Question: 

Can a person have an ileostomy or J pouch without exhausting all medical management – This is a colorectal surgeon question. I have reached out to one of our colorectal surgeons, and he says it is unusual to perform the surgery, but it could be done.

Response:

There are pros and cons to both Ileostomy and J pouch procedures.

A J pouch procedure is usually either a two or 3 stage procedure. If you are wondering whether an ileo or J pouch is better, sometimes a 3 stage procedure can help make this decision.

A 3 stage procedure: 

Stage one is the removal of the colon and the creation of an end ileostomy. (The anus is preserved). This stage, which can be anywhere from 3 months to a few years, allows the individual to live with an ileostomy and see how they manage. If they find it uneventful, many elect to stay with an ileostomy.

Stage two is the creation of the J pouch and a loop ileostomy

Stage three is the reversal of the loop ileostomy, which activates the pouch

A 2 stage procedure – no opportunity to determine if they like having an ostomy as the pouch is created, and often, the loop is a more challenging stoma to manage.

Stage 1 is the creation of the J pouch and loop ileostomy

Stage 2 is the reversal of the ostomy, which activates the pouch

The following pros and cons are based on experience from patients and are not inclusive of all pros and cons.

Ileostomy – Pros and cons

Pros

  1. You don’t need to find a bathroom to empty, technically could empty your pouch into any container.
  2. Depending on the output consistency, you have more control over when to empty. E.g., you can wait 10min or ½ hour depending on how full the pouch is.
  3. Only one surgery
  4. Once the stoma is settled and a pouching system is determined that fits your abdomen and lifestyle, few problems occur.

Cons

  1. If the created stoma is not ideal – flush or in creases and folds, pouching could be challenging, leading to skin issues.
  2. Depending on the province one lives in, there could be coast associated with purchasing supplies.
  3. Access to ostomy nurses varies across Canada.
  4. Development of parastomal hernia if not cautious – sometimes not preventable regardless of being cautious
  5. Modified diet, especially in the first 6-8 weeks
  6. Dehydration if you don’t drink enough or replace electrolytes ( food or electrolyte replacement tablets)

J Pouch – Pros and cons

Pro’s

  1. No need to wear an external pouch
  2. No cost to supplies; you may need to purchase medication like Imodium, which might not be covered
  3. No parastomal hernia
  4. Once the pouch is connected, few dietary restrictions
  5. Less electrolyte replacement needed

Con’s

  1. Multiple surgeries
  2. Once the J pouch is connected
    1. Initially, incontinence may occur, especially at night may require incontinence products.
    2. Skin issues if incontinent requiring barrier creams
    3. Decreased sleep until able to control the pouch
    4. Need to learn how to empty the pouch and also how to hold the stool in to allow the pouch to stretch to develop capacity
  1. Frequent bathroom visits
  2. Pouchitis can occur, which is inflammation of the pouch – requires medication. If the pouchitis does not resolve over time, one may need to remove the pouch and get an ileostomy. Only a small percentage of patients have this happen.
  3. Depending on the province’s access to resource nurses – NSWOC may be limited.
  4. Usually, medication to thicken the output to help with incontinence is not always covered.

On the Westcoast we have formed a Young people’s ostomy group – usually under 50 and this question comes up a lot. We have individuals with both Ileostomy and J pouches attending the group. We have also formed a J Pouch group where often we have individuals considering a J Pouch attend. If you wish to share the emails please see below:

Ostomy group (under 50)  – unitedostomy2017@ gmail.com

J Pouch group – BCJpouchgroup@gmail.com

If anyone wishes to join to please send an email and we will add them to the mailing list to receive a Zoom invite to the next meeting

Lauren Wolfe RN, BSN, MClSc (WH), NSWOC, CWOCN

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