I have had a K pouch for many years. For some reason tonight, I have felt the need to empty my pouch. I put the catheter in and nothing really comes out. I add about 50cc's of water and dont' get a return. I did this 3 or 4 times and didn't see very much water come out.

So I waited a couple hours and tried again. Same thing. Now I have put a few hundred cc's of water into my pouch but I'm not getting a return.

Could it be a blockage? Should I keep irigating and see if eventually it blows out? I am worried because now I feel distended.

Any ideas or tips?

Sorry to hear your pouch is not behaving. You could have a partial blockage. Go on a liquid diet of Ensure or Boost for 24 hours. Keep moving around. Get on your hands and knees and rock forward and backwards and move your rear from side to side as well. If you get really bad belly pain that does not let up and / or you start to vomit, go to the ER. They can do some x-rays, etc. to see if you are blocked or not.

I would slow up on the irrigating if you are getting nothing in return.

Good luck and keep us posted.

I suggest calling your physician. Is there someone nearby who can deal with a k pouch? do not trust any emergency room that knows nothing about k pouches.
My son nearly died becasue of that. Another patient once had his k pouch removed becasue an er dr didn't know what it was and the guy was unconscious from a car accident.
DrFazio told us the worst thing to do is not eat. This is why I say call your own Dr.

If one has a partial blockage in a K-pouch or lower intestine, you DO NOT want to eat. Most doctors allow nothing by mouth as long as there is a blockage, if that is indeed what it is.

Any good ER can do x-rays and see if there is a sign of a blockage. They give pain meds and sometimes put an NG tube down to let any fluid come out. Some even put a cath in the pouch and put it on gentle suction. [ The BCIR folks in Florida do this.]

I have had a K pouch for 31 years and had many partial blockages.

I just had one that was minor, and Dr. Bauer of NYC told me to stay on Ensure for 24 hours. Again, sometimes they allow NO food at all.

It would be a good idea call your Dr. and run the things I have told you by him. See what he says.

Again, good luck.

This message has been edited. Last edited by: Bodoni,

Thank you for the feedback. I had some success this morning. It might be pouchitis and I am feeling bloated. I have had partial blockages in the past where something was too big to fit thru the openings on the catheter but they always seemed to resolve on their own. I've never had to go to an ER and, honestly, my Dr. doesn't understand my pouch. I have seen 2 gastroenterologists who all say the same stuff and it's very cursory at best. Sucks when you hear that the k-pouch is passe' and it was state of the art when they did it. I get pouchitis pretty often. Seems the flagyl doesn't work as effectively as it used to.

Even with the difficulties I have, I wouldn't trade it for a regular ostomy.

Dr Jay Singh in Atlanta may be able to scope it and determine the problem. He is excellent. Studied with Dr Fazio in Ohio. He does not do K pouch surgery but is quite capable of diagnosing and treating.

Well I have been able to empty my pouch today. It is probably pouchitis and gave me a sense of being full when I wasn't. It doesn't explain the irrigation not coming out but... I am feeling better.

Another question, I have recently undergone weight loss surgery (lap-band) and have lost 95 lbs. Maybe this significant weight loss and changed how my pouch is positioned or how I am intubating. Any ideas?

Oh, I definitely think a drastic weight loss can affect your valve and the lay of your pouch. Plus, you may have some adhesions in there that were not present before the lap-band surgery.

Jan

i'm very interested in this.
can someone detail out what exactly a 'blockage' is as opposed to an 'adhesion' and how you know (well...i guess besides the very very obvious) if you have one?)
i know that my intubation 'routine' if you will, has changed mildly in the past couple months. not that it isn't working, it is. but it just seems to be different than what it was initially.

in five days will be my one year post op anniversary. so i'm just very extra observant of EVERYthing y'know?

i keep writing down any and every question i have for my year follow up. these would be one of my questions

First of all, most blockages in K-pouch or BCIR patients are not caused by food -- but caused by adhesions. [ Adhesions are the sticky strands of tissue from surgery that make your gut stick together and things get caught up inside your bowels. ]

Doctors don't like to perform surgery for blockages because it can cause more adhesions and henceforth, more blockages. And on and on.

Anyway, back to blockages. A blockage is usually caused by a kinked or twisted piece of intestine. They are not to be played with. If a bad or full blockage goes for too long, it can cause a piece of intestine to die. That's why if one has vomiting and / or continual severe pain, you should go to your ER and notify your GI surgeon. X-rays or MRI's will usually show where the blockage is and what is causing it.

The treatment is usually bowel rest. No foods. [ At times they will let you drink Ensure or Boost for a short time.] Some pain medication. An N/G tube. [ Sometimes the doctor may force some thinned barium into the bowel. Occasionally, that will open things up. ] Plus, they want you to move around a lot. The BCIR folks in Florida even put the pouch on gentle suction.

Not that I am an expert by any means. I have had my pouch since I was 15 and am 41 now. My GI used to refer to dificult foods that weren't chewed thoroughly enough to fit thru the catheter openings as blockages. I have experienced this in the past several times. Feeling distended, knowing I had to empty and getting some stool but then stopping. Typically I would find something "stuck" in a catheter hole like a chunk of mushroom, popcorn kernals, nuts, etc. I've learned to chew my food thoroughly and which foods don't digest well enough to pass easily thru the catheter. I was told those problem foods, if unable to pass thru the catheter might require an ER to intubate you and use something to extract those pieces of food manually. For me, I have gone 1/2 a day and either built up enough pressure or the pouch slowly digested the material to enable it to pass.

I have never experienced something where my intestinal tract was "blocked" by food. So far it has always continued along until it hit my pouch and my problems have always been either positioning the catheter into the pool of stool (coined phrase?!?) or having too large of pieces to pass thru the catheter opening. These have been the more frequent struggles of my k-pouch.

That said, when I met with the Weight Loss Surgeon, he discussed the concern of adhesions in my abdomen. He said anywhere the surgeon touched/cut in my abdomen had scars or adhesions. He said with Ileostomy patients, they touch all 4 quadrants of your abdomen as your large intestine is in all four quadrants. This leaves scars (or adhesions) behind. He had to cut thru any scar tissue to access the stomach and his concern was bleeding, etc. I could see where your pouch might develop adhesions where they stitched the small intestine together to form the pouch and/or outside the pouch where the pouch sits in your abdomen. I don't know how small intestines develop adhesions as they are not muscle or fibrus by nature. His conern was external to the digestive tract -- adhesions or scars in my abdomen. I think his exact words were "adhesions develop wherever the surgeon physically touched your abdominal wall. that's one reason we do laproscopic surgeries today."

I find this topic interesting and appreciate everyone's feedback and comments. For me, having had a lap band has significantly reduced how much food I eat and the quantity of output from my pouch. My GI thought this would only help the repeated pouchitis infections I get since I would have alot less stool going thru the pouch. I haven't seen the reduction in infections yet but that would be a bonus. It's probably more to do with position of the resevoir when the catheter goes in and the fact that my abdomen is laying quite differently than it has for 20+ years. Having a GI series, MRI and/or scope in the pouch to better understand this issue is probably my next step. I am passing stool but the water I was irrigating with wasn't coming back out at the same quanitity which to me means 1) it's NOT food I'm swallowing or a blockage as it is material I am adding to the pouch and not seeing come back out and 2) it could be something I ate blocking the holes in the catheter or 3) some kind of change in how the pouch is sitting in my abdomen now that I've lost 95 lbs.

I will continue to keep you guys updated.

Mick,

Food that won't pass though the holes in your catheter are NOT blockages. As long as food passes from your stomach to your pouch, you are okay. Most folks with K pouches do not eat mushrooms, big nuts, etc. Corn on the cob and popcorn give some folks problems. IF you do eat these food, they MUST be chewed really, really well. [ As you said, if then - you let the food sit in the pouch longer until it is digested more, it is likely to pass through the catheter. ]

As I said before, MOST blockages are caused by a kink or twist in the small intestines -- not by food.

Hi Mick,

I think maybe a different turn of phrase would be better so that people don't get confused.

Most people refer to a bowel obstruction as a blockage and I think this is what Bondoni is referring to in his answer to you. Your intubating tube may get blocked with food and I suppose technically that can be referred to as a blockage of sorts but what most people here mean by blockage is bowel obstruction.

A partial bowel obstruction can occur if there is a narrowing or kink in the intestine which won't allow fibrous food to pass and so it backs up and causes pain and distention. A complete bowel obstruction is where even liquids won't pass. The adhesions that cause this can be both external of and internal in the digestive tract. If you have had your bowel cut into you can get internal scarring/adhesions where that piece of bowel has been reconnected as well as intra-abdominal adhesions caused by bowel manipulation during surgery. You can also get adhesions inside the digestive tract from Crohns or other bowel diseases.

Well at least that's my understanding.

I hope you feel better soon.

Take care

Shell

Shell, well said. Thanks, John

Chris had what is referred to as sludge in the pouch, similar to the bezoars thing with the pills accumulating.
The hot green tea loosens it up so it can pass through when intubating. It is not a blockage per say but a build up. I guess that sometimes when he intubates he thinks it is empty and it really isn't.
What a learning experience this has turned out to be.

I am very grateful for all the input though becasue it helps for future reference and knowledge is power!