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.

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.

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.

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.