anybody increase the size of the holes in the catheter?

I find no need for you to "empty" completely. There is always a continual flow into your pouch from the small intestines, as with people who have their large bowel.  The other issue is the clogging with large un-digested food. This will happen and is a part of cath-ing. You can completely eliminate foods that can clog OR be happy with un-clogging and being WELL. Reasonable food intake AND enough liquid helping with digestion and keeping yourself hydrated.

Ray

ray

thanks so much for your response.  i agree that there is no need to completely empty.  however, i am still questioning whether the sludge or pieces of food clogging the two holes is preventing the proper amount of stool to be evacuated.  you say it is a part of cath-ing.  does that mean you pull the catheter out, clean in, and re-insert or do you just wait until the next time?  i am certainly drinking enough fruit juice, electrolytes and water so am well hydrated, which does help the flow.

upon the ostomy nurse's suggestion i ordered a marlen 34 FR catheter.  will see if it is too large to use or if ok, then if it helps.  should arrive next week.  suggestions are always welcome.  thanks, janet

If you have food too big to pass through the holes remove, unclog and re-insert cath. Remember to chew extra well and stay away from the foods that just won't digest well. Keep a mental note of what you ate that is causing the problem. If you have just sludge left in cath your fine till next cathing.

Ray

Larger (34 vs 30) cath simple means the inside diameter of the cath is larger. The holes may not be. I've never used or seen a 34. Compare it to your present cath.

And let us know.

Ray

thanks for the advice.  i have been keeping a log of food in, stool out and that figured out the obvious.  i'm getting used to the sludge left in the catheter.

checked out the difference between the 30 and 34 FR and you are right, the holes are the same size.  cancelled the order.  thanks, janet

As you gain more experience with the pouch (I've had 28 years worth), you will begin to notice what foods cause problems by physically blocking the tube  with food particles (for me: things like mushrooms, carrots, celery, fruits etc...) and which foods cause the outflow to thicken up to the point of making it difficult for the food to move through the catheter (for me: foods like mashed potatoes). It is somewhat of a bummer not to be able to eat some of the foods I enjoy, but couldn't enjoy much at all before the Koch Pouch was placed!!

I do have a bottle of lactulose to use in times of significant thickening. It will help to loosen things up but can give you some stomach cramping until emptying complete. I have found coffee helps too.

Another tip, if you haven't done this already, is to cut the tube down to a size that safely allows for it to extend out from the pouch enough to empty, but decreases the distance the stool has to travel thereby lowering the overall resistance somewhat. I keep my tube in a Ziploc type sandwich bag and I have cut my tubes down to fit comfortably in the bag when bent into a semi-circle type shape.

thanks for the suggestion of shortening the catheter, which i will do after gaining more experience.  right now it occasionally flings around and what a mess it can make!!

i suspect that lactulose would be problematic due to my lactose intolerance.  somebody on this site suggested using miralax.  the ostomy nurse was adamant NOT to use it.  (must say it works great for my cat's constipation.)   she contends drinking high sugar--can be 100% fruit not refined--juice is necessary.  i drink it, but dislike doing so as don't think getting 500+ calories a day from juice is that healthy and simply don't like juice.  i will try coffee again.  does it need to be black or can i add some cream?  

i also irrigate a lot to break up the thickness.  that works fine at home, but not so great in public toilets.  i'm learning and not letting the problems stop me from doing anything.  by getting out and being in new situations it challenges me to figure out how to make each situation work.

thanks so much for taking the time to think about and share your experiences.  janet

I drink black decaf. Don't like drinking all that sugar either.

The thickness may be the result of the foods you are eating. I have actually been doing pretty much a South Beach type high protein low carb diet for the past 10 years or so. Staying away from carbs helps a lot. I have found the less bread and potatoes I eat, the better the flow out of the tube. I do eat lots of fish and chicken. I did like vegetables a lot but they always clogged my tube. I can pretty much tolerate plain cucumbers and a moderate amount of Romaine lettuce chewed well. Mushrooms, inadvertently ingested,  cause the most problem!!

Don't worry..with time everything will get a bit easier as you become more adept  at emptying. When I go out, I always wear a good ol fashion'  fanny pack (makes my kids cringe with embarassment!!) which has convenient pockets for my cut down tube,  as well as the cut in half kotex ultra thin pads I use to cover the stoma between emptying.

Live and learn...By the way, just when you think that you have mastered the learning curve and know your body, pouch and diet, life will inform you that your digestive process has changed and that you now can no longer eat those foods that worked so well and can start eating others!

I was mostly lactose intollerant for about 20+yrs and now, other than milk I am fine...my pouch hates eggs (?), white flour, potatoes and whole grain rice but loves white rice and whole grain flour!

It practically sings with joy if I can find a ban muffin!

Bananas are always great. 

For now my day-to-day diet is black coffee (a full pot) and 1glass of juice +water in the morning...until my pouch is cleared out then 1 banana around 11am.

Lunch in 2-3yoghurts, another banana at 3ish (depending on classes) and a light snack at 6ish (apple, granola bar or a cookie and coffee).

Dinner is always a protein (meat, fish, chicken...) with 1-3 cooked veggies, a soup or salad.

I eat my carbs alone (bread day) or at 6pm...if not I stick to proteins and veggies (fruits are eaten alone in either the morning or as a snack...they digest better that way for me)

This is my pouch-happy diet...been working for 25yrs.

Whenever I fall off of the wagon I have problems but as soon as I get back on my pouch is fine...

ps...peanut butter is a whole food group!  

sharon

thanks guys for these suggestions and food plans.  it seems that no matter what i eat there is still 'sludge' in the stoma end of the catheter.  i irrigate several times, squat over the toilet so that the tube is pointed straight down--encouraging gravity to drain out the sludge--and still sludge.  i need to go on an elimination diet and log in/out everything.  simply have not gotten myself to take such action.

in the meantime i had problems getting the catheter inserted properly and almost needed to make an emergency visit to the cleveland clinic.  (more $$$ and time.)  i'm doing better now but am not sure if i damaged the valve or not.   i tend to worry, so this adventure is adding to my stress.

sharon--what do you mean that pb is a whole food group?  i have some almond butter, but don't eat it very often.  should i avoid it?

happy chewing!  janet

I always have stuff in the tube when I rinse it in the sink, But I am happy if I am able to put a good amount in the toilet first. I have also found that in place of juice a cup of warm water with 1/2 squeezed lemon juice and 2 table spoons of aloe vera gel. (Mix it up, then drink immediately after your meal). If I don't have access to this I drink at least 16oz of grape/apple 100% fruit juice immediately after meal. And then I will repeat the juice 1 hour later with just a cracker to further flush. I prefer not using the juice as well due to calorie content. Peanut butter will make it thicker, as will almond butter, but a little in moderation shouldn't be too problematic. 

Also, when my catheter gets bent, the holes "scrape" on the way out and I know its time for a new catheter. Just be careful of making holes larger or using one with too large of holes. Good luck!

Janet, 

What I meant about peanut butter (or almond or cachew) is that I eat it for any meal and replace just about any protien with it (for me it is both a fat due to the high calorie count and a protein as well as a sweet treat...it covers all bases with me.

I have found 2 not-so-kosher tricks that my doctor agrees with (and laughted his head off when he heard them)...I use Alli (sp?) the fat reducing med (OTC) that separates a part of the fat in your food and isolates it so that it isn't absorbed, sort of coats things...not a good thing for most normal beings...it gives them anal leakage (so not good for J pouchers) but on the rare occasions that I eat a lot of carbs (pizza, pasta, bread & cheese) with fat I know that I am in for tons of sludge...so I pop one...and the fat sort of coats the carbs and the pouch empties perfectly...end of problem...no sludge.

When traveling abroad where I cannot get prune or grape juice (although I pack green tea bags ) I use sparringly a sort of herb tea that cleans out the colon...(I found it on vacation in Turkey one year and mistakenly thought it was a diuretic tea...nope...like drinking draino on steroids!)...I keep a few bags in my carry on and just in case of mega-sludge I drink a tiny little cup of tea...boom!

Neither solution is reccomended over long periods of time nor as a daily cleaner but as a pinch hitter in extreme situations...and BEWARE...things run through you very quickly, that includes your meds...so they may not absorb at all...if you are on the pill, essential meds or antibotics you are not protected when you use them...over-use can cause vitamin and mineral difficiencies as well as dehydration...

Sharon

Hi Janet,

Was wondering if you've found a catheter that works for you? I've had my BCIR for about a year now and I still can't find a catheter that does a good job without causing too much bleeding or damage.

Also, just like you I had trouble keeping my output the right consistency until I found Werther's Sugar Free Caramel Chews. 1-2 usually doe stye job and keeps things quite loose. The whole grape/prune juice trick was making me too nauseous! 

Anyways, hope this helps.

Xx Avery