Saturday, August 27, 2011

Is there any reason to measure pouch output?


Is there any reason to measure pouch output?
            Once you get to know what the character and the volume of your pouch are like you can probably simply attend to the business of emptying it. However, for the first few weeks or months mucus production will vary and the capacity of the pouch will gradually increase.
            If you drain the catheter directly into the toilet bowl it’s hard to appreciate the amount and the character of the urine, i.e., if it’s concentrated and you’re behind on fluids, if it’s cloudy and possibly infected or if there is a small amount of blood present. If there’s lots of mucus the flow might be very slow, making it hard to tell if the pouch is really empty.
            Eighteen months after surgery I’m still emptying the pouch into a measuring cup placed in the bathroom sink. An inexpensive plastic one with a capacity of one quart works fine. You’re not likely to ever put out more than 1,000 ml at a time and it’s easy to pour it into the commode.
            Volume, of course, will vary with fluid intake, ambient temperature, physical activity and other factors. I aim for an output of about 100 ml per hour.
            I use the measuring cup when I irrigate to be sure that I’m getting out as much irrigation fluid (sterile saline) as I put in.

Sunday, August 21, 2011

Protect the stoma


Protect the stoma
            The visible opening of the Indiana pouch is actually the lining of the small intestine. Nature never intended for it to be exposed to the environment for years but it does hold up pretty well in spite of that. There are a couple of reasons to keep it covered. 
            The cells that make up the lining of the intestine produce mucus constantly. It may not be much and it can easily be absorbed by a cotton round or 2 x 2 gauze pad. The former is a little more gentle on the exposed mucosa and the surrounding skin. Some Indiana pouches leak more than others; the cotton round or gauze are at least a little protective.
            Having never been without the cotton round or gauze I don’t know how susceptible the stoma is to the chafing of clothing but I’d rather not cause any irritation there.
            Some IP-ers add a little more protective absorbency with nursing pads or sections of feminine napkins. The former are more expensive but they work out well for those who only have to replace them every couple of days.
            If any readers can suggest alternatives to these ideas, feel free to reply to this blog.

Sunday, August 14, 2011

Does cranberry juice prevent pouch infections?


Does cranberry juice prevent pouch infections?
            For decades, some physicians have recommended that persons prone to bladder infections drink up to a quart of cranberry juice every day. The success rate, as shown in several studies, is about 35%. Chemicals within cranberry juice prevent some strains of the E. coli bacterium from adhering to the bladder wall.
            There are no studies yet on cranberry juice and Indiana Pouch infections and there probably won’t be any in the near future, if ever.
            First, a pharmaceutical company can’t patent cranberry juice, so why spend the money on research? Considering the small number of patients with an IP, Ocean Spray, which markets about 70% of the juice in the U.S., probably won’t do any studies, either.
            Second, pouch infections aren’t common, although some unfortunate patients get them repeatedly. The lining of the IP is much different from the lining of the original urinary bladder and the presence of colonic mucus might have either a positive or negative effect on potential infecting organisms. After all, the human colon tolerates most strains of E. coli very well.
            Finally, drinking up to a quart of cranberry juice every day is a challenge. It’s one of the reasons that research studies get scratched – too few participants can drink that much juice every day for the year or more that it takes to gather meaningful statistics.

Sunday, August 7, 2011

How often to irrigate an Indiana Pouch


How often do you need to irrigate?
            After reading numerous blogs and medical journal articles on this subject I’ve come to the personal conclusion that one irrigation per day (about 200 ml. or five 40-50- ml syringefuls) is worth doing. Here’s why.
            Stone formation within the pouch appears to be more common in persons who irrigate infrequently or not at all. Components of mucus might provide the nucleus for a stone. It takes a year or more, in most people, for the colon to slow down its mucus production. Although I produce less mucus after more than a year than I did in the first couple of months, I’m still surprised occasionally by the large amount that is present. (The next time I go to a Chinese restaurant I’ll avoid the egg-drop soup!)
            Sometimes the largest amount shows up in the third or fourth syringeful. It also helps to vary the position (depth) of the catheter. Unlike your bladder that left the hospital before you did, the new one does not have a smooth interior but has some nooks and crannies – not very scientific terms but descriptive.
            If you make it a practice to irrigate at about the same time every day it will become a habit but not a burdensome one. 
            Guaifenesin might help to reduce mucus. We'll cover it in a later blog.
Check with your surgeon to be sure that he or she agrees with this opinion.