine, to the J pouch, and then through the body like how it did back when you had a rectum. 

These two types of surgery are usually the most common kinds of performances, and sometimes, they can do this with one step, where the ileostomy doesn’t get made, the rectum and colon get removed, and then they make a J pouch in your rectal stump, all in one procedure. 

In some cases, they may do this in three different phases, and usually involve up to a 7 day hospital stay.  This can be complex, and hard to understand without a visual aid and such, which is why it’s hard to sometimes be ready for it. 

After Surgery 

Usually, once completed, it might be a long time before you get “normal” bowel movements. Normal post j pouch surgery usually doesn’t mean normal from the standards of the person that’s there. Usually the bowel movements aren’t as controlled, don’t happen often, may not be formed, and might be painful.  It can have a smooth consistency. 

You may experience up to six movements that are controlled in most cases. Someone may think this is an improvement from bloody diarrhea, but usually it can be a bit weird to adjust. In general, once recovery is complete and the person learns which foods aggravate it, usually, it feels good. There are come complications that can happen. one of them includes the nutrition may be decreased in some cases. 

Some may also have strictures, which can narrow the anus cause of scarring, which can obstruct the bowels, make the food a bit difficult, or the stool has trouble moving through your digestive tract when it comes to these movements. 

You also may have skin erosion, since there is nothing that’s absorbing the excess acid in this case.  Sometimes, it may cause burning. Incontinence may happen during recovery too, along with pochettes, which is usually when the pouch is inflamed. 

It also may cause diarrhea or more loose stools in some cases. Sometimes, this is common, and if you’re eating stuff that isn’t starchy, it may cause issues with the stool. Finally, dehydration can happen in some cases due to the excessive bowel movements, and the diarrhea should usually be monitored, and the fluid intake should increase.