Permanent End Ileostomy | J Pouch | K Pouch & BCIR |
Will need one more major surgery to remove rectum and possibly revise stoma. | Will need one more major surgery to remove rectum and create the j-pouch; and three months later will need another surgery (takedown) to activate the j-pouch and close the stoma opening. | One major surgery is usually necessary whether as primary (colectomy to pouch), removal of J pouch or conversion from end ileostomy |
Physical appearance – will have a bag attached to abdomen 24/7. | No external visual sign except scars on abdomen. | The only external sign is a button hole size stoma, flush with the skin and located below the belt line (lower than most end ileos). |
Ileostomy is permanent—no reversal possible. | J-pouch can eventually fail, leading to another surgery to remove the j-pouch and create a permanent end ileostomy. However, studies show j-pouch success rate is approximately 90%. | The success rate for both procedures is about 94%, with failure defined as need to remove the pouch and revert to an end ileostomy. |
Rectal cancer risk should be nonexistent. | Rectal cancer risk is extremely low. | Rectum is not present, so no cancer risk. |
Parastomal hernia (beneath stoma) risk is high. | Hernia risk is low; same as before surgeries. | Hernia risk around stoma is very low, but easily corrected by surgery. |
Moderate risk of intestinal obstruction primarily resulting from poor diet choices (ER visits a possibility). | Lower obstruction risk (however, still need to be vigilant with diet) | Low risk of intestinal obstructions, but when present, they are often caused by adhesions (present in any abdominal surgery). |
Must stay hydrated, and increase use of electrolyte beverages. | Must stay hydrated, increase use of electrolyte beverages. | Must stay hydrated, increase use of electrolyte beverages. |
Low stricture risk | Higher stricture risk from scar tissue as a result of multiple surgeries (dilation or surgery to remove strictures is always a possibility). | Stricture rate is related to stoma stenosis (narrowing of opening) and is not common. |
Low risk of fistulas | Low risk of fistulas, but higher probability than with an ileostomy | Fistulas are not common and can occur in those with Crohn’s disease. |
No incontinence issues | Possibility of incontinence or rectal leakage | No incontinence issues. Stool and gas are completely contained in the internal pouch. |
Skin irritation (itching and burning) always a possibility around stoma site. Treatment can take weeks to reverse. | Severe skin irritation (“butt burn”) an issue, but only during the first few months after surgery. Supposed to get better with time as anal skin adapts. Treatment is using creams/ointments and a hand-held bottle bidet and/or a toilet seat bidet ($300-$500). | Skin irritation around stoma is very rare and easily treated with creams and ointments. There is discharge from the stoma of a small amount of clear and non-caustic mucus, but this is absorbed by a small dressing used to cover the stoma. |
No hemorrhoids (“back door” is sealed). | Hemorrhoid inflammation always a possibility. | No hemorrhoids (“back door” is sealed). |
Stoma prolapse or stoma ulceration is a possibility (treatment is stoma revision surgery). | Pouchitis or Cuffitis always a possibility resulting in high number of bathroom trips similar to a UC flare (treatment is antibiotics). | Pouchitis is always a possibility resulting in the need to empty pouch more often. It is customarily treated with antibiotic and/or probiotics. |
Need to purchase medical (ostomy) supplies rest of life, insurance does not cover everything so can be expensive. | Few medical supplies for j-pouch needed, if ever. In the beginning, there will be creams/ointments and maybe a bidet toilet seat. | The only supplies needed are a silicone (plastic) catheter, stoma covers/dressings and lube for inserting the catheter. Annual supply cost is usually under $200, and the catheters and some stoma covers may be covered by insurance. |
Changing the pouch every 3-4 days can be stressful and inconvenient. Can create anxiety. | J-pouch can create anxiety with pouchitis and/or cuffitis flares. | No external hardware is needed. |
Bag leaks are stressful (doesn’t happen often but always a threat). Must carry supplies everywhere just in case. | Leakage is rare. Can hold off need to empty for over an hour. | Leakage is very rare. Can hold off need to empty for over an hour. There are no problems using public restroom, porta potties, or the woods if camping. No change of clothes is ever needed. |
Need to empty bag 8 or more times per day/night. | Need to empty j-pouch 4-8 times per day/night and that’s after months of j-pouch stretching to accommodate more volume. | The pouch is emptied with a small silicone catheter, 3-5 times a day at your convenience. The catheter is easily concealed in a small case, pocket or purse. Emptying the pouch is painless and can usually be done in just a few minutes |
The bag is “in the way” when doing activities such as household chores, washing the car or exercising. Must use a wrap to hold the bag close to body. | No issues with a j-pouch. | There is no external hardware present to cause problems doing any kind of activity. |
Seatbelt – need a protector. Also when driving long distances, need to check the bag often for fullness and to adjust for easy flow. | No seatbelt issue, no issue with long driving--you will know (sensation) when the j-pouch needs emptying. | No seatbelt issue, no issue with long driving--you will know (sensation) when the pouch needs emptying and have sufficient tine to reach a restroom. |
Dressing for work or play can be an issue – belts in particular, and pant waist must be oversize to accommodate a stoma guard and to keep bag from strangulating. Tying the right shoe or putting on right sock puts pressure on the bag when bending down. The bag feels like it could pop from the pressure. | No issue with clothing choices. Dressing is easy, same as before surgeries. Can wear regular sizes and not worry about the j-pouch | Can wear any clothing, including tight pants, swim suits, etc. The stoma is located below the belt line and a stoma cover does not show through clothing. |
Swimming and other activities can be a challenge. Could require special wraps and/or special bathing suit. | No issues with swimming and other activities. | No issues with swimming and other activities. |
Weightlifting/Gym workouts can pose issues—Must use caution with certain exercises. Dressing for the gym can be challenging in locker room. | Weightlifting/Gym can pose issues—must use caution with certain exercises (deadlifts in particular). Some forums say no lifting over 25 lbs., whereas others say it is an individual limit. No issue with locker room dressing. | Weightlifting/Gym can pose issues—must use caution with certain exercises (deadlifts in particular). Your surgeon should be consulted regarding exercise and lifting limitations. No issue with locker room dressing |
Showering can be a challenge, particularly at the gym. “Wet bag” is uncomfortable after showering (temporary until it dries). | No issues with showering anywhere. | No issues with showering anywhere. The stoma cover is small and not conspicuous. |
With the colon missing, absorption of certain vitamins and minerals may be impaired. Periodic blood tests for iron, ferritin and vitamin B-12 are needed. Never use time release medication or pills/capsules that will not dissolve in the stomach. | With the colon missing, absorption of certain vitamins and minerals may be impaired. Periodic blood tests for iron, ferritin and vitamin B-12 are needed. Never use time release medication or pills/capsules that will not dissolve in the stomach. | With the colon missing, absorption of certain vitamins and minerals may be impaired. Periodic blood tests for iron, ferritin and vitamin B-12 are needed. Never use time release medication or pills/capsules that will not dissolve in the stomach. |
Can generally eat most foods you enjoy. | Can generally eat most foods you enjoy. You may find that some foods may cause loose stools. It is best to start with small quantities and see what produces the best results. | Can generally eat most foods you enjoy. Many vegetables contain fibers that do not digest well and can clog the catheter when emptying the pouch. It is easy, but inconvenient, to remove the catheter, remove the fiber and then re-insert the catheter. Everyone’s system is different, so experiment with small quantities to see what works best. |
