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 does not leak out. Instead, a tube called a catheter is inserted when it is time to empty the pouch.

As the pouch fills with intestinal contents (liquids, partly digested food etc.), pressure builds up in 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 or continent ileostomy as instructed by your doctor or other medical professional. How often the pouch needs to be drained varies from person to person but there are some general guidelines. Immediately 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 two or three weeks to allow the pouch to heal and mature. After the three weeks you should drain the pouch about four to six times per day. However, this varies from person to person and the frequency may reduce further over time.

Discuss your specific needs with your doctor, surgeon or your stoma nurse (a nurse who specialises in the care of stomas. Most likely this person will meet, or has met, with you before the operation and will continue to instruct you on how to take care of your stoma, ostomy or pouch)

Guidelines for draining the pouch

• Constant drainage is recommended for the first two or three 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 a water-soluble lubricant (DO NOT use Vaseline or other 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 period, irrigate the catheter twice a day with 30ml (two tablespoons) of tap water and let it drain off. (See "Instructions for catheter care" below 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 checking 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 two or three centimetres.