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.

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.

Emergency IP kits for the compulsive

Emergency kits for the compulsive IP-er

            If you’re a worry-wart like me or a survivalist you might consider these extra kits.

            For the emergency automobile trunk backpack: in addition to the fire extinguisher, first aid kit, flashlight, emergency blanket, a few bottles of water and food bars and whatever else you’ll think you’ll need when stranded in an hours-long traffic jam, or worse, we IP-ers have some special needs. I keep the equivalent of the Day-Tripper (see last week’s blog) in the trunk backpack.

            Bug-Out-Bag: Survivalists know all about this. Our Southern California family has had to evacuate in minutes because of wildfires and we each have a backpack with water, food bars, first aid kit, cash, extra clothing, etc. Now I have IP supplies as well. My IP B.O.B. contains enough supplies for four days, about half the contents of the One-Weeker.

            I rotate all my perishable supplies and my catheters, gel and saline every six months – January and July. That way, nothing gets wasted but we’ll be ready the next time a fire roars up the canyon behind our home. Your catastrophe could be a flood, hurricane or tornado. Not being able to pee might also be a catastrophe.

           

IP Travel Kits

Travel kits for IP-ers.

            The One-Shot. This is small enough to fit in my jacket pocket, and ladies have even more options. It’s for brief outings like the theatre, restaurants, etc, and an emergency in case of an unexpected leak. I haven’t had to use it yet.

            Contents are in a zip-lock bag with one each: catheter, packet of lube, 2x2 gauze pad, 1/3 sanitary pad, folded paper towel, hand sanitizer, paper tape, large spring-type paper clip to hold my shirt out of the way.

            The Day-Tripper. This is the one that is always with me in my vehicle. A small camera bag is ideal; a small fanny-pack works fine.

            Contents: 4 each of catheter, lube, gauze, pad. One hand sanitizer, clip, a couple of small zip-lock bags for disposal if needed. Two folded paper towels.

            The One-Weeker. A soft computer case with 50 catheters (packed at the last minute – few of us have that many extra) and matching numbers of lube packets, a sleeve of cotton rounds, a full roll of paper tape, a liter of sterile saline or your favorite irrigation fluid, syringe and fluid container, paper towels, about 10 absorbent pads, a few zip-lock bags, hand sanitizer and shirt-holding paper clip. I pack a large (24” x 30”) disposable pad in case of a night-time leak at a hotel or someone else’s home.

            Next week’s blog: emergency kits for the compulsive.

Have Indiana Pouch, will travel.

            Plan ahead. For a car trip we aim for a 4-hour pit stop at a nice facility such as a Hilton Garden, Marriott, etc. Their restrooms almost always have a diapering station, even for dads – perfect for laying out the items we need, or at least a handicapped stall with plenty of room.

            I’m prepared to cath early at 3 hours if traffic up ahead is likely to be heavy. One extra catheterization per day is no big deal if it will avoid being stuck with no place to go.

            You probably won’t have to irrigate during a day trip unless you have a young IP and still have lots of mucus.

Airplane lavatories are cramped but still have enough counter space. If you do have to have saline for irrigation in your carry-on, a letter from your doctor should take care of that problem to get through security.

Be sure to make a practice run at home to be sure that you will have everything you need in your travel kit.

I have five (!) different kits for travel – will cover them in later blogs.

Irrigation solutions

Irrigation solutions

What is the best/safest/least expensive/practical irrigation solution for an Indiana pouch?

            My surgeon recommends sterile normal saline, which costs more than $10 per liter. One liter lasts about a week, a fair piece of change in a year -- a problem if you don’t have insurance coverage. It is sterile, with a long shelf life and it is probably the safest irrigation solution available.

            Is sterility critical? No, since the IP usually has a few benign bacteria in it, as noted in an earlier post. However, be sure to maintain every element of your irrigation – hands, catheter, irrigation solution, solution container, syringe, etc. -- scrupulously clean. You don’t want to replace the good bacteria with the bad ones.

            Does it have to be a “physiologic salt solution” like normal saline?  Normal saline is neither too concentrated nor too dilute so that it can be given intravenously. The normal urinary bladder and the bowel-become-bladder can tolerate both a concentrated (“salty”) or a very dilute urine, so tap or distilled water are both OK for irrigation. Again, the emphasis must be on near-sterility, so boil your water.

Avoiding infection

Almost all IPs contain some bacteria. Studies show that they are the same types that occur in the large bowel but apparently the pouch and bacteria have reached a truce and they don’t usually cause infection. That truce does get broken occasionally and most IP-ers can expect to have a UTI eventually. Here are some thoughts on minimizing infection. We'll cover cranberry and other products another time.

            Use disposable catheters whenever possible. Medicare patients are eligible to receive up to 200 catheters per month. (Tips on care of reusables in a future blog.)

            Drain the pouch as completely as possible every time.

            Follow your doctor’s orders regarding irrigation. Most recommend it daily.

Maintain extreme cleanliness of the irrigation syringe. Although I have seen recommendations for using a turkey baster, the bulb is difficult to clean and can’t be visually inspected. I re-use “disposable” syringes for about a week, rinsing them first in tap water and then in a 50-50 vinegar solution after each use.

Gloves are not necessary but thorough handwashing is a must. A hand sanitizer adds to protection but handle the catheter and syringe carefully anyway.