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A
Hi everyone,
Would like to get your opinions about these subjects:

Point 1 : there’s a theory which seems to make a lot of sense that pouchitis is the result of bacterial overgrowth, which is itself caused by faecal stasis in the pouch due to incomplete emptying of the pouch (see links about this theory in PS1 at the bottom of the post)

Point 2 : it seems that people who have Koch pouches and continent urostomy pouches (which are also made of intestine) are advised by doctors to wash their pouch at least once a day (see links in PS2 at the bottom of the post).

Now for my questions :

1. Do you have (from your personal experience, that of others etc) evidence which proves or disproves this theory about the relationship between incomplete pouch emptying and pouchitis ?

2. Do you have an idea about why k-pouchers and urostomy pouchers are advised to wash their pouch once a day but we j-pouchers are not ?

Obviously if the theory is right, complete emptying and washing the j-pouch once a day (with a catheter) could treat/prevent pouchitis ... In the same way that brushing your teeth and using dental floss everyday avoids having food left stuck between the teeth, subsequent bacterial overgrowth and gingivitis :-)

Thanks in advance for your answers !
A

PS1 : links about point 2 :
- question to Grace about pouchitis at : https://www.j-pouch.org/q&a.html
- http://www.ncbi.nlm.nih.gov/pubmed/17278237
- http://www.gastrores.org/index...article/view/599/666 (see the paragraph about UC and pouchitis)

PS2 : links about point 2 :
- page 12 of this document for Koch pouches :
www.ouh.nhs.uk/patient-guide/l...C101101kochpouch.pdf
- p 10 of the continent urostomy guide here for urostomy pouches :
http://www.ostomy.org/Ostomy_Information.html#wocn

Replies sorted oldest to newest

Jan DollarJan DollarModerator, RN, retired
From my reading of medical literature, incomplete emptying and fecal stasis are only factors that can lead to pouchitis, but not the only factor. While the Q&A with Grace is pretty good and mostly valid, all of it is very old, so don't consider it as evidence of current medical opinion.

Did you see the article in the "sticky" that is quite current and comprehensive?
http://j-pouch.org/eve/forums/...1071921/m/5217016766

Not all j-pouches are prone to incomplete emptying and fecal stasis. This is true when there are structural defects or functional problems from pelvic floor dysfunction. Plus, most cases of pouchitis are not chronic or recurring, so causative factors are not the same.

As to why k-pouches have the recommendation to irrigate and rinse and the j-pouch does not, in most cases, it is about the physics of the pouch, not the material it constructed from. K-pouches must be emptied manually. J-pouches have the benefit of your natural sphincters and gravity. So, one concept does not necessarily apply to the other. That said, those j-pouchers who have problems emptying and struggle with chronic pouchitis, a nightly tap water enema may prove to be very useful, and a good strategy to consider, especially if you are facing surgery.

Jan Smiler
Jan Dollar
J JJAMember
I've been using a bidet with enema feature for about 4 years. Love that it helps me get nice and empty. Two years later Indefeloped chronic, refractory pouchitis. My pouchitis does not respond to antibiotics-it does respond to anti inflamatories and immunosuppressants.

I suppose if ones pouchitis is caused by bacterial overgrowth due to stool pooling,mthen perhaps more regular cleaning out of pouch/washing it could help? But there are likely s feral different "types" of pouchitis out there so it is hard to say what may work for one may not work for another.
J
skn69skn69Member
Arnaud,
I've had my k pouch for 35yrs...and I've been irrigating my pouch 2-3xs/day ever since.
The dynamics of a k pouch are the fact that the valve is situated at aporx the middle to lower 1/3rd of the pouch...you intubate but never really reach the stuff hanging out on bottom of the pouch most of the time...Whereas the j pouch exits through the bottom...litterally.
So we irrigate to get all the junk hanging out down there...which can include undesolved pills, debris of stuff that didn't digest and who knows what else.
When we irrigate we sort of push on the plunger of the syringe and pull back a bit...a few times...to sort of mix up the stuff and facilitate their exit...it works quite well.
Not at all sure that that is why we tend to have less pouchitis but I guess that it could not hurt you (unless you are rough or use too hot water)...
As said, not all pouchitis is the same and I am sure that it can come from a dozen different origins...
So try...And see if it helps you...and keep us posted.
Sharon
skn69
A ArnaudMember
Thanks to all for your answers !

Jan, yes I had read Bo Shen's article. In it he actually also mentions fecal stasis 2 or 3 times as a possible cause for pouchitis. But, agreed, it's only one possible cause among several others, as is confirmed by JJA and Allykat.
And thanks to you and to Sharon for the explanations about k-pouches, it makes sense ...
Interesting to note that k-pouches tend to have less pouchitis though, it probably confirms the theory that it's a possible cause.
Will indeed try the daily rinsing and will keep you posted !
Take care, A
A
Jan DollarJan DollarModerator, RN, retired
I am not sure that k-pouches have less pouchitis, but it probably is true that pouchitis with a k-pouch is more manageable.

You need to remember that selection criteria for a k-pouch is at least as selective as for a j-pouch (except for sphincter weakness, which not a concern). The reason for a failed j-pouch may make you ineligible for a k-pouch. Those who have a failed j-pouch due to Crohn's are not candidates for a continent ileostomy, due to the high failure rate.

Also, not all pouchitis symptoms are pouchitis. Could be SIBO or IPS, which could just as easily occur with a k-pouch. I think that pouchitis with a continent ileostomy is perceived as more tolerable because you don't have that urgency and less risk of incontinence.

Jan Smiler
Jan Dollar
A ArnaudMember
Thanks Jan.
Actually, unlike what I've said in earlier (1-2 months ago) threads, the likelihood is that I don't have Crohn's (I only had pre-pouch ileitis, probably due to backwash stool, itself caused by my anastomotic stricture).
And I definitely don't want to have a k-pouch !
I think my situation is very accurately described at p1544 of Bo Shen's article : "anastomotic stricture can be associated with pouchitis, presumably owing to bacteria overload from prolonged fecal stasis. The release of the obstruction, often along with concurrent antibio, may promote the resolution of pouchitis".
Have so far released the obstruction with a Medina catheter, but am going to also try to dilate the stricture in the next weeks ... And hopefully I'll keep my j-pouch !
Thanks again for your answer Smiler
A
Jan DollarJan DollarModerator, RN, retired
Yeah, anal stricture can lead to a whole boat load of woes, and it is a never ending story. If you can get that thing to stay dilated, then half your troubles are probably licked. The trick is to get this done without sphincter damage.

But, there are a few here who have avoided further surgery and maintained their pouch health by use of rinsing/draining via catheter.

Good luck!

Jan Smiler
Jan Dollar

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