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when do you call it quits with your j pouch and just go back to the bag? 

I had my take down about a year an a half ago and it's been hell the whole time. Naturally I just threw out all my osteomy stuff bc I was convinced I wasn't going back after all this time. But now I'm in so much pain again. I usually have maybe two good days a week and it's just not good enough. I am a very active and healthy person and my diet is extremely restricted and I cannot get the exercise that I would like to. I am definitely depressed. I had my fair share of complications with my ileostomy and those fears are still at the for front. I just can't take being in pain all the time anymore. Not knowing when I'm going to be sick, not knowing what to eat or when to eat. I can't be reliable I can't work I don't have a life that I think one should have. 

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Clark, Scott's question is good. I'd like to also suggest something that helped me when I was too anxious and depressed to make sense of everything. I actually made a list of pros and cons of keeping my jpouch and of having a permanent ostomy (those were my two options; there are others.) I added to the list as things happened or occurred to me...things like, "I'm missing another family event; I'm so anxious I can't sleep which gave me a migraine; this is affecting my relationships with my family." I also wrote down positive and negative ways that an ostomy would affect my life. After a full YEAR, I compared notes. It helped me come to a decision and, luckily, my surgeon was on board and optimistic. You may want to add the BCIR option to your list. BillV is the go-to person for that info.

Really, actually looking at the list helps create a whole picture, especially when your emotions are so raw that you can't even focus.

 

You will know.  

I went through the whole shabang.  You sound like me. 

I went 26 months before I said enough.  It was worse than the uc I originally had.  I kept seeing Dr's and trying different things only to get worse.  But I tried.  I could only seek so long before I would either go insane or have it kill me. Which it was. Being blunt. It was slowly killing me. That's how I see it now looking back and looking for answers and solutions was fruitless.  Sometimes they just don't work.  At least in my situation. It was healthy and nothing was wrong with it. Just didn't work. 

I'm happy and healthy now.  I made it through.  And I don't give a damn if people think the end ileo is a curse. It's not. It's a cure.  I know.  It cured me.  

Good luck if you continue to look for solutions. I'm not saying give up now.  But you will know when it's time if it comes to that.  And if it does and if you are as sick as you say you are. You will wonder why you waited so long. I did. 

Lambiepie. 

I slept 8 straight hours last night! I remember I was lucky to get 3 hours sleep while going through all that. Sleep is wonderful. I didn't get up once all night. My appliance was full when I woke. But that's no big deal. It didn't hurt! 

Richard. 

It is certainly beneficial to take sufficient time to collect your thoughts and do your research.  You are faced with a major decision under circumstances that appear to prompt a quick solution.  I second Lambiepie’s suggestion of making a list.  Before deciding to have any surgery, I would want to be sure that I have made a good effort to improve my j pouch’s performance to an acceptable level.  You may want to get a second opinion from a doctor with lots of experience in treating pouch problems.  Once your j pouch has been removed, there is no going back.

In June, I read a post containing a chart comparing an end ileostomy with a j pouch.  Based on my familiarity (and personal experience) with the subject, I added a third column for the K Pouch/BCIR.  This chart should be of help in evaluating each of your surgical alternatives should you decide to have your j pouch removed.  There is a lot of information on each procedure available on the internet.  You can also send me a PM with any specific questions that you have. Here is my list:

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.

Everyone has given you good advice. I had my j-pouch diverted to a permanent ileostomy before having it removed. I just couldn't talk myself into having it out. It rested without use for 6 months and was still causijg me problems. So I had it out. I had 2 operations when I should have had 1 plus I should have done it a long time before the diversion. My quality of life is better. It was the right decision for me.

Mysticobra posted:

 

You will know.  

I went through the whole shabang.  You sound like me. 

I went 26 months before I said enough.  It was worse than the uc I originally had.  I kept seeing Dr's and trying different things only to get worse.  But I tried.  I could only seek so long before I would either go insane or have it kill me. Which it was. Being blunt. It was slowly killing me. That's how I see it now looking back and looking for answers and solutions was fruitless.  Sometimes they just don't work.  At least in my situation. It was healthy and nothing was wrong with it. Just didn't work. 

I'm happy and healthy now.  I made it through.  And I don't give a damn if people think the end ileo is a curse. It's not. It's a cure.  I know.  It cured me.  

Good luck if you continue to look for solutions. I'm not saying give up now.  But you will know when it's time if it comes to that.  And if it does and if you are as sick as you say you are. You will wonder why you waited so long. I did.

Lambiepie. 

I slept 8 straight hours last night! I remember I was lucky to get 3 hours sleep while going through all that. Sleep is wonderful. I didn't get up once all night. My appliance was full when I woke. But that's no big deal. It didn't hurt! 

Richard. 

Sleep, beautiful sleep!!

It is so individual...sort of like "when do you stop hitting your head against the wall"?

Depends on your pain & misery tollerance vs your optimism...which one wins out? And why?

I have a k pouch, same pouch, different exit strategy,  I fought to rid myself of my sick colon for 10 yrs...noone wanted to do it to me back then...the horrors had no name...til I took things I to my own hands and had my pouch done.

It saved my life...when it started to fall apart I fought tooth and nail to save it because I had seen and tasted freedom thanks to it...many would have given up so much sooner...

For me it is a question of quality of life...if you have no life then it is time to make choices (after having tried everything and done your utmost to make it work)...your pouch is supposed to be a solution bot the problem.

Depending on your actual health and tolerance you may wish to look into a continent pouch or not...they come with their own set of challenges and can be miracles, he'll or both...

Good luck no matter what you choose. 

Sharon 

Quote 

"Depends on your pain & misery tollerance vs your optimism...which one wins out? And why?" 

I cannot write that way. 

And yes Bill. 

It all also depends on what you want to live with. 

I agree 100 percent.  

Exhaust your options and Thats  where you will be. Lol. 

It's how it worked out for me. And I'm in a good place. 

Not  to make fun of the situation. But that's what happens.  We all just want a normal place to be. 

Clark. I hope you can find it. When you do. You will know. 

Clark

I can't add to the good advice that everybody has given you. I can empathize, however,  with how your situation could lead to depression, frustration and not knowing what to do.  I recall that all too painfully.

 A couple of thoughts   What type of doctor are you seeing i.e. a surgeon or a G.I. specialist?   Have you been scoped and if so did they find active pouchitis? Most patients respond to antibiotics and are successfully on their way.    There are many other specific problems that generally can be treated. It would be good to know what the specific diagnosis is before thinking of having the J removed.

Good luck and keep us posted 

Docs aren't really sure what's up... my pouch has looked 100 percent A okay since I've gotten it. I've been scoped a bunch of times. Though I've had terrible pain with bowel movements which they finally after a year of misery figured out a solution to the fissures I am having but they still give me grief just not as bad. I have many BMs a day which make those worsen.  I'm still trying to be patient I just have been suffering from fatigue and dizziness as well and I don't what to do there. 

The GI diagnosed me with irritable pouch syndrome (lol) and gave me gabopentin to try which is supposed to help with that and with some of the pain. This also adds to the tiredness and dizziness but I'm going to try to stick it out longer this time. I got fed up with the side effects and quit after two weeks last time.  

I hope the gabephentin helps. It didn't help me with my j-pouch but it is prescribed for my perpherial neuropathy in my feet.  There is a large range of doses.  Maybe you are getting too strong of a dose? Just an idea if it continues to bother you maybe your doctor will reduce the dose. I started at a lower dose and it was increased several times.

I was told I had IPS before I ever had pouchitis and there is research on the subject. 

As Richard said I know what you are going through. Things will ultimately get better. 

I'm just super sensitive to most medications I'm on a very low dose just 100mg a day.  If anything it might help with my anxiety a bit bc that seems to make everything worse. I dunno I just feel very foggy I'm hoping if I push through a little it'll stop effecting me so strongly. 

Thank you everyone for your advice and experience shares it is all very helpful obviously it's hard to get advice from people bc this isn't super common. At least I've yet to meet anyone in person with it 

Because of complications I never had the take down surgery and have been living with the ileostomy for 5 years now. I still have the j-pouch and although not hooked up, it does leak sometimes requiring me to wear a pad. But surgery to remove that would probably require them to move the pouch to the other side. I'm 61 now and not hyped about major surgery anymore since the initial was scary  in itself with some complications.

Anyway to answer your question I can only say that my life with the pouch has been so much better. I can do things I couldn't before and eat just about anything. Yes it's a hassle sometimes, but quality of life is better for me. I hope you find the path that works out the best for you!

Jo, BCIR stands for Barnett Continent Intestinal Reservoir, a modification of the K pouch that has a collar of intestinal tissue to better stabilize the valve.  Both the BCIR and the K pouch have a high success rate (about 94%), high patient satisfaction and work the same way.  I must caution you that many surgeons are either not knowledgeable about these procedures or may speak negatively about them.  Hopefully, your surgeon can give you some positive feedback.   Both of the continent ileostomy procedures are much more complex than the end ileostomy and are performed by a limited number of surgeons.

There is an excellent website for my BCIR surgeon, Dr. Ernest Rehnke: www.bcir.com. This website has lots of information about the procedure, an informative video presentation and you can request a list of about 300 people with BCIR’s who you can contact. I would be happy to provide additional information if you would send me a PM with your contact information.

Bill

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