Why you shouldn't restrict fluid intake

Why you shouldn’t restrict fluid intake

            Indiana pouch patients quickly become aware that restricting fluid intake lets them go an hour or two longer between catheterizations, a useful device to avoid interrupting travel or a social event. That’s OK for special times but it shouldn’t become a habit.

            Inadequate intake of fluids is an invitation to dehydration, especially among older persons, the group that is more likely to have had bladder replacement surgery. Don’t rely on thirst to let you know when you need fluid. The thirst mechanism is quite unreliable in persons over the age of 60. Dehydration causes fuzzy thinking, poor concentration and it increases the risk of falls. In IP patients it causes mucus to become thicker.

            In normal persons as well as in those with an IP, inadequate fluid intake over time increases the risk of stones within the pouch or the kidneys. If you have a personal or a family history of kidney stones you should take extra care to avoid dehydration.

            Whether from an Indian pouch or a normal bladder, urine should always be light yellow and there should be only a mild odor. There are so many factors that affect urine volume (food and fluid intake, ambient temperature, humidity, physical activity, altitude) that the oft-quoted “8 glasses  day” doesn’t make sense. If you’re lounging outside on a cool day it’s too much; if you’re doing yard work on a hot, humid day it’s too little.

Catheterization and cleanliness

Catheterization and cleanliness

            In multiple studies over several decades, thorough handwashing has been found to be an effective way of preventing transmission of harmful germs from one person to another. Potentially dangerous bacteria surround us and coat every object that we touch. That includes things that we don’t seem to think about, like computer keyboards. Yet, even in places that we should worry about, like public toilets, many users breeze right past the bank of sinks on the way out the door.  

            Catheterizing an Indiana pouch doesn’t have to be an absolutely sterile procedure but it should be as clean as is practical. Ordinary soap and warm water work fine; antibacterial soaps are not necessary and some authorities feel that they select out resistant germs over the long run. That probably matters in the hospital but not in your home, so use an antibacterial soap if it makes you feel more secure. 

            How long should handwashing take? Use the same routine that some infectious disease specialists recommend: lather as long as it takes to sing two choruses of Happy Birthday.

            As a little extra insurance I use an antibacterial foam just before picking up the catheter. That’s probably a little overkill but the extra peace of mind costs only pennies.

Bleeding from the stoma

Bleeding from the stoma

            An occasional spot of blood might appear on the dressing that covers the urostomy. That’s no big deal, since the mucosa, the lining of the small intestine that forms the opening, is somewhat fragile.

            Frank blood in the urine is another matter. There are several reasons, including trauma to the pouch somewhere between the stoma and the new bladder during insertion of the catheter. Other causes include infection and stone.

Cancer within the pouch is a remote possibility and it sometimes causes bleeding.  But be reassured: after more than 20 years’ experience only about a half-dozen cases have been reported. If you have had a personal or family history of multiple polyps of the colon, consider discussing pouchoscopy with your urologist. It makes sense to look at the colon-become-bladder at least as often as your gastroenterologist recommends colonoscopy.

            Obvious blood in the urine is always an indication to see your physician without delay.

Supplies: saving out-of-pocket expenses

Supplies: saving out-of-pocket expenses

            Most persons with an Indiana pouch are old enough to be on Medicare, which covers the cost of catheters and some other supplies. There are items that are our own responsibility and I’d like to share my experience in regard to a couple of them.

            I had quite a shock when I paid $4.40 for a single roll of paper tape at a local chain pharmacy. Motivated to go online, I found the identical item for 72 cents.

            My favorite irrigation syringe comes with a tray, fluid container and towel and is made by Bard. It costs $2.78 online. It is not the least expensive set and it’s meant to be single-use. However, with proper cleaning and a 50-50 vinegar/water rinse it lasts for at least a week before getting too stiff to work easily. Less expensive syringes become unusable after a few irrigations.

            If you prefer sterile 2 x 2 gauze pads instead of (unsterile) cotton rounds, the cost at the pharmacy is considerable. They are available online at a fraction of the local retail cost. Cotton rounds are usually available at the Dollar Store for half price.

            My online vendor is Quality Medical Supplies. I have no financial interest in any company and you might find others that are even less expensive. Please do share that information with me and readers of this blog.