Indiana Pouch: A continent catheterizable pouch

What is meant by urinary diversion?

If an individual losses his or her bladder due to any injury, trauma, or cancer, the urinary system demands to be diverted for the outflow of the urine through the body. This process is termed urinary diversion.

What are some considerations for the urinary diversion after the removal of the bladder?

After the removal of the bladder, urine can be controlled by:

  • Ileal conduit: In this process, a small piece of ileum is stitched to the abdominal wall. The urine is constantly released through this opening. That’s why a patient needs to wear a pouch over the skin.
  • Neobladder: A portion of the small intestine is involved in making an artificial bladder and it is then attached to the urethra.
  • Continent catherizable pouch: In this process, a pouch is made inside the body. Urine is stored in this pouch and is drained many times a day using a catheter. The most used and common type of pouch is the Indiana pouch.

What do you mean by Indiana Pouch?

Indiana pouch is a type of continent catherizable urine pouch. A portion of the small intestine, cecum, or ascending colon can be involved in pouch formation.

The ileum is pulled and brought to the abdominal wall near the belly button or at the right side of the abdomen, resulting in an opening called a stoma. The urine is then collected in this pouch. The pouch can be drained by using a catheter. That’s why this process is known as catherizable drainage. The catheter is inserted into the colon pouch. The urine is drained out due to gravity. When the drainage is complete the catheter is taken out. This is a continent reservoir. As it can be understood that there is a limited storage capacity, that’s why the patient needs to drain the urine many times a day.

What are the important parts of the urinary system?

The urinary system comprises two kidneys. There are two ureters in the tube that takes urine from the kidneys to the bladder. The bladder is a portion where the urine is stored temporarily. Then the urine leaves the body through the urethra.

What do you mean by a stoma?

The terminal of a small or large bowel that is brought to the abdominal wall and external to the skin is known as a stoma. The catheter is inserted into the stoma and finally, it reaches the internal pouch. You can’t feel anything on your stoma because there are no nerve endings. It will shrink in size within two months of the surgery. The sutures that were placed near the stoma will take some to come out. These sutures can be engrossed.

Which tubes (temporary) tubes can be seen coming out of the stoma, following an Indian Pouch surgery?

Two tubes are introduced into the skin. The tube which is placed in the cecum is known as the cecostomy tube. It is a large bore-type tube that allows the urine and mucus to be drained out easily.

Another small tube is placed in the stoma into the pouch. It acts as a scaffold to aid the stoma in the healing process.

Ureteral stents can also be seen. These stents help the ureters to reconcile the pouch.

An abdominal drain is also used for the draining of any blood or mucus present in the abdominal cavity.

How many days a patient needs to stopover in the hospital?

A patient with Indiana pouch surgery needs to remain in the hospital for seven to ten days following the surgery. It depends on the medical condition of the patient.

Which are some common instructions while leaving the hospital?

You will receive several instructions when you will be discharged from the hospital. Most, them are about how to change and empty your pouch or how to take care of yourself and your stoma. It is advised to drain the pouch three to four times a day to avoid mucus accretion and blockage of the tubes.

When do you need to revisit the hospital after the surgery?

X-ray of the internal pouch is done within the 3rd week of the surgery. This is known as pouch-o-gram. If the pouch looks completely healed then the cecostomy is covered with the cap and you learn how to drain urine using a catheter. The cecostomy can be uncovered again if there is any difficulty in using the catheter.

How long a patient should wait to resume driving?

A patient should avoid driving for the first three to four weeks of the stoma surgery. Once the X-ray is cleared you can drive.

How much time is needed to recover completely?

It will take almost six weeks to recover. But a patient needs almost three months to feel energetic.

What is the best schedule for draining the pouch after the removal of tubes?

Initially, it is important to drain the pouch after every two hours. Because the capacity of the pouch at that time is 200ml, so you need to drain the pouch to prevent any skin issues. But after three to six months the size of the pouch is stretched and capacity is doubled. Then you need to drain it after every four to six hours. Indiana pouch demands time to increase the capacity.

What are some possible side effects of the Indiana pouch?

Some possible side effects are:

  • B12 deficiency
  • A large amount of mucus production
  • Infections in the urinary tract
  • Incontinence
  • Stoma scars

How to Change a Stoma Bag 

A stoma bag is one that needs to be changed as often as you feel you have to change. 

Some people  may do it once a day, other times it’s about 3 or more times. Typically it’s every time a bowel movement occurs. When it comes to ileostomy, you’ll typically have a pouch that is drainable, which can be emptied during the day and then changed every couple of days depending on how long the wafter lasts. 

It’s a little bit scary at first, but here, we’ll discuss the different ways to do it, and once you work on it, you’ll find it only take sa few minutes to do. 

Changing the Stoma Bag 

First, you must check to make sure you’ve got everything needed for the change, such as wet wipes that don’t have a smell, dry wipes, an adhesive remover spray or some wipes, the barrier spray or rings or paste, the bag itself, and a sack for disposal. Typically you’re probably already fitted with all of these. 

Next, make sure the bag is the right size and adjust as necessary for the bags itself. 

First there, wash your hands before you start with this process. 

The next thing you should do of course is to make sure you’ve got wipes on hand to make sure it doesn’t spill into the clothes itself.   

Next, when you hold the skin near the stoma in a taut manner, you first peel back the bag in a slow and careful manner. Keep the tissues on hand to wipe the top area of the bag where it’s peeled to avoid spillages at the opening. Remove your bag, and then put it in the disposable sack. 

Slowly clean the skin with warm water and wipe. Don’t try to do this with soap and water since it can be abrasive, but instead use wet wipes that aren’t fragranced. 

Next dry it until it’s dried to prevent irritation, then dispose of the wipes. 

If there are barrier rings, pastes, or sprays, use this now, but make sure it’s totally dry before you apply it. 

Next you want to apply the bag by folding the wafer back in half to line up the holes with the stoma. From the bottom, roll it over the stoma, then smoothen it down to get rid of creases and gaps. Cover the hand near the top as the warmth moves to the adhesion to keep it there. 

Get rid of the old sack in the normal hygienic manners so that it’s properly disposed of. 

And that’s what it takes. It’s really not that hard to get rid of an old stoma bag and changing the stoma bag as well. It is important to maintain good hygiene with this, since with improper hygiene, it can cause infection or worse. In some cases, improper changing and disposal of this can lead to possibilities for blockage and other such issues. 

That’s a big part of it, and many people don’t realize that this is super important. 

If you have questions about the changing and disposing of the stoma bag, along with the cleaning, you should never hesitate to ask your stoma nurse or your doctor about it. That’s because, for a lot of people, they don’t even realize that it’s a problem, and in a lot of instances, it can become a big issue if there is infection and the like. Cleaning and changing the stoma bag is not only good hygienic practices but also is good too if you are worried about the social repercussions of this. 

Stoma complications 

Sometimes, when you get a stoma, you have to adjust to the changes. This of course, may be obstacles does happen when you’re starting this because it is something new.  You may of course not know what the most common stoma complications are, and if they happen.  Here, we’ll go over the most common complications associated with having a stoma, and of course what you may need to do if these said problems do happen. 

The Most Common Complications 

The most common complications are usually the following: 

  • Irritations and skin problems 
  • Stoma leaks 
  • Bleeding 
  • Retracted or a prolapsed stoma 
  • Parastomal hernia 
  • Blockages and bowel obstructions 

Here, we’ll go over the most common ones in a bit of detail, and of course, when it’s both normal, and when it’s not. 

Skin Problems 

Skin problems around the stoma is the most common complication out there. not only is having it something that’s uncomfortable, but it does also affect how it attaches to your skin, causing leaks and furthering the damage to the skin. 

Typically, these happen for a few different reasons. 

First is there’s fecal contact with the skin, and if that’s happening, it can be corrosive, breaking down when there’s contact, so make sure you wear it in a way that doesn’t affect skin contact.

You also may want to ensure that you have a proper-fitting stoma, or else the gaps will cause skin irritation as well. 

Finally, it may happen due to products, so you should make sure that if it does happen, you talk to the ostomy nurse to see if there are alternatives. 

Leakage 

Leakage happens from ill-fitting stoma bags and ostomates who put it wrong. 

While leaks are usually nothing to worry about if it’s a rare thing, if it happens a lot, it may cause stress. 

You can prevent this by making sure there aren’t gaps. If you do have a retracted or flat soma, make sure that the nurse offers a convex wafer, and only use those. 

Stoma Bleeding 

Stoma bleeding is another common thing since there are blood vessels located at the top, and they bleed easily. If it is happening, it’s usually due to irritation, and if there is bleeding around the edges. 

If it’s from the inside though, talk to a nurse, since that of course is a sign of internal bleeding possibly, and if there is certain issues, they can help. 

Retracted and prolapsed stomas 

In some cases, the stoma may retract in. in that case, a convex wafter or pressing the stoma forward with an ostomy belt can help.  The surgeon may also re-sit the stoma if it’s uncomfortable 

If the stoma is prolapsed, that means it protrudes out way too far, and usually this happens with weight gain, weak abdominals, surgical techniques, pregnancy, and sudden pressures. 

How to prevent it? Well, you might want to make sure that you get the right medical advice you need in the event it does overly protract out. 

Parastomal hernia 

This is when the loops bulge through a weakened stoma, typically looking bulkier. This usually causes issues with stoma inheritance and the like, and may cause pain, vomiting and the like. It’s important to see your doctor in this case. 

If you have major problems in the stoma that usually aren’t caused by normal adjustments, you should most definitely talk to the doctor about it. 

A bowel obstruction might happen too, but usually that is rare. But these are the most common complications that happen when you have a stoma, and what can happen as well. 

What Can You Eat With A Stoma

Many people who learn that I have an ostomy get really curious about the types of food that I am able to eat. I totally understand this curiosity, since osomty is truly one of the weirdest medical innovations that we can see in our time. However, there are a lot of misconceptions out there about what people with ostomies are able to eat and all that.

Ostomies are actually a huge blessing for anyone suffering with severe medical issues, and it can often mean that they can get back to doing activities they enjoy like traveling, playing sports, being active, and doing all sorts of other things like that. Looking very closely at your diet with an ostomy is important, especially because of the nature of individuals that are in need of getting an ostomy. Since most people who have stomas put in have already spent years of living with bad digestive and stomach issues, it is extremely common for these people to be malnourished and have some less than ideal perspectives on eating and what constitutes a healthy diet. That is why it is super important to talk about what is okay for people to eat after they have had that life changing surgery.

The old saying that everyone knows – “you are what you eat” – is actually a lot more true than what most people think. The same thing applies to people who have ostomies as well. Eating right can mean the difference between a healthy mind and body, or someone who is basically just a walking dumpster fire. Even with an ostomy, a person’s body will still digest and absorb nutrients from food in the same way; that is the beauty of ostomy! It is crazy to see how far our medical advancements have come and what we are able to do with the human body if we put our experts on the case. With all that being said, each person is different and their bodies will react differently to various foods.

Why do you think that some people are allergic to things like milk while others are not? It is because we are all just different in our own way. When someone just gets their surgery done and has a stoma put in, the most important thing to do is to start eating things. Most people completely lose their appetite for a few days once they get an ostomy, but it is actually really crucial to eat food during the recovery process from surgery. To start off, the doctors recommend eating really bland foods that will not be risky for your stomach or digestive system to try to react to, especially since you are still recovering from surgery.

Once things have started to get better for you and your stoma is stabilized a bit more, you can actually begin to start eating more normal foods again. Though this might be really exciting at first and make you want to eat all your old favorites again, it is worth mentioning that your body will not always react to food in the same way that it used to. Because of this simple fact, it is more advisable to slowly introduce new foods in order to fully evaluate and identify how each food affects your stoma and your body. The last thing you need is to start eating a bunch of food and not be able to figure out which food is making your digestive system go crazy.

Traveling With An Ostomy

The world we live in is just so big if you think about it. There are so many different countries with different cultures, climates, and landscapes that are just begging to be explored. Everybody loves to travel, whether it be more local traveling or traveling abroad. I have personally never left the country that I was born in, but I would really like to get out and explore the world more when I have a bit more money that I can work with. It is hard to think about traveling the world when you do not have very much money to your name. However, my heart goes out to the people who want to travel but feel like they cannot because of their medical needs and setbacks.

What I am referring to are those people with a surgery called an ostomy. There are actually a lot of people with ostomies who travel regularly, so much so that I am going to write this entire article about what it looks like to travel with an ostomy. Traveling can be stressful and complicated at times, and it can be even more so with the added difficulty of living with a stoma. After all, making sure that you have enough ostomy supplies at all times can be a real scary challenge. The last place you want to end up is somewhere you’ve never been before without a spare ostomy pouch. That is why I am writing this article to help prepare people with ostomies for the world of traveling. 

When it comes to traveling, packing for the trip is just as important as figuring out where you want to go. The way that you pack your belongings up to prepare for traveling is going to depend a lot on where you are going and how long you will be staying there. For example: if you are planning a trip to Alaska, your packing list will look a lot different than if you are preparing to go on a vacation in Hawaii. With all that being said, packing your ostomy supplies for the trip is going to be the most important thing that you do in your entire life.

One suggestion that I have for you is to buy some of your most necessary ostomy products and accessories in bulk, and prepare to have them packed and ready way before you ever leave to catch the flight to your destination. In addition, it is critically important that you figure out exactly how long you will be staying wherever you go so that you can pack enough ostomy supplies. Oh, and while you’re packing ostomy supplies, it is important that you pack way more than you need. After all, it is better to have too much supplies on hand than not enough at all. Another thing to consider is that you will want to bring certain ostomy supplies on the plane with you (if you are flying) so that you can change your ostomy pouch if need be.

If you are traveling with other people, then make sure that you let them know about the specific things you will need to do to ensure that you are living your best life and taking care of your ostomy. DO not neglect your ostomy hygiene and take care of your stoma because you are too busy and on vacation.

Working Out With an Ostomy 

Working out has always been a huge part of my life. I know that a lot of people are too lazy to make it to the gym or cannot afford to pay a membership or something like that, and that is totally something that I understand. However, I have made it a part of my daily routine to make it into the gym whenever possible before I go to work in the morning. Working out has always been a way for me to start my day the right way and clear my ahead before I begin working. Also, the mental and physical benefits of working out everyday are scientifically proven, and there is no doubt in my mind that working out makes things a lot easier overall, even on the days when I don’t feel like getting up early from my bed and making it into the gym.

All that being said, my life changed a lot back in 2016 when I had to undergo a serious surgery called an ostomy. For those of you reading this who do not know what an ostomy is, it’s basically where the surgeon cuts you open and reroutes your intestines, colon, or some other body part so that it protrudes out from your abdomen and feeds into a bag called an ostomy pouch that is worn underneath one’s clothes at all times. I know that this sounds really disgusting and uncomfortable, but that is really the truth of what an ostomy is.

When I first got my ostomy done, I was worried that I would never again be able to workout in the same way that I used. I am a relatively healthy guy, but I knew that not being able to workout regularly would be a huge potential strain on my mental and physical health. I voiced my concerns about not being able to workout to the doctor, who assured me that I would be able to workout more once I fully recovered from surgery, even with the addition of a stoma and having to wear an ostomy pouch at all times.

Even though the doctor was reassuring in this way, I was still worried about what would happen to my daily workout regimen and how it would affect my life overall. However, I am happy to share that after a few weeks of recovering from surgery, I was able to get cleared by my doctor to head back into the gym and start working out regularly. So, if you are still reading up to this point, then you may be curious as to if there is a difference in the way that I am able to workout now that I have a stoma.

It is safe to say that, because of my ostomy, my life has changed in a lot of different ways. However, working out has not changed that much since getting my ostomy. One thing that is definitely annoying is having to wear an ostomy pouch while working out. However, other than that, not much has changed about my routine or what I am able to do and not do in the gym. Granted, it is true that I need to be careful about lifting heavy weights nowadays, since I am at greater risk for developing a hernia at some point. But other than that, my stoma makes me unstoppable!

Which Ostomy Pouch Should You Buy

If you are reading this, then there is a good chance that you have recently undergone an ostomy and are in need of some brief guidance and information regarding ostomy pouches. The truth of the matter is that there are quite a few different types of ostomy pouches available on the market, and there is some knowledge required in order to pick out the type that’s right for you based on your lifestyle, your stoma, and your situation.

For example, I went through a long period of trial and error myself when it came to finding the right ostomy pouch for me. That is why I wanted to take the time to write this article on the internet for people like me who just need some simple guidance on ostomy pouches and which kind to buy. Keep in mind that I am not a doctor or any sort of medical expert; rather, I am simply a guy who has a lot of knowledge about ostomy products and pouches and wants to help you make a good decision on what ostomy pouch you should buy. So let’s stop wasting time and start talking about ostomy pouches right away.

The first thing that I need to talk about when it comes to ostomy pouches is the difference between a one-piece pouch and a two-piece pouch. Like the name describes, a one-piece ostomy pouch is one that has the skin barrier and the actual ostomy pouch put together in one system and cannot become separated. These types of ostomy pouches are great for anybody who is looking for an easier way to conceal the ostomy pouch, since these tend to fit closer to the body and are less noticeable compared to the two-piece systems. In addition to being easier to conceal, these one-piece ostomy pouches are more convenient for anyone who wants to participate in some sort of physical activity or sport, since they have a small profile and are easy to adjust to your body.

However, it should be noted that these one-piece pouches are usually a lot more troublesome when it comes time to change out the pouch for a new one; this is because the skin barrier and the pouch do not separate, meaning that one has to remove the entire skin barrier of the pouch just to change the bag. This is not necessarily a huge dealbreaker, but many people say that this can lead to some irritation of the skin around the stoma or the stoma itself. I have personally only had good experiences with one-piece ostomy pouches, though I only use them when I am working out or playing ultimate frisbee with my friends.

In contrast, two-piece ostomy pouches are actually much more convenient when it comes time to change the pouch since the bag can be detached from the skin barrier. Because of this, it is totally possible and even simple to change the pouch without having to also remove the skin barrier that can be irritating for your skin around the stoma and the stoma itself. With all that being said, it is also true that two-piece ostomy pouches are more noticeable than one-piece pouches, so if you are ashamed to go out in public and have people notice that you are wearing an ostomy pouch, then the two-piece pouch may not be for you.