Things To Know About J-Pouch

After removing the colon and rectum, a surgeon must devise a method to allow the removal of solid wastes from the body. One of several methods in this regard is the creation of a j-pouch, which is a surgically created reservoir at the end of the patient’s small intestine. This internal reservoir is situated over the anal canal, allowing the patient to pass out stools through the anus.

The reason it is called a j-pouch is that it is created by folding the end of the small bowel into itself. After the procedure, it serves as storage that stores stools before the patient moves the bowels. The best thing about this procedure is that it eliminates the need to wear an ostomy pouch.

Conditions raising the need for a j-pouch

A j-pouch or ileoanal reservoir is a preferred option for people suffering from chronic ulcerative colitis. The doctor will decide to refer a patient to a surgeon when symptoms are uncontrollable through medical therapies and other treatments. Other conditions for which the j-pouch can be a good treatment option include adenomatous polyposis (FAP) and colon and rectal cancer.

Benefits of a j-pouch

Control over bowel movements is the most significant benefit of having a j-pouch. That is because this procedure uses the functional anal canal for the passage of stools. The patient can get to the restroom as soon as he feels the need to move his bowels.

J-Pouch Surgery: What To Expect

  • There may be three steps involved in a j-pouch treatment. Most of the time, surgeons complete the procedure in two steps.
  • During the first surgery, the surgeon removes the colon and rectum. The end of the small bowel is folded into itself and connected to the top of the anal canal.
  • The patient gets a temporary ileostomy for the removal of wastes. It gives the newly created j-pouch some time to heal. Ileostomy surgery results in the creation of a stoma, which is an opening on the abdominal surface to allow bodily wastes to leave the body. The patient needs to wear an ostomy bag over the stoma to collect bodily wastes.
  • The surgeon calls the patient for another surgery to reverse the ileostomy and reconnect the bowel. After the procedure, waste materials leave the body through the anus instead of the stoma.
  • In some cases, the surgeon may choose to perform the entire procedure in one stage. It means that the patient will not get a temporary ileostomy. The reason your surgeon may want to do it is an increased risk of infection.

What to expect after the procedure

  • It will take some time before your body adapts to your j-pouch. During the first few weeks, you may have to go to the toilet up to 12 times a day. This frequency will reduce over time.
  • Male patients may experience sexual dysfunction due to nerve damage during the procedure.
  • Female patients may develop scar tissues around their ovaries, leading to infertility.

You may need to consider bringing some lifestyle changes to help your body adapt to the newly created bowel diversion in the form of a j-pouch. Be sure to discuss everything with your healthcare provider.

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Damaged Skin Is A Significant Cause Of Concern

You should not ignore the red and irritated skin around the stoma. Your ostomy appliance fits around the stoma only if the peristomal skin is healthy. It allows the skin barrier of the ostomy appliance to form a tighter and more secure seal with it. In case the peristomal skin is damaged, you need to contact an ostomy care specialist as soon as possible. Ostomy care specialists are well aware of individual needs, and they know how to tailor a treatment that is perfect for a specific individual. It is crucial for you to not settle with the pain and irritation in the skin around your stoma.

There can be several factors that can result in skin problems around your stoma. The most common ones of those culprits include leakage of waste, wearing a wrong skin barrier, sensitivity to a skincare product you have been using, and frequent ostomy pouch changes.

Generally, a cut-to-fit ostomy pouch has been the most preferred option considered by a majority of people with ostomies. There are several reasons this ostomy pouch is a great fit for most types of stomas. The fact that it allows you to cut the skin barrier to fit the shape and size of your stoma is the good enough reason you should prefer choosing a cut-to-fit skin barrier to manage your ostomy. It’s a perfect solution for the stomas that change their shape and size frequently.

Remember, if your peristomal skin feels tingling, burning, itching, or any other kind of discomfort, don’t ignore it. It’s not normal. Look under the flange to check the skin underneath it. The earlier you catch the problem, the sooner you will be able to get rid of it.

It would be worth describing a few tips for treating skin irritation with stoma powder.

  • Apply stoma powder over the dry and clean skin. Avoid using soaps and other products that contain chemicals and perfumes.
  • Apply a dusting of the stoma powder on the area of peristomal skin that is red or itchy. Brush of the excess powder using a soft cloth.
  • Dap the skin prep over the powdered area. It will seal the stoma powder in place to promote the healing of the skin.
  • Many people think that baby powder works the same way as the stoma powder. Both are different products. Baby powder can’t absorb water like the stoma powder.

The steps mentioned above should help you get rid of the skin problem in its early phase. If there is no improvement, you must contact the ostomy care nurse for immediate troubleshooting.

Impotence After Ostomy Surgery

Some men get impotence after ostomy surgery. This state refers to the loss of sexual enjoyment, and inability to sustain an erection long enough to ejaculate. It can be quite frustrating in the end.

It may sound like a challenge, but talking to your spouse about this matter can help you to live a healthy and happy life. It is necessary to remain honest to get your spouse on board to deal with this phase. All it requires is positivity to get back your strength.

It can be temporary

It is not uncommon to have temporary impotence after ostomy surgery. After the operation, you might experience a loss of sexual desire and performance. Don’t be discouraged about it. The healing process could take a long time. It may take up to two years for you to recover fully. After two years, you will be able to know whether or not the issue is permanent. If you are receiving chemotherapy or radiation, this can also leave an impact on your sexual performance.

It can be a lifestyle issue

Impotence can be a complicated problem. It can occur in men of different ages, and for varying reasons. More often than not, it is not even a direct result of surgery.

Impotence can be a result of both psychological and physical factors. In many cases, it is only due to the doubt about your ability to have erections or climax. If that is the case, a vicious cycle of loss of belief and continued failure starts, and it continues until you do something about it.

Other lifestyle issues that can contribute to impotence include:

  • Fatigue
  • Use of drugs and alcohol
  • Smoking
  • Performance anxiety

Impact of surgery is not out of the question

Sometimes, any damage to the nerves that govern erection or ejaculation during ostomy surgery can lead to impotence. The nerve pathway, which gives way to stimuli to travel to result erection, is very close to the rectum. If this pathway receives damage during the surgical procedure, it can affect a person’s ability to have or maintain an erection.

Men with colostomy are more vulnerable to impotence, especially the ones undergoing extensive colostomy surgery. Such treatment can result in damage to the nerves that run stimuli that result in an erection.

In most of the cases, the impotence resulting from surgery is not permanent. Even in that case, medical science has developed enough to help impotent people.

Things You May Want To Know About Stoma Reversal

A stoma is formed with the loop of bowel, which the surgeon brings to the surface of the abdomen. Based on the type of ostomy, a stoma is created on the colon or the small intestine. The patient has to wear an ostomy bag over the stoma to collect feces or urine. With a permanent stoma, a patient has to stick with the ostomy care regimen for the rest of his life. A temporary stoma, on the other hand, is reversed after the diseased part of the intestinal tract heals.

Stoma reversal surgery involves reconnecting the stoma, which is a piece of the bowel, with the remaining part of the colon or small intestine. The doctor then closes the stoma site using sutures. The reversal procedure for both colostomy and ileostomy is the same.

Your doctor will recommend the reversal of your stoma only if he is confident about you regaining your bowel movement. He will run some tests to check if your bowel has recovered, and that your sphincter muscles are strong enough to help you deal with the bowel movements.

Who can have stoma reversal?

You can consider yourself a good candidate for stoma reversal surgery if you have enough of the rectum left intact, have sufficient muscle strength in your sphincters, don’t have any disease left in the colon or other areas of the intestinal tract, or are in good overall health. The optimal time for stoma reversal surgery is three to twelve months, depending on when your colon heals.

Stoma reversal surgery

Generally, stoma reversal surgery is not as complicated as ostomy surgery, unless you have any other complications, such as a hernia. It can be open surgery, or a laparoscopic one, depending on the case complexity. Your doctor will tell you which option is appropriate for you. Generally, the surgical procedure for stoma reversal takes 1-2 hours.

After the stoma reversal

You cannot expect immediate normalcy in your bowel functions after the stoma reversal. The disconnected part of your bowel had to remain out of action for several months, so you have to be ready to wait for a few more months before your bowel starts functioning again.

That said, you are going to have to stick with a liquid diet for 24 hours after the surgery. After that, you can switch to soft foods. You can move around to stimulate the bowel movement. You might have to stay in the hospital for 3-5 days. During that period, you will have access to the highly trained ostomy care staff that can help you with the critical recovery process during your stay at the hospital.

When you may start with the normal diet and a bit intense physical activity depends on how soon your intestinal tract regains strength. By following the doctor’s instructions, you can ensure a quicker recovery.

Some Most Common Stoma Complications

Stoma problems are not uncommon. They occur from time to time, and from case to case. Most of these issues are not severe and are preventable by adjusting your routine, switching to a different product, or making a diet change.

That said, we are now going to talk about the most common stoma complications.

Stoma skin problems

Perhaps the most common stoma complication is related to the skin around the stoma. Not only can the peristomal skin complications turn out to be quite uncomfortable for the patient, but they can also compromise the seal formed between the wafer and the skin, leading to the leakage and further skin problems.

One of the reasons for the occurrence of skin complications is the fecal contact with the skin. This contact can lead to soreness and irritation. The stomal output can be more acidic and corrosive if you have an ileostomy. You have to make sure that your stomal output is not coming in contact with the skin.

Another reason is the ill-fitting of stoma appliances. Every ostomy appliance comprises a skin barrier, which has a hole to make the wafer fit around the stoma. Ill-fitting is when that hole doesn’t fit the size and shape of the stoma. Any part of the skin that remains exposed under the skin barrier is susceptible to skin complications. If your stoma is not of regular shape and size, you may benefit from cut-to-fit ostomy pouching systems.

Stoma bleeding

A stoma has a lot of blood vessels all over its exposed and unexposed surface. The most common reason for the stoma bleeding to occur is the bag rubbing around the stoma. Sometimes, bleeding occurs when you clean the stoma. If the bleeding occurs from inside the stoma, you need to contact your doctor or ostomy care nurse immediately because it might be a problem inside the intestinal tract. You can prevent external bleeding by being careful with your stoma.

Retraction and prolapse

Stoma protrudes slightly from the surface of the abdominal wall. The length of the protrusion depends on the type of ostomy you have. A stoma retraction refers to the less or no protrusion of stoma, which can lead to the ill-fitting of the ostomy bag. Generally, you can take care of stoma retraction by using ostomy bags with convex wafers.

Another issue is the prolapse, which involves the stoma extending beyond normal. Health issues that might cause prolapse may include weakness of the abdominal wall, rapid weight gain, and large incision in the abdominal wall. A prolapsed stoma can make it impossible for the fesses to pass through it. You can use a different ostomy bag to put your stoma at ease. If the prolapse is severe, you can discuss the option of re-siting of your stoma with your surgeon.